{"reference":"Hi, Hi there, good morning.\n\n Hi, good morning.\n\n Um, I'm Doctor Dean Resor from . Nice to see you.\n\n That's the same thing.\n\n OK great! So before we start your appointment, could you please confirm your full name and date of birth?\n\n Yeah sure! Um, my name is Jim Gowers and I was born in nineteen fifty eight uh on the eighth of August.\n\n That's great. Thank you so much for that. Um, you look a lot younger, so, um\n\n Yeah.\n\n Does that, that would make you roughly about fifty years old, fifty one, fifty one years old. Is that is that correct or?\n\n Yeah, yeah around that. Yeah about sixty, yeah.\n\n Six, OK, perfect. All right. So, um, nice to see see you this morning. Are you in a private place where you are OK to speak freely?\n\n Yep.\n\n Yes, I am. Yeah.\n\n OK fantastic! So um, how can I help you today?\n\n Um, yeah. I was, I was having, um, a bit of chest discomfort. So, I was doing some gardening, um, a couple of hours ago.\n\n And I felt not exactly a pain but um like a a pressure on my chest, um, feels like someone sitting on my chest.\n\n Um, and, I've noticed, um, a bit of nausea, not, no vomiting but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n Right, OK.\n\n Now, do you have those these symptoms right now or have they gone off now?\n\n Um, no, they're still present.\n\n OK. So, you've still got the chest discomfort right now?\n\n Yes.\n\n OK, um.\n\n We're probably gonna have to call an ambulance for you.\n\n OK. So what I'm gonna do, is I'm gonna task my colleague next to me to sort that out. While we do that I'm gonna ask you a few more questions, OK?\n\n OK.\n\n Mmm, sure.\n\n We're gonna a bit more information to the, to help the ambulance team when they, when they arrive, OK.\n\n Sure.\n\n So just to, just to double check, um, where exactly in the chest is the pain?\n\n Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my my pecs, so, um, yeah but not not necessarily to one side, um, and it's quite diffuse pain.\n\n Is, is it spreading anywhere else, like down into your arm, up to the jaw, in your neck, anything like that?\n\n Yeah. It's, it's, um, mainly in my left arm, er, it's feeling a little bit, um, er, painful, and, and in my shoulder as well.\n\n Right, OK. Do you remember what you were doing at the time?\n\n Uh yes, so it started uh just when I was gardening. So nothing that was too strenuous um I was just kneeling down and\n\n Uh, yeah, wasn't running or anything, it wasn't during any physical exercise.\n\n Sure, OK. And, and how much activity do you do normally? Do you walk a lot or do you run or do you do anything?\n\n No, I don't, I, I generally don't do much activity at all, um, you know.\n\n Have you had this before?\n\n No, this is the first time, actually.\n\n Right, OK. Can are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n Yeah.\n\n Um, yeah. It's, it's beating a bit faster now. I think that's 'cause I'm a little bit stressed.\n\n Um, about the situation but I haven't noticed it, um, beating faster than usual, um, and I did today.\n\n So, I know you're stressed but, but we've got an ambulance coming on the way, OK? So um, we'll take care of everything, so don't, don't worry. Who's in the house with you at the moment?\n\n Yeah.\n\n OK, thank you.\n\n Uh, no, no one's in the house at the moment.\n\n OK. Um, and is your front door open?\n\n Uh, yes, it's open.\n\n OK so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that, in case people need access, they could access you.\n\n Yeah, yeah .\n\n Alright. Um, so, um, uh, are you a smoker at all?\n\n Uh, yeah, I smoke, um, a fair bit so I smoke about ten cigarettes, uh, a day. Um, yeah.\n\n How long have you been smoking for?\n\n Uh, for the past fifteen years.\n\n Fifteen years, OK. Um, do you have, um, high blood pressure or high cholesterol or diabetes or anything?\n\n Yeah.\n\n Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n OK. Have you ever had your cholesterol checked?\n\n No.\n\n OK, all right. Um, now anyone in your wider in, in your family, sorry, in your parents, did either of them have any heart problems, or heart attacks, or anything like that?\n\n Yes.\n\n Um, yes, so, my, um, father died of a heart attack, um, and my mother had some heart problems.\n\n OK. Uh, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had the heart attack?\n\n Um, he was about my age.\n\n Right so just under sixty, around sixty.\n\n Yes, around sixty, yes.\n\n Yeah, OK, alright. Um, do you drink much alcohol?\n\n Um, yeah, I drink, um, about, per week, probably about seven or eight pints a week.\n\n OK, is that a, a beer you're talking about, yeah?\n\n Ohh. Yeah, yes.\n\n Uh, I, I can't tell from the video, are you overweight?\n\n Um, yes, I'm overweight, yeah.\n\n Right, OK. Alright. Um, uh now um, you, do you normally live alone?\n\n Yeah.\n\n Uh, yeah. I live alone, uh, at the moment. Yeah, uh, it's just me in the house.\n\n Sure, OK, and, and, uh, are you working at the moment?\n\n Yeah yeah, I, I work, yeah.\n\n Right, what do you work as?\n\n Um, I work as a restaurant owner. So I own a sushi shop.\n\n Right, OK. Alright. Um, so, um, the, the symptoms that you've described to me\n\n Yeah.\n\n Um, they indicate the possibility of, um, a heart attack.\n\n OK? So, I'm not saying you definitely have a heart attack, but we, that, it's our number one priority to exclude that.\n\n OK.\n\n OK, so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come.\n\n OK, yeah.\n\n OK. when they come, what they'll do is, they're gonna put some stickers on your chest and do an ECG.\n\n OK, yeah. Thank you.\n\n And then decide where to take you after that, OK?\n\n OK.\n\n OK, no.\n\n And um, what, what, uh, can I just double check? Do you have, um, any allergies to any medication?\n\n Yes, actually, I have, um, an allergy to aspirin.\n\n Right, OK.\n\n Yeah, and no other allergies.\n\n Sure. Uh, what's the nature of that allergy to aspirin? Do you, does it, does it cause you heartburn? Or is it like an allergic reaction?\n\n Um\n\n Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life threatening.\n\n Um, I've, I, sometimes even have it and it's, it's a, it's a mild reaction to it.\n\n OK, all right. It's very important that you communicate that to the hospital.\n\n Yeah.\n\n Um, the detail you just told me, because, um, we, we may need to consider aspirin despite allergy, OK?\n\n OK.\n\n Ohh, OK.\n\n Um, alright, um, now in terms of, um, what happens from here\n\n OK.\n\n That team will assess you and then they may take you into one hospital or another based on how bad , what the ECG looks like and what kind of treatment you might need, OK?\n\n Uh huh.\n\n Um, what I'm going to do is, we'll stay on the line for the time being, OK, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, alright?\n\n OK.\n\n OK.\n\n OK, OK, sure.\n\n OK.\n\n Yeah, thank you.\n\n we'll end the conversation after the purposes. Is that OK?\n\n Yeah, that's, OK. OK, thank you very much.\n\n thanks! Bye!\n\n Thank you. Bye.","products":{"hanah":[{"label":"Run 1","wer":17.339312406576983,"text":"Then all of that stuff is very different than that.\n\n  Uh, hi there, good morning.\n\n  Hi, good morning.\n\n  Um, I'm Dr. Dean Merzer from GP at home, nice to see you.\n\n  Nice to see you too.\n\n  Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n  Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n  That's great, thank you so much for that. Um, you look a lot younger, so—\n\n  Yeah.\n\n  So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct, or?\n\n  Yeah, yeah, around that. Yeah, about 60, yeah.\n\n  60, okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n  Yes, I am, yeah.\n\n  Okay, fantastic. So, um, how can I help you today?\n\n  Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n  Right, okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n  Um, no, they're still present.\n\n  Okay. So you've still got the chest discomfort right now?\n\n  Yes.\n\n  Okay. Um, we're probably going to have to call an ambulance for you.\n\n  Okay.\n\n  To take you to the hospital, okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n  Yeah, sure.\n\n  It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n  Sure.\n\n  So just to— just to double-check, um, where exactly in the chest is the pain?\n\n  Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n  Okay.\n\n  Um, and it's quite a diffuse pain.\n\n  Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n  Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful, and— and in my shoulder as well.\n\n  Right, okay. Do you remember what you were doing at the time?\n\n  Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n  Sure, okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n  No, I don't— I— I generally don't do much activity at all.\n\n  Okay.\n\n  Um, yeah.\n\n  Have you had this before?\n\n  No, this is the first time, actually.\n\n  Right, okay. Can you—\n\n  Yeah.\n\n  Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n  Um, yeah, it's— it's beating a bit faster now, I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n  Okay.\n\n  Um, today.\n\n  So I— I know you're stressed, but we've got an ambulance coming on the way, okay?\n\n  Yeah.\n\n  So, um, we'll take care of everything, so don't— don't worry.\n\n  Okay.\n\n  Thank you for being in the house with you at the moment.\n\n  Uh, no, no one's in the house at the moment.\n\n  Okay. Um, and is your front door open?\n\n  Uh, yes, it's open.\n\n  Okay, so maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n  Yeah.\n\n  All right.\n\n  Yeah.\n\n  Um, so, um, uh, are you a smoker at all?\n\n  Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n  How— how long have you been smoking for?\n\n  Uh, for the past 15 years.\n\n  15 years, okay. Um.\n\n  Yeah.\n\n  Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n  Yeah, I have high blood— uh, blood pressure, but, um, not diabetes.\n\n  Okay. Have you ever had your cholesterol checked?\n\n  No.\n\n  Okay, okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did—\n\n  Yes.\n\n  —did either of them have any heart problems or heart attacks or anything like that?\n\n  Um, yes, so my, um, father died of a heart attack.\n\n  Okay.\n\n  Um, and my mother had some heart problems.\n\n  Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n  Um, he was about my age.\n\n  Right, so about just under 6— around 60.\n\n  Yes, around 60, yes.\n\n  Yeah, okay. All right. Um, do you drink much alcohol?\n\n  Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n  Okay, is that a— a beer you're talking about?\n\n  Oh, beer, yes.\n\n  Okay. Um, I— I can't tell from the video. Are you overweight?\n\n  Um, yes, I'm overweight, yeah.\n\n  Right.\n\n  Yeah.\n\n  Okay, all right. Um, uh, now, um, you're— do you normally live alone?\n\n  Uh, yeah, I live alone, uh, at the moment, yeah.\n\n  Okay.\n\n  Uh, it's just me in the house.\n\n  Sure, okay. And— and, uh, are you working at the moment?\n\n  Yeah, yeah, I— I work, yeah.\n\n  Right, what do you work as?\n\n  Um, I work as a restaurant owner.\n\n  Okay.\n\n  So I own a sushi shop.\n\n  Right, okay.\n\n  Yeah.\n\n  All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay.\n\n  Okay.\n\n  So, I'm not saying you definitely have a heart attack, but we— that— so our number one priority to exclude that, okay?\n\n  Okay.\n\n  So.\n\n  Yeah.\n\n  —ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n  Okay.\n\n  All right.\n\n  Yeah, thank you.\n\n  When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n  Okay.\n\n  —they'll decide where to take you after that, okay?\n\n  Okay.\n\n  All right. And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n  Yes, actually, I have, um, an allergy to aspirin.\n\n  Right, okay.\n\n  Yeah, and no other allergies.\n\n  Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a— an allergic reaction?\n\n  Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n  Okay.\n\n  Yeah.\n\n  All right. It's very important that you communicate that to the hospital.\n\n  Okay.\n\n  —as detailed as you've just told me, because, um, we— we may need to consider aspirin despite.\n\n  Oh, okay.\n\n  —allergy, okay? Um.\n\n  Okay.\n\n  All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay?\n\n  Okay.\n\n  Um, what I'm going to do is we'll stay on the line for the time being.\n\n  Okay.\n\n  Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on, all right?\n\n  Okay. Okay, sure.\n\n  Okay.\n\n  Yeah, thank you.\n\n  Thank you. Is it now? We'll— we'll end the conversation now for the purposes of.\n\n  Yeah.\n\n  —is that okay?\n\n  That's okay. Okay, thank you very much.\n\n  Okay, thanks. Bye-bye.\n\n  Thank you, bye.","marks":[[0,57,"Hi",false],[124,130,"Resor",false],[136,146,".",false],[168,196,"That's the same thing. OK",false],[331,335,"Jim",true],[362,367,"nineteen fifty eight",false],[379,382,"eighth",false],[483,485,"Does",false],[641,649,"Six OK",false],[686,686,"see",false],[742,753,"you are OK",false],[769,769,"Yep.",false],[1055,1064,"someone",false],[1477,1485,"gonna",false],[1524,1566,"OK.",false],[1580,1588,"gonna",false],[1599,1607,"gonna",false],[1677,1685,"gonna",false],[1716,1729,"OK OK. Mmm",false],[1740,1748,"We're gonna",false],[1778,1778,"to help",false],[2155,2157,"into",false],[2186,2189,"your",false],[2586,2591,"during",false],[2721,2726,"",false],[2819,2824,"you know.",false],[3100,3107,"'cause",false],[3231,3231,"and I did",false],[3402,3430,"Who's",false],[3467,3467,"Yeah. OK thank you.",false],[3729,3742,"could",false],[3767,3777,"",false],[3786,3786,". 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OK OK",false],[7435,7462,"",false],[7491,7498,"after",false],[7603,7611,"Bye",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Central diffuse chest pressure/tightness x ~2 hrs, onset while gardening/kneeling; non-strenuous activity.\""],["The note captures: Chest discomfort remains present during the consultation.","yes","\"sx ongoing during consultation.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Pain radiates to L arm and shoulder.\""],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"Associated nausea without vomiting, sweating and SOB.\""],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Feels HR faster currently, attributed to stress.\""],["The note captures: This is the first similar episode.","yes","\"First episode; no similar previous sx.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smokes ~10 cigarettes/day x 15 yrs.\""],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","HTN, \"Overweight per pt. Low usual physical activity\" all recorded and listed as CV risk."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of MI at ~60 yrs; mother had heart problems.\""],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin causes mild swelling; \"Advised to tell ambulance/hospital staff full details of aspirin reaction.\""],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Advised to remain accessible at open front door/hallway while awaiting crew; pt alone at home.\""],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible MI/cardiac ischaemia\" and \"need to exclude this urgently\"; not presented as confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance arranged for urgent assessment.\""],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"Ambulance team to perform ECG and determine appropriate hospital destination/treatment.\""],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","no","The note does not mention the clinician staying on the line until the ambulance arrives or handing over."]],"claims":[],"note":"Subjective\nCentral diffuse chest pressure/tightness x ~2 hrs, onset while gardening/kneeling; non-strenuous activity.\nSensation of someone sitting on chest; sx ongoing during consultation.\nAssociated nausea without vomiting, sweating and SOB.\nPain radiates to L arm and shoulder.\nFirst episode; no similar previous sx.\nFeels HR faster currently, attributed to stress; no awareness of faster-than-usual HR earlier today.\nSmokes ~10 cigarettes/day x 15 yrs.\nPMH: HTN. No DM. Cholesterol not previously checked.\nFHx: father died of MI at ~60 yrs; mother had heart problems.\nOverweight per pt. Low usual physical activity.\nAlcohol: ~7–8 pints beer/week.\nLives alone; front door open. Works as restaurant owner/sushi shop owner.\nAllergy: aspirin causes mild swelling; pt reports reaction not life-threatening and has occasionally taken aspirin.\nObjective\nRemote/video consultation; no documented vitals or physical examination findings.\nAssessment\nPossible MI/cardiac ischaemia: persistent central exertional chest pressure with L arm/shoulder radiation, diaphoresis, nausea and SOB.\nElevated CV risk: HTN, smoking, overweight, physical inactivity and FHx premature cardiac disease.\nAspirin allergy with swelling requires urgent clarification by ambulance/hospital team.\nPlan\nAmbulance arranged for urgent assessment and transfer to hospital.\nAdvised to remain accessible at open front door/hallway while awaiting crew; pt alone at home.\nExplained concern for possible heart attack and need to exclude this urgently; reassured ambulance team would assess.\nAmbulance team to perform ECG and determine appropriate hospital destination/treatment.\nAdvised to tell ambulance/hospital staff full details of aspirin reaction; clinician explained aspirin may still need consideration despite reported allergy.","review":116.78947368421052,"saved":219.21052631578948,"clean":false,"effort":6.666666666666667,"sig":[]},{"label":"Run 2","wer":16.965620328849027,"text":"Thanks. Good afternoon. It's very different than that.\n\n  Uh, hi there. Good morning.\n\n  Hi. Good morning.\n\n  Um, I'm Dr.\n\n  Dr. Dean Merzer from GP at home. Nice to see you.\n\n  Nice to see you too.\n\n  Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n  Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n  That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n  Yeah.\n\n  So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n  Yeah. Yeah, around that. Yeah, about 60, yeah.\n\n  60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n  Yes, I am. Yeah.\n\n  Okay, fantastic. So, um, how can I help you today?\n\n  Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n  Right. Okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n  Um, no, they're still present.\n\n  Okay. So you've still got the chest discomfort right now?\n\n  Yes.\n\n  Okay. Um, we're probably going to have to call an ambulance for you.\n\n  Okay.\n\n  To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n  Yeah, sure.\n\n  It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n  Sure.\n\n  So just to— just to double-check, um, where exactly in the chest is the pain?\n\n  Um, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n  Okay.\n\n  Um, and it's quite a diffuse pain.\n\n  Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n  Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful, and— and in my shoulder as well.\n\n  Right. Okay. Do you remember what you were doing at the time?\n\n  Uh, yeah, so it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n  Sure. Okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n  No, I don't. I— I generally don't do much activity at all.\n\n  Okay.\n\n  Um, yeah.\n\n  Have you had this before?\n\n  No, this is the first time, actually.\n\n  Right. Okay. Can— um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n  Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n  Okay.\n\n  Um, today.\n\n  So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n  Yeah.\n\n  So, um, we'll take care of everything, so don't— don't worry.\n\n  Okay.\n\n  Thank you for being in the house with you at the moment.\n\n  Uh, no, no one's in the house at the moment.\n\n  Okay. Um, and is your front door open?\n\n  Uh, yes, it's open.\n\n  Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n  Yeah.\n\n  All right.\n\n  Yeah.\n\n  Um, so, um, uh, are you a smoker at all?\n\n  Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n  How— how long have you been smoking for?\n\n  Uh, for the past 15 years.\n\n  15 years. Okay. Um.\n\n  Yeah.\n\n  Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n  Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n  Okay. Have you ever had your cholesterol checked?\n\n  No.\n\n  Okay. Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did.\n\n  Yes.\n\n  Did either of them have any heart problems or heart attacks or anything like that?\n\n  Um, yes. So my, um, father died of a heart attack.\n\n  Okay.\n\n  Um, and my mother had some heart problems.\n\n  Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n  Um, he was about my age.\n\n  Right. So about just under 6— around 60.\n\n  Yes, around 60, yes.\n\n  Yeah. Okay. All right. Um, do you drink much alcohol?\n\n  Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n  Okay. Is that a— a beer you're talking about?\n\n  Oh, beer, yes.\n\n  Okay. Um, I— I can't tell from the video. Are you overweight?\n\n  Um, yes, I'm overweight, yeah.\n\n  Right.\n\n  Yeah.\n\n  Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n  Uh, yeah, I live alone, uh, at the moment, yeah.\n\n  Okay.\n\n  Uh, it's just me in the house.\n\n  Sure. Okay. And— and, uh, are you working at the moment?\n\n  Yeah, yeah, I— I work, yeah.\n\n  Right. What do you work as?\n\n  Um, I work as a restaurant owner, so I own a sushi shop.\n\n  Right. Okay.\n\n  Yeah.\n\n  All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n  Okay.\n\n  So I'm not saying you definitely have a heart attack, but we— that— so our number-one priority to exclude that, okay?\n\n  Okay.\n\n  So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n  Okay.\n\n  Yeah.\n\n  Yeah, thank you.\n\n  When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n  Okay.\n\n  They'll decide where to take you after that, okay?\n\n  Okay.\n\n  And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n  Yes, actually. I have, um, an allergy to aspirin.\n\n  Right. Okay.\n\n  Yeah, and no other allergies.\n\n  Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it, like, a— an allergic reaction?\n\n  Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n  Okay. All right.\n\n  Yeah.\n\n  It's very important that you communicate that to the hospital.\n\n  Okay.\n\n  And that detail you've just told me, because, um, we— we may need to consider aspirin despite.\n\n  Oh, okay.\n\n  Allergy, okay? Um.\n\n  Okay.\n\n  All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n  Okay.\n\n  What I'm going to do is we'll stay on the line for the time being.\n\n  Okay.\n\n  Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right?\n\n  Okay. Okay, sure.\n\n  Okay.\n\n  Yeah, thank you.\n\n  Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n  Yeah.\n\n  Is that okay?\n\n  That's okay. Okay, thank you very much.\n\n  Okay, thanks. Bye.\n\n  Thank you, bye.","marks":[[0,60,"Hi",false],[118,128,"Doctor",false],[134,140,"Resor",false],[146,157,".",false],[178,206,"That's the same thing. 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OK OK",false],[7369,7396,"",false],[7425,7432,"after",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"central, diffuse chest pressure commencing while gardening a few hours earlier.\""],["The note captures: Chest discomfort remains present during the consultation.","yes","\"ongoing during consult.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to L arm and shoulder.\""],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"Associated SOB, diaphoresis, nausea without vomiting.\""],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Reports HR feels faster currently; attributes this to stress.\""],["The note captures: This is the first similar episode.","yes","\"Denies prior similar episode.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smokes 10 cigarettes/day for 15 years.\""],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","HTN, reported overweight and low baseline physical activity all documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of MI at approximately age 60; mother had heart problems.\""],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin causes swelling, mild; advised to inform ambulance/hospital team."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone, front door open, advised to remain accessible at front entrance."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"concerning for possible ACS/MI\"; not presented as confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance arranged/expected for urgent assessment.\""],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"Ambulance team to perform ECG and determine receiving hospital/required treatment.\""],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"clinician to remain on call pending arrival.\""]],"claims":[],"note":"Subjective\nReports new-onset central, diffuse chest pressure commencing while gardening a few hours earlier; ongoing during consult.\nDescribes sensation as someone sitting on chest; not sharp pain.\nAssociated SOB, diaphoresis, nausea without vomiting.\nRadiation to L arm and shoulder.\nDenies prior similar episode.\nReports HR feels faster currently; attributes this to stress. No earlier palpitations reported today.\nLow baseline physical activity.\nPMH: HTN. Denies DM. Cholesterol status unknown; reports never checked.\nFHx: father died of MI at approximately age 60; mother had heart problems.\nSmokes 10 cigarettes/day for 15 years.\nAlcohol: 7–8 pints of beer/week.\nReports overweight.\nLives alone; no one else currently at home. Front door open.\nDrug allergy: aspirin causes swelling; described as mild/non-life-threatening. No other allergies reported.\nObjective\nTelehealth consultation.\nNo physical examination, vital signs or ECG documented.\nAssessment\nAcute central chest pressure with L arm/shoulder radiation, SOB, diaphoresis and nausea, persistent at assessment.\nSymptoms concerning for possible ACS/MI, particularly with HTN, smoking, overweight, sedentary lifestyle and significant FHx of premature cardiac disease.\nAspirin allergy with swelling reported; relevant to acute management.\nPlan\nAmbulance arranged/expected for urgent assessment and transfer to hospital.\nAdvised to remain accessible at front entrance while awaiting ambulance; clinician to remain on call pending arrival.\nAmbulance team to perform ECG and determine receiving hospital/required treatment.\nAdvised to inform ambulance/hospital team of aspirin allergy and nature of reaction.","review":74.52631578947368,"saved":261.4736842105263,"clean":true,"effort":0.0,"sig":[],"mb":9.906491,"latency":15.471,"signable":89.99731578947369},{"label":"Run 3","wer":16.965620328849027,"text":"Senti, ragazzo, this is very different than that.\n\n  Uh, hi there, good morning.\n\n  Hi, good morning.\n\n  Um, I'm Dr. Dean Merzer from GP at Home, nice to see you.\n\n  Nice to see you too.\n\n  Okay, great. So, before we start your appointment, could you please confirm your full name and date of birth?\n\n  Yeah, sure. Um, my name is Tim Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n  That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n  Yeah.\n\n  So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct, or—\n\n  Yeah, yeah, around that. Yeah, about 60, yeah.\n\n  About 60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n  Yes, I am, yeah.\n\n  Okay, fantastic. So, um, how can I help you today?\n\n  Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a, a pressure on my chest, um, it feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n  Right, okay. Now, do you have those, these symptoms right now, or have they gone off now?\n\n  Um, no, they're still present.\n\n  Okay. So you've still got the chest discomfort right now?\n\n  Yes.\n\n  Okay. Um, we're probably going to have to call an ambulance for you, to take—\n\n  Okay.\n\n  Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n  Yeah, sure.\n\n  It'll be a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um—\n\n  Sure.\n\n  So, just to, just to double-check, um, where exactly in the chest is the pain?\n\n  Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my, my pecs, so, um, yeah, but not, not necessarily to one side.\n\n  Okay.\n\n  Um, and it's quite a diffuse pain.\n\n  Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n  Yeah, it's, it's, um, mainly in my left arm, uh, it's feeling a little bit, um, uh, painful.\n\n  Okay.\n\n  And, and in my shoulder as well.\n\n  Right, okay. Do you remember what you were doing at the time?\n\n  Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, it wasn't running or anything, it wasn't doing any physical exercise.\n\n  Sure, okay. A-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to, do anything?\n\n  No, I don't, I, I generally don't do much activity at all.\n\n  Okay.\n\n  Um, yeah.\n\n  Have you had this before?\n\n  No, this is the first time, actually.\n\n  Right, okay. Can you—\n\n  Yeah.\n\n  Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n  Um, yeah, it's, it's beating a bit faster now, I think that's because I'm a little bit stressed.\n\n  Okay.\n\n  Um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n  Okay.\n\n  Um, today.\n\n  So, I know you're stressed. We've got an ambulance coming on the way, okay?\n\n  Yeah.\n\n  So, um, we'll take care of everything, so don't, don't worry.\n\n  Okay, thank you.\n\n  If you're in the house with you at the moment?\n\n  Uh, no, no one's in the house at the moment.\n\n  Okay. Um, and is your front door open?\n\n  Uh, yes, it's open.\n\n  Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you.\n\n  Yeah.\n\n  All right.\n\n  Yeah.\n\n  Um, so, um, uh, are you a smoker at all?\n\n  Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n  Uh, how long have you been smoking for?\n\n  Uh, for the past 15 years.\n\n  15 years, okay. Um—\n\n  Yeah.\n\n  Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n  Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n  Okay. Have you ever had your cholesterol checked?\n\n  No.\n\n  Okay, okay. All right. Um, now, anyone in your wider family, in your family, sorry, in your parents, did—\n\n  Yes.\n\n  —did either of them have any heart problems or heart attacks or anything like that?\n\n  Um, yes, so my, um, father died of a heart attack.\n\n  Okay.\n\n  Um, and my mother had some heart problems.\n\n  Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he, he had that heart attack?\n\n  Um, he was about my age.\n\n  Right, so about just under six, around 60?\n\n  Yes, around 60, yes.\n\n  Yeah, okay. All right. Um, do you drink much alcohol?\n\n  Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n  Okay, is that a, a beer you're talking about?\n\n  Oh, beer, yes.\n\n  Okay. Um, I, I can't tell from the video. Are you overweight?\n\n  Um, yes, I'm overweight, yeah.\n\n  Right.\n\n  Yeah.\n\n  Okay, all right. Um, uh, now, um, you're do you normally live alone?\n\n  Uh, yeah, I live alone, uh, at the moment, yeah.\n\n  Okay.\n\n  Uh, it's just me in the house.\n\n  Sure, okay. And, and, uh, are you working at the moment?\n\n  Yeah, yeah, I, I work, yeah.\n\n  Right, what do you work as?\n\n  Um, I work as a restaurant owner.\n\n  Okay.\n\n  So I own a sushi shop.\n\n  Right, okay.\n\n  Yeah.\n\n  All right. Um, so, um, the, the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n  Okay.\n\n  So, I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\n  Okay.\n\n  Okay?\n\n  Okay.\n\n  So, ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n  Okay.\n\n  Yeah.\n\n  Yeah, thank you.\n\n  When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then—\n\n  Okay.\n\n  —decide where to take you after that, okay?\n\n  Okay.\n\n  And, um, what, what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n  Yes, actually, I have, um, an allergy to aspirin.\n\n  Right, okay.\n\n  Yeah, and no other allergies.\n\n  Sure. Uh, what's the nature of that allergy to aspirin? Do you does it, does it cause you heartburn, or is it like a, a allergic reaction?\n\n  Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've I sometimes even have it and it's, it's a it's a mild reaction to it.\n\n  Okay. All right.\n\n  Yeah.\n\n  It's, it's very important that you communicate that to the hospital.\n\n  Okay.\n\n  Uh, detail you've just told me, because, um, we, we may need to consider aspirin despite—\n\n  Oh, okay.\n\n  —allergy, okay? Um, all right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need, okay?\n\n  Okay.\n\n  Um, what I'm going to do is we'll stay on the line for the time being.\n\n  Okay.\n\n  Uh, until they come, and then, um, once they come, then I'll hand over to them and I'll explain what's going on, all right?\n\n  Okay. Okay, sure.\n\n  Okay.\n\n  Yeah, thank you.\n\n  Thank you. Isn't that we'll, we'll end the conversation now for the purposes—\n\n  Yeah.\n\n  —is that okay?\n\n  That's okay. Okay, thank you very much.\n\n  Okay, thanks. Bye.\n\n  Thank you, bye.","marks":[[0,55,"Hi",false],[122,128,"Resor",false],[134,144,".",false],[166,194,"That's the same thing. OK",false],[330,333,"Jim",true],[360,365,"nineteen fifty eight",false],[377,380,"eighth",false],[481,483,"Does",false],[639,653,"Six OK",false],[690,690,"see",false],[746,757,"you are OK",false],[773,773,"Yep.",false],[983,988,"not",false],[1064,1073,"someone",false],[1486,1494,"gonna",false],[1530,1555,"OK.",false],[1569,1577,"gonna",false],[1588,1596,"gonna",false],[1666,1674,"gonna",false],[1705,1718,"OK OK. Mmm",false],[1729,1737,"We're gonna",false],[1769,1772,"to help",false],[2102,2113,"Is is",false],[2152,2154,"into",false],[2183,2186,"your",false],[2598,2603,"during",false],[2636,2647,"OK. And and",false],[2730,2735,"",false],[2828,2833,"you know.",false],[3109,3116,"'cause",false],[3252,3252,"and I did",false],[3417,3446,"Who's",false],[3482,3482,"Yeah. OK thank you.",false],[3745,3758,"could",false],[3783,3793,"",false],[3802,3802,". 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OK OK",false],[7402,7429,"",false],[7458,7465,"after",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Acute central, diffuse chest pressure/discomfort onset during gardening a few hours prior.\""],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consultation.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to L arm and shoulder.\""],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"Associated nausea without vomiting, diaphoresis and SOB.\""],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Reports heart beating faster currently, attributed to stress.\""],["The note captures: This is the first similar episode.","yes","\"First episode of this nature.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smokes 10 cigarettes/day for 15 years.\""],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","HTN, overweight and low baseline physical activity documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died from MI at approximately age 60; mother had heart problems.\""],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin causes swelling, mild; advised to inform ambulance/hospital staff."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone, currently alone; advised to remain at open front door/hallway."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"raise concern for ACS/MI; urgent exclusion required.\""],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Urgent ambulance attendance arranged/requested.\""],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"Ambulance team to perform ECG and determine receiving hospital/required treatment.\""],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"clinician to remain on call pending arrival.\""]],"claims":[],"note":"Subjective\nTim Gowers; DOB 08/08/1958.\nAcute central, diffuse chest pressure/discomfort onset during gardening a few hours prior; described as someone sitting on chest.\nSymptoms ongoing at time of consultation.\nAssociated nausea without vomiting, diaphoresis and SOB.\nRadiation to L arm and shoulder.\nFirst episode of this nature.\nGardening involved kneeling; pt reported no strenuous activity/exercise at onset.\nReports heart beating faster currently, attributed to stress; no earlier awareness of increased HR today.\nPMH: HTN. Denies DM. Cholesterol not previously checked.\nFHx: father died from MI at approximately age 60; mother had heart problems.\nSmokes 10 cigarettes/day for 15 years.\nAlcohol: 7–8 pints of beer/week.\nReports overweight and low baseline physical activity.\nLives alone; currently alone at home. Front door open.\nWorks as restaurant/sushi shop owner.\nAllergy: aspirin—reports swelling, described as mild/non-life-threatening; no other allergies reported.\nObjective\nVideo consultation only; no vitals, physical examination or ECG available.\nPt confirmed ongoing chest discomfort during consultation.\nAssessment\nAcute ongoing central chest pressure with L arm/shoulder radiation, diaphoresis, nausea and SOB.\nSymptoms and significant CV risk factors (HTN, smoking, overweight, low activity, FHx premature cardiac disease) raise concern for ACS/MI; urgent exclusion required.\nAspirin allergy with swelling is clinically relevant for pre-hospital/hospital management.\nPlan\nUrgent ambulance attendance arranged/requested for emergency assessment and transfer.\nAdvised pt to remain available at open front door/hallway for ambulance access; clinician to remain on call pending arrival.\nAmbulance team to perform ECG and determine receiving hospital/required treatment.\nAdvised pt to inform ambulance/hospital staff of aspirin allergy and swelling reaction.","review":85.26315789473684,"saved":250.73684210526318,"clean":true,"effort":0.0,"sig":[],"mb":9.872311,"latency":17.51,"signable":102.77315789473684},{"label":"Run 4","wer":17.11509715994021,"text":"Thanks. Good afternoon. It's very different than that.\n\n  Uh, hi there. Good morning.\n\n  Hi. Good morning.\n\n  Um, I'm Dr. De\n\n an Mercer from GP at Home. Nice to see you.\n\n  Nice to see you too.\n\n  Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n  Yeah, sure. Um, my name is Dean Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n  That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n  Yeah.\n\n  So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n  Yeah. Yeah, around that. Yeah, about 60, yeah.\n\n  60. Okay, perfect. All right. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n  Yes, I am. Yeah.\n\n  Okay, fantastic. So, um, how can I help you today?\n\n  Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n  Right. Okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n  Um, no, they're still present.\n\n  Okay. So you've still got the chest discomfort right now?\n\n  Yes.\n\n  Okay. Um, and. We're probably going to have to call an ambulance for you.\n\n  Okay.\n\n  To take you. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n  Yeah, sure.\n\n  It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n  Sure.\n\n  So just to— just to double-check, um, where exactly in the chest is the pain?\n\n  Um, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n  Okay.\n\n  Um, and it's quite a diffuse pain.\n\n  Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n  Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and— and in my shoulder as well.\n\n  Right. Okay. Do you remember what you were doing at the time?\n\n  Uh, yeah. So it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, it wasn't running or anything. It wasn't doing any physical exercise.\n\n  Sure. Okay. A-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n  No, I don't— I— I generally don't do much activity at all.\n\n  Okay.\n\n  Um, yeah.\n\n  Have you had this before?\n\n  No, this is the first time, actually.\n\n  Right. Okay. Can you—\n\n  Yeah.\n\n  Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n  Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed.\n\n  Okay.\n\n  Um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n  Okay.\n\n  Um, today.\n\n  So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n  Yeah.\n\n  So, um, we'll take care of everything. So don't— don't worry.\n\n  Okay.\n\n  Thank you. You're in the house with you at the moment?\n\n  Uh, no, no one's in the house at the moment.\n\n  Okay. Um, and is your front door open?\n\n  Uh, yes, it's open.\n\n  Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they— they can access you.\n\n  Yeah.\n\n  All right.\n\n  Yeah.\n\n  Um, so, um, uh, are you a smoker at all?\n\n  Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n  How— how long have you been smoking for?\n\n  Uh, for the past 15 years.\n\n  15 years. Okay. Um.\n\n  Yeah.\n\n  Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n  Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n  Okay. Have you ever had your cholesterol checked?\n\n  No.\n\n  Okay. Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did.\n\n  Yes.\n\n  Did either of them have any heart problems or heart attacks or anything like that?\n\n  Um, yes. So my, um, father died of a heart attack.\n\n  Okay.\n\n  Um, and my mother had some heart problems.\n\n  Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n  Um, he was about my age.\n\n  Right. So a— a just under 6, around 60.\n\n  Yes, around 60, yes.\n\n  Yeah. Okay. All right. Um, do you drink much alcohol?\n\n  Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n  Okay. Is that a— a beer you're talking about?\n\n  Oh, beer, yes.\n\n  Okay. Um, I— I can't tell from the video. Are you overweight?\n\n  Um, yes, I'm overweight, yeah.\n\n  Right.\n\n  Yeah.\n\n  Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n  Uh, yeah, I live alone, uh, at the moment, yeah.\n\n  Okay.\n\n  Uh, it's just me in the house.\n\n  Sure. Okay. And— and, uh, are you working at the moment?\n\n  Yeah, yeah, I— I work, yeah.\n\n  Right. What do you work as?\n\n  Um, I work as a restaurant owner.\n\n  Okay.\n\n  So I own a sushi shop.\n\n  Right. Okay.\n\n  Yeah.\n\n  All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n  Okay.\n\n  So I'm not saying you definitely have a heart attack, but we— that's our number-one priority to exclude that.\n\n  Okay.\n\n  Okay?\n\n  Okay.\n\n  So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n  Okay.\n\n  Yeah.\n\n  Yeah, thank you.\n\n  When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then decide where to take you after that, okay?\n\n  Okay.\n\n  And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n  Yes, actually. I have, um, an allergy to aspirin.\n\n  Right. Okay.\n\n  Yeah, and no other allergies.\n\n  Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction?\n\n  Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n  Okay. All right.\n\n  Yeah.\n\n  It's very important that you communicate that to the hospital.\n\n  Okay.\n\n  Uh, detail you've just told me, because, um, we— we may need to consider aspirin despite.\n\n  Oh, okay.\n\n  Allergy. Okay? Um, all right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you into one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n  Okay.\n\n  What I'm going to do is we'll stay on the line for the time being.\n\n  Okay.\n\n  Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right?\n\n  Okay. Okay, sure.\n\n  Okay.\n\n  Yeah, thank you.\n\n  Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n  Yeah.\n\n  Is that okay?\n\n  That's okay. Okay, thank you very much.\n\n  Okay, thanks. Bye.\n\n  Thank you, bye.","marks":[[0,60,"Hi",false],[118,136,"Doctor Dean Resor",false],[142,153,".",false],[174,202,"That's the same thing. OK",false],[337,341,"Jim",true],[368,373,"nineteen fifty eight",false],[385,388,"eighth",false],[489,491,"Does",false],[588,588,"or",false],[643,651,"Six OK",false],[688,688,"see",false],[744,755,"you are OK",false],[771,771,"Yep.",false],[1057,1066,"someone",false],[1484,1492,"gonna",false],[1531,1557,"OK.",false],[1571,1579,"gonna",false],[1590,1598,"gonna",false],[1668,1676,"gonna",false],[1707,1720,"OK OK. 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OK OK",false],[7354,7381,"",false],[7410,7417,"after",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Central chest pressure 'commenced while gardening a few hours prior'."],["The note captures: Chest discomfort remains present during the consultation.","yes","'Symptoms ongoing during consultation.'"],["The note captures: Pain radiates to the left arm and shoulder.","yes","'left arm/shoulder pain'."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","'nausea without vomiting, diaphoresis, SOB'."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","'Reports heart rate feels faster currently, attributed to stress'."],["The note captures: This is the first similar episode.","yes","'First episode; no similar prior symptoms.'"],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","'Smokes 10 cigarettes/day for 15 years.'"],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","HTN, overweight and sedentary lifestyle listed."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","'father died from MI at approximately age 60; mother with heart problems.'"],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin swelling, mild; 'Advised to inform ambulance/hospital staff of aspirin allergy'."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","'Advised to remain accessible near/open front door as alone at home.'"],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","'concerning for ACS/MI'; 'possible MI'."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","'Ambulance requested for urgent assessment/transfer'."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","'Ambulance team to perform ECG and determine appropriate hospital destination'."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","'Clinician planned to remain on call pending ambulance arrival and provide handover.'"]],"claims":[],"note":"Subjective\nAcute central, diffuse chest pressure commenced while gardening a few hours prior; described as feeling like someone sitting on chest.\nSymptoms ongoing during consultation.\nAssociated nausea without vomiting, diaphoresis, SOB and left arm/shoulder pain.\nReports heart rate feels faster currently, attributed to stress; no earlier palpitations reported today.\nFirst episode; no similar prior symptoms.\nGardening activity described as non-strenuous; generally sedentary.\nPMH: HTN. Denies DM. Cholesterol status not previously checked.\nFHx: father died from MI at approximately age 60; mother with heart problems.\nSmokes 10 cigarettes/day for 15 years.\nAlcohol: 7–8 pints of beer/week.\nReports overweight.\nDrug allergy: aspirin causes swelling; described as mild and non-life-threatening. No other allergies reported.\nLives alone; front door open. Employed as restaurant owner.\nObjective\nRemote/video consultation.\nNo examination findings, observations or ECG documented.\nAssessment\nAcute persistent central chest pressure with diaphoresis, SOB, nausea and radiation to left arm/shoulder concerning for ACS/MI.\nCV risk factors include HTN, smoking, reported overweight, sedentary lifestyle and significant FHx of premature cardiac disease.\nAspirin allergy (swelling) relevant to acute management.\nPlan\nAmbulance requested for urgent assessment/transfer due to possible MI.\nAdvised to remain accessible near/open front door as alone at home.\nClinician planned to remain on call pending ambulance arrival and provide handover.\nAmbulance team to perform ECG and determine appropriate hospital destination/treatment pathway.\nAdvised to inform ambulance/hospital staff of aspirin allergy; clinician noted aspirin may still need consideration despite reported allergy.","review":78.31578947368422,"saved":257.6842105263158,"clean":true,"effort":0.0,"sig":[],"mb":9.910588,"latency":28.514,"signable":106.82978947368422},{"label":"Run 5","wer":17.56352765321375,"text":"Thanks. What about something very different than that?\n\n  Uh, hi there. Good morning.\n\n  Hi, good morning.\n\n  Um, I'm Dr. Dean Merzer from GP at home. Nice to see you.\n\n  Nice to see you too.\n\n  Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n\n  Yeah, sure.\n\n  Sure.\n\n  Um, my name is Tim Gowers, and I was born in 1958. Uh, on the 8th of August.\n\n  That's great. Thank you so much for that. Um, you look a lot younger, so—\n\n  Yeah.\n\n  So that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct?\n\n  Yeah, yeah, around that. Yeah, about 60, yeah.\n\n  60. Okay, perfect. All right.\n\n  Yeah.\n\n  So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely?\n\n  Yes, I am, yeah.\n\n  Okay, fantastic. So, um, how can I help you today?\n\n  Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest. Um, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\n  Right, okay. Now, do you have those— these symptoms right now, or have they gone off now?\n\n  Um, no, they're still present.\n\n  Okay. So you've still got the chest discomfort right now?\n\n  Yes.\n\n  Okay. Um, we're probably going to have to call an ambulance for you.\n\n  Okay.\n\n  To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay?\n\n  Yeah, sure.\n\n  It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um.\n\n  Sure.\n\n  So just to— just to double-check, um, where exactly in the chest is the pain?\n\n  Um, it's in the, uh, middle of my chest, um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side.\n\n  Okay.\n\n  I mean, it's quite a diffuse pain.\n\n  Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that?\n\n  Yeah, it's— it's, um, mainly in my left arm, uh, it's feeling a little bit— um, uh, painful.\n\n  Okay.\n\n  And— and in my shoulder as well.\n\n  Right, okay. Do you remember what you were doing at the time?\n\n  Uh, yeah, so it started, uh, just when I was gardening. So nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything, it wasn't doing any physical exercise.\n\n  Sure, okay. And— and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything?\n\n  No, I don't— I— I generally don't do much activity at all.\n\n  Okay.\n\n  Um, yeah.\n\n  Have you had this before?\n\n  No, this is the first time, actually.\n\n  Right, okay. Can—\n\n  Yeah.\n\n  Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n\n  Um, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual.\n\n  Okay.\n\n  Um, today.\n\n  So I— I know you're stressed. We've got an ambulance coming on the way. Okay?\n\n  Yeah.\n\n  So, um, we'll take care of everything, so don't— don't worry.\n\n  Okay, thank you.\n\n  We'll put you in the house with you at the moment.\n\n  Uh, no, no one's in the house at the moment.\n\n  Okay. Um, and is your front door open?\n\n  Uh, yes, it's open.\n\n  Okay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you.\n\n  Yeah.\n\n  All right.\n\n  Yeah.\n\n  Um, so, um, uh, are you a smoker at all?\n\n  Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah.\n\n  How— how long have you been smoking for?\n\n  Uh, for the past 15 years.\n\n  15 years. Okay. Um.\n\n  Yeah.\n\n  Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\n\n  Yeah, I have high blood, uh, blood pressure, but, um, not diabetes.\n\n  Okay. Have you ever had your cholesterol checked?\n\n  No.\n\n  Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did—\n\n  Yes.\n\n  Did either of them have any heart problems or heart attacks or anything like that?\n\n  Um, yes, so my, um, father died of a heart attack.\n\n  Okay.\n\n  Um, and my mother had some heart problems.\n\n  Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack?\n\n  Um, he was about my age.\n\n  Right, so about just under 6— around 60.\n\n  Yes, around 60, yes.\n\n  Okay. All right. Um, do you drink much alcohol?\n\n  Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week.\n\n  Okay. Is that a— a beer you're talking about?\n\n  Oh, beer, yes.\n\n  Okay. Um, I— I can't tell from the video. Are you overweight?\n\n  Um, yes, I'm overweight, yeah.\n\n  Right.\n\n  Yeah.\n\n  Okay. All right. Um, uh, now, um, you're— do you normally live alone?\n\n  Uh, yeah, I live alone, uh, at the moment, yeah.\n\n  Okay.\n\n  Uh, it's just me in the house.\n\n  Sure. Okay. And— and, uh, are you working at the moment?\n\n  Yeah, yeah, I— I work, yeah.\n\n  Right. What do you work as?\n\n  Um, I work as a restaurant owner.\n\n  Okay.\n\n  So I own a sushi shop.\n\n  Right, okay.\n\n  Yeah.\n\n  All right. Um, so, um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay?\n\n  Okay.\n\n  So I'm not saying you definitely have a heart attack, but we— that— so our number one priority to exclude that, okay?\n\n  Okay.\n\n  So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay?\n\n  Okay.\n\n  All right.\n\n  Yeah, thank you.\n\n  When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then.\n\n  Okay.\n\n  They'll decide where to take you after that, okay?\n\n  Okay.\n\n  And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\n\n  Yes, actually, I have, um, an allergy to aspirin.\n\n  Right, okay.\n\n  Yeah, and no other allergies.\n\n  Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a— an allergic reaction?\n\n  Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening. Um, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it.\n\n  Okay. All right.\n\n  Yeah.\n\n  It's very important that you communicate that to the hospital.\n\n  Okay.\n\n  And how detailed you've just told me, because, um, we— we may need to consider aspirin despite.\n\n  Oh, okay.\n\n  Allergy, okay? Um.\n\n  Okay.\n\n  All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what the ECG looks like and what kind of treatment you might need, okay? Um.\n\n  Okay.\n\n  What I'm going to do is we'll stay on the line for the time being.\n\n  Okay.\n\n  Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on, all right?\n\n  Okay. Okay, sure.\n\n  Okay.\n\n  Yeah, thank you.\n\n  Thank you. Is it now? We'll— we'll end the conversation now for the purposes?\n\n  Yeah.\n\n  Is that okay?\n\n  That's okay. Okay, thank you very much.\n\n  Okay, thanks. Bye.\n\n  Thank you, bye.","marks":[[0,60,"Hi",false],[127,133,"Resor",false],[139,150,".",false],[171,199,"That's the same thing. OK",false],[322,327,"",false],[346,349,"Jim",true],[376,381,"nineteen fifty eight",false],[393,396,"eighth",false],[497,499,"Does",false],[596,596,"or",false],[651,659,"Six OK",false],[708,708,"see",false],[764,775,"you are OK",false],[791,791,"Yep.",false],[1001,1006,"not",false],[1079,1088,"someone",false],[1501,1509,"gonna",false],[1548,1590,"OK.",false],[1604,1612,"gonna",false],[1623,1631,"gonna",false],[1701,1709,"gonna",false],[1740,1753,"OK OK. Mmm",false],[1764,1772,"We're gonna",false],[1802,1802,"to help",false],[2084,2099,"um and",false],[2179,2181,"into",false],[2210,2213,"your",false],[2622,2627,"during",false],[2757,2762,"",false],[2855,2860,"you know.",false],[3132,3139,"'cause",false],[3263,3263,"and I did",false],[3430,3463,"Who's",false],[3500,3500,"Yeah. OK thank you.",false],[3762,3775,"could",false],[3800,3810,"",false],[3819,3819,". 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Describes sensation of someone sitting on chest.\nAssociated SOB, diaphoresis and nausea; denies vomiting.\nPain radiates to L arm and shoulder.\nFirst episode of this type. Gardening was not perceived as strenuous; normally minimally active.\nReports HR feels faster currently, attributed to stress; no unusual palpitations earlier today.\nPMH: HTN. Denies DM. Cholesterol not previously checked.\nFHx: father died from MI at approximately pt’s current age; mother had cardiac problems.\nSmokes ~10 cigarettes/day for 15 yrs. Drinks ~7–8 pints beer/week. Self-reports overweight.\nLives alone. Front door open. Works as restaurant/sushi shop owner.\nAllergy: aspirin causes swelling; described as mild/non-life-threatening. No other allergies reported.\nObjective\nVideo consultation.\nNo physical examination, vital signs or ECG documented.\nAssessment\nAcute ongoing central chest pressure with L arm/shoulder radiation, SOB, diaphoresis and nausea, concerning for possible ACS/MI.\nCardiac risk factors include HTN, smoking, low activity level, self-reported overweight and significant FHx of premature cardiac disease.\nAspirin allergy with swelling requires communication to ambulance/hospital team.\nPlan\nAmbulance arranged for urgent assessment and hospital transfer.\nAdvised to remain accessible near/open front door while awaiting ambulance, as pt is alone.\nClinician discussed possible MI/need to urgently exclude ACS.\nAmbulance team to perform ECG and determine destination/treatment pathway.\nPt advised to inform ambulance/hospital team of aspirin allergy and reaction details.\nPlan was to remain on call pending ambulance arrival and provide handover; consultation then ended.","review":81.78947368421052,"saved":254.21052631578948,"clean":true,"effort":0.0,"sig":[],"mb":9.903719,"latency":20.512,"signable":102.30147368421052}],"heidi":[{"label":"Run 1","wer":17.11509715994021,"text":"Hi there. Good morning. Hi. Good morning. I'm Dr. Dean Moser from GP at Henn. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um... So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, that's 60, yeah. Sixty. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't, don't worry. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years, okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol, diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry, in your parents, did yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. But what do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, uh, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-like, okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay.-the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? We, we'll, we'll end the consultation now for the purposes? Yeah. Is that okay? Thanks. Okay. Okay, thank you very much. Take care, thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,60,"Resor",false],[66,77,".",false],[95,117,"That's the same thing. OK",false],[249,252,"Jim",true],[279,283,"nineteen fifty eight",false],[296,299,"eighth",false],[391,393,"Yeah. Does",false],[490,490,"or",false],[523,539,"about",false],[547,551,"yeah. Six OK",false],[662,673,"you are OK",false],[689,689,"Yep.",false],[890,892,"",false],[969,978,"someone",false],[1419,1436,"OK.",false],[1577,1581,"OK OK. Mmm",false],[1589,1593,"We're gonna",false],[1625,1628,"to help",false],[1678,1687,"OK.",false],[1788,1790,"",false],[1993,1995,"into",false],[2024,2027,"your",false],[2415,2420,"during",false],[2444,2458,"Sure OK. And",false],[2545,2550,"",false],[2630,2635,"you know.",false],[2707,2727,"OK. 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OK",false],[6842,6851,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"onset ~2 hours ago while gardening\"; pressure \"like someone sitting on chest\", central."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms currently present\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Associated pain in left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Lists nausea, sweating and SOB but does not note absence of vomiting."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Reports heart beating faster, attributes to stress\"."],["The note captures: This is the first similar episode.","yes","\"No previous episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history is not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Only \"Generally low physical activity levels\"; hypertension and overweight omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history of father MI and maternal heart problems not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Advised to communicate aspirin allergy (mild allergic reaction with swelling, not life-threatening) to hospital staff\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"No one else home; front door left open for ambulance access\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"concerning for possible MI, requiring urgent evaluation\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance called for urgent transport to hospital\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Mentions facility determined \"based on ECG findings\" but does not state ambulance crew will perform the ECG and attributes decision to hospital team."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","\"Clinician to remain on line until ambulance arrival\" but handover to crew omitted."]],"claims":[],"note":"Subjective:\n\n- New onset chest discomfort, nausea, sweating and SOB, onset ~2 hours ago while gardening\n\n- Chest discomfort described as pressure, \"like someone sitting on chest\", central over pectoral muscles, diffuse\n\n- Symptoms currently present\n\n- Associated pain in left arm and shoulder\n\n- Onset during non-strenuous activity (gardening, kneeling)\n\n- Generally low physical activity levels\n\n- No previous episodes\n\n- Reports heart beating faster, attributes to stress\n\n- No one else home; front door left open for ambulance access\n\n\n\n\nObjective:\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment:\n\n- Clinical presentation concerning for possible MI, requiring urgent evaluation\n\n\n\n\nPlan:\n\n- Ambulance called for urgent transport to hospital for further assessment and management\n\n- Advised to communicate aspirin allergy (mild allergic reaction with swelling, not life-threatening) to hospital staff\n\n- Clinician to remain on line until ambulance arrival\n\n- Hospital team to assess and determine appropriate facility based on ECG findings and treatment needs","review":147.2763157894737,"saved":188.7236842105263,"clean":false,"effort":26.666666666666668,"sig":[["missing","Smoking approximately ten cigarettes daily for fifteen years.","Smoking for 15 years is a major cardiac risk factor needed for ACS risk stratification, and it is missing entirely."],["partial","Hypertension, overweight and low baseline physical activity are relevant risk factors.","The note leaves out known hypertension (the key past history) and overweight in a suspected ACS."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","The note leaves out the father's MI at about 60, a major risk factor for ACS risk assessment."]],"mb":34.544326,"latency":26.882,"signable":174.1583157894737},{"label":"Run 2","wer":17.48878923766816,"text":"Well, that's something very different than that. Hi there. Good morning. Hi, good morning. Um, I'm Dr. Dean Mesler from GP at Han. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um... Yeah. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, that's 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, and the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry about it. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-uh, detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay... okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Thank you. Is it now? We, we'll, we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.","marks":[[0,48,"Hi",false],[108,114,"Resor",false],[120,130,".",false],[148,170,"That's the same thing. OK",false],[302,305,"Jim",true],[332,336,"nineteen fifty eight",false],[349,352,"eighth",false],[450,452,"Does",false],[549,549,"or",false],[582,591,"about sixty",false],[599,607,"Six OK",false],[718,729,"you are OK",false],[745,745,"Yep.",false],[946,948,"",false],[1025,1034,"someone",false],[1475,1492,"OK.",false],[1633,1637,"OK OK. Mmm",false],[1645,1649,"We're gonna",false],[1681,1684,"to help",false],[1734,1743,"OK.",false],[1844,1846,"",false],[2043,2045,"into",false],[2071,2078,"in your",false],[2466,2471,"during",false],[2495,2509,"Sure OK. And",false],[2596,2601,"",false],[2681,2686,"you know.",false],[2758,2778,"OK. 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OK OK",false],[6767,6798,"",false],[6827,6834,"after",false],[6909,6919,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset a couple of hours ago while gardening\" with pressure in the middle of the chest."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"symptoms still present\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiating to the left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Nausea, diaphoresis and SOB listed; \"Denies vomiting\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"notes heart beating faster currently due to stress\"."],["The note captures: This is the first similar episode.","yes","\"First-time occurrence\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smoker: 10 cigarettes daily for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and \"Generally sedentary lifestyle\" all documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of MI around 60; mother history of heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Mild swelling reaction documented and \"Advised to communicate aspirin allergy to hospital staff\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone and \"Advised to keep front door open for paramedic access\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"concerning for possible cardiac event; urgent assessment required to exclude MI\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance called for urgent transfer to hospital\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"paramedics will perform ECG and determine appropriate hospital based on findings\"."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"to remain on the line until paramedics arrive\"."]],"claims":[],"note":"Subjective\n\n- Chest discomfort, described as pressure in the middle of the chest, radiating to the left arm and shoulder\n\n- Associated nausea, diaphoresis and SOB\n\n- Onset a couple of hours ago while gardening (non-strenuous activity); symptoms still present\n\n- Denies vomiting\n\n- Denies palpitations initially; notes heart beating faster currently due to stress\n\n- First-time occurrence\n\n- Lives alone; no one else in the house currently\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Symptoms concerning for possible cardiac event; urgent assessment required to exclude MI\n\n\n\n\nPlan\n\n- Ambulance called for urgent transfer to hospital\n\n- Dr. Jane Doe to remain on the line until paramedics arrive\n\n- Advised to keep front door open for paramedic access\n\n- Explained paramedics will perform ECG and determine appropriate hospital based on findings and treatment needs\n\n- Advised to communicate aspirin allergy to hospital staff, as aspirin may still be considered\n\n\n\n\nPast Medical History\n\n- Hypertension\n\n- Overweight\n\n\n\n\nSocial History\n\n- Smoker: 10 cigarettes daily for 15 years\n\n- Alcohol: 7-8 pints of beer per week\n\n- Lives alone\n\n- Works as a restaurant owner (sushi shop)\n\n- Generally sedentary lifestyle\n\n\n\n\nFamily History\n\n- Father: died of MI around 60 years of age\n\n- Mother: history of heart problems\n\n\n\n\nAllergies\n\n- Aspirin: mild allergic reaction including swelling, not life-threatening","review":62.84210526315789,"saved":273.1578947368421,"clean":true,"effort":0.0,"sig":[],"mb":38.334958,"latency":28.061,"signable":90.9031052631579},{"label":"Run 3","wer":17.040358744394617,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Mezza from GP at Han. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And, and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't, I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't, don't worry about it. Okay. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol, diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, uh, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. It's very important that you communicate that to the hospital- Okay.-detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-IoV. Okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Uh-huh... the team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? We, we'll, we'll end the consultation now for the purposes? Yeah. Is that okay? That's... Okay. Okay, thank you very much. Take care. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[59,64,"Resor",false],[70,80,".",false],[98,120,"That's the same thing. OK",false],[252,255,"Jim",true],[282,286,"nineteen fifty eight",false],[299,302,"eighth",false],[392,394,"Yeah. Does",false],[491,491,"or",false],[540,548,"Six OK",false],[659,670,"you are OK",false],[686,686,"Yep.",false],[887,889,"",false],[966,975,"someone",false],[1416,1433,"OK.",false],[1574,1578,"OK OK. Mmm",false],[1586,1590,"We're gonna",false],[1622,1625,"to help",false],[1675,1684,"OK.",false],[1785,1787,"",false],[1990,1992,"into",false],[2021,2024,"your",false],[2412,2417,"during",false],[2441,2452,"Sure OK.",false],[2544,2549,"",false],[2627,2632,"you know.",false],[2704,2724,"OK. Can",false],[2886,2893,"'cause",false],[3005,3005,"and I did",false],[3156,3178,"Who's",false],[3214,3214,"Yeah. 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OK OK",false],[6706,6726,"",false],[6742,6762,"conversation after",false],[6840,6850,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Onset a couple of hours prior while gardening; pressure sensation, central."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms currently ongoing\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, diaphoresis and SOB captured, but absence of vomiting not stated."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","Reports awareness of faster heart rate, attributed to stress."],["The note captures: This is the first similar episode.","yes","\"No prior similar episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","no","Hypertension, overweight and low activity not documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy (swelling, mild) and importance of informing hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; advised to keep front door open."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"suggestive of possible myocardial infarction\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance called for urgent assessment\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","no","No mention of ambulance ECG or destination decision."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Remain on the line until ambulance arrival for handover\"."]],"claims":[],"note":"Subjective:\n\n- Kim Gowers, DOB 08/08/1958, presented with chest discomfort and associated symptoms.\n\n- Onset a couple of hours prior while gardening (kneeling, non-strenuous activity).\n\n- Describes pressure sensation on chest, \"like someone sitting on chest\".\n\n- Associated nausea, diaphoresis, SOB.\n\n- Symptoms currently ongoing.\n\n- Chest discomfort diffuse, central/pectoral, not lateralised.\n\n- Radiation to left arm and shoulder.\n\n- No prior similar episodes.\n\n- Denies palpitations until recently, attributed to stress.\n\n- Lives alone; no one else in house.\n\n\n\n\nObjective:\n\n- Telehealth consultation; no physical examination performed.\n\n- Reports awareness of faster heart rate, attributed to stress.\n\n\n\n\nAssessment:\n\n- Clinical presentation suggestive of possible myocardial infarction.\n\n\n\n\nPlan:\n\n- Ambulance called for urgent assessment and transport to hospital.\n\n- Advised to keep front door open for ambulance access.\n\n- Counselled on importance of informing paramedics and hospital staff re: aspirin allergy (swelling, mild, non-life-threatening).\n\n- Remain on the line until ambulance arrival for handover.","review":145.9078947368421,"saved":190.0921052631579,"clean":false,"effort":30.0,"sig":[["missing","Smoking approximately ten cigarettes daily for fifteen years.","Smoking is a major cardiac risk factor needed for ACS risk assessment."],["missing","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension and other cardiovascular risk factors are absent from a suspected-MI note."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Premature paternal MI is a key risk factor for ACS and is omitted."]],"mb":38.384352,"latency":25.789,"signable":171.69689473684213},{"label":"Run 4","wer":17.11509715994021,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Mesler from GP at Hen. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Garris, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort. So I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the the ambulance team when they when they arrive. Okay? Sure. So just to just to double check, where exactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So\n\nUm, yeah, but not not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry. In your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. What when they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. No. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. Uh, it's very important that you communicate that to the hospital- Okay... detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-liab. Okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Is it now? 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OK OK",false],[6655,6675,"",false],[6691,6711,"conversation after",false],[6789,6799,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Central chest pressure onset ~2 hours ago while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), sweating, SOB\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Reports palpitations, heart beating faster, attributed to stress\"."],["The note captures: This is the first similar episode.","yes","\"No prior similar episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smoker ~10 cigarettes/day x 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Hypertension and overweight captured; low baseline physical activity omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of heart attack ~60; mother had heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy with mild swelling; counselled to communicate it to hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; advised to keep front door open for ambulance."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"possible myocardial infarction\"; priority to exclude cardiac event."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance called for urgent transport to hospital\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Mentions decision \"based on ECG\" but attributes it to the hospital team and does not state the ambulance will perform the ECG."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Remain on line until ambulance arrives, then handover to paramedics\"."]],"claims":[],"note":"Subjective\n\n- Chest discomfort, onset ~2 hours ago while gardening (kneeling, light activity, not strenuous)\n\n- Described as pressure, \"like someone sitting on chest\", rather than pain\n\n- Diffuse, central chest over pectoral region\n\n- Radiation to left arm and shoulder\n\n- Associated nausea (no vomiting), sweating, SOB\n\n- Symptoms ongoing\n\n- Reports palpitations, heart beating faster, attributed to stress\n\n- No prior similar episodes\n\n- Lives alone, no one else in house\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Symptoms suggestive of possible myocardial infarction\n\n- Priority to exclude cardiac event given symptom nature and family history\n\n\n\n\nPlan\n\n- Ambulance called for urgent transport to hospital\n\n- Advised to keep front door open for ambulance access\n\n- Counselled on importance of communicating aspirin allergy to hospital staff\n\n- Remain on line until ambulance arrives, then handover to paramedics\n\n- Hospital team to assess and determine appropriate transfer/treatment based on ECG and clinical findings\n\n\n\n\nSocial History\n\n- Smoker ~10 cigarettes/day x 15 years\n\n- Alcohol ~7-8 pints beer/week\n\n- Overweight\n\n- Lives alone\n\n- Works as restaurant owner (sushi shop)\n\n\n\n\nPast Medical History\n\n- Hypertension\n\n- No diabetes\n\n- Cholesterol not previously checked\n\n\n\n\nFamily History\n\n- Father died of heart attack ~60 years of age\n\n- Mother had heart problems\n\n\n\n\nAllergies\n\n- Aspirin (allergic reaction - swelling, mild, not life-threatening)","review":90.52631578947367,"saved":245.47368421052633,"clean":false,"effort":6.666666666666667,"sig":[],"mb":34.153012,"latency":29.219,"signable":119.74531578947366},{"label":"Run 5","wer":17.189835575485798,"text":"Well, that's very difficult. Hi there. Good morning. Hi, good morning. Um, I'm Dr. Dean Moser from GP at Hen. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um. So that, that would make you roughly about 50 years old, 51, 51 years old. Is that, is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect.\n\nAll right. Yeah. So, um, nice to see you to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am. Yeah. Okay, fantastic. So, um, how can I help you today? Um, yeah, I was, I was having, um, a bit of chest discomfort. So I was doing some gardening, um, a couple of hours ago, and I felt n- not exactly a pain, but, um, like a, a pressure on my chest. Um, feels like someone's sitting on my chest. Um, and I've noticed, um, a, a bit of nausea, not, no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\n\nRight. Okay. Now, do you have those these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you today. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um, where exactly in the chest is the pain? Um, it's in the m- uh, middle of my chest, um, over, uh, yeah, my, my pecs, so-\n\nUm, yeah, but not not necessarily to one side. Um, and it's quite a diffuse pain. Right. Is, is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's, it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and, and, in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening, so nothing that was too strenuous. Um, I was just kneeling down and, uh, yeah, wasn't running or anything. I wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't... I, I generally don't do much activity at all.\n\nUm, yeah. Have you had this before? No, this is the first time, actually. Right. Okay. Okay. Yeah. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's it's beating a bit faster now. I think that's because I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't don't worry about it. Anyone in the house with you at the moment? Uh, no, no one's in the house at the moment. Okay. Um, and i- is your front door open?\n\nUh, yes, it's open. Okay, so maybe we'll, we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can, they can access you. Yeah. All right. Yep. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about ten cigarettes, uh, a day. Um- Yeah. How long have you been smoking for? Uh, for the past fifteen years. Fifteen years. Okay. Um- Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked?\n\nNo. Okay. Alright. Now anyone in your wider family in your family, sorry, in your parents, did Yes. Did either of them have any heart problems or heart attacks or anything like that? Yes. So my father died of a heart attack. Okay. And my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack? He was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about seven or eight pints a week.\n\nOkay. Is that a fear you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah. Right. What do you work as? I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me\n\nThey indicate the possibility of a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then Okay. Decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah, it's an allergic reaction, so I swallow, um, a bit, but, um, nothing life-threatening. Um, I've, I sometimes even have it, and it's, it's a, it's a mild reaction to it. Okay. All right. Uh, it's very important that you communicate that to the hospital- Okay.-uh, detail you've just told me, because, um, we, we may need to consider aspirin despite- Oh, okay.-liverie, okay? Um- Okay. All right. Um, now, in terms of, um, what happens from here- Okay... the hospital team will assess you, and then they may take you in to one hospital or another based on how bad, uh, what, what the ECG looks like and what kind of treatment you might need, okay? Um- Okay. What I'm gonna do is we'll stay on the line for the time being.\n\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay, sure. Okay. Yeah, thank you. Thank you. 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Good morning. Hi. Good morning. I'm Doctor. Dean Mesler from GP at Han. Nice to see you. Nice to see you.\n\nOkay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure. Um, my name is Kim Gowers, and I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so, um, um.\n\nSo that that would make you roughly about fifty years old, fifty one fifty one years old. Is that is that correct? Yeah. Yeah. Around that. Yeah. That's sixty. Yeah. Sixty. Okay. Perfect. Alright. Yeah. So nice to see to see you this morning. Are you in a private place where you're okay to speak freely? Yes. I am. Yeah. Okay. Fantastic. So how can I help you today? Yeah. I was I was having a bit of chest discomfort. So I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but, like, a a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed a bit of nausea. Not\n\nNo vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest. Right. Okay. Now, do you have those, these symptoms right now, or have they gone off now? Um, no, they're still present. Okay. So you've still got the chest discomfort right now? Yes. Okay. Um, we're probably gonna have to call an ambulance for you to take. Okay. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Sure. Give a bit more information to the, the, the ambulance team when they, when they arrive, okay? Um- Sure. So just to, just to double-check, um-\n\nWhere exactly in the chest is the pain? It's in the middle of my chest, over, yeah, my my pecs. So, yeah, but not not necessarily to one side. And it's quite a diffuse pain. Right. Is it spreading anywhere else, like, down to your arm, up to the jaw and the neck, anything like that? Yeah. It's it's mainly in my left arm. It's feeling a little bit painful and in in my shoulder as well. Right. Okay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and\n\nUh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. A- and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No, I don't, I, I generally don't do much activity at all. Um, yeah. Have you had this before? No, this is the first time, actually. Right, okay. Yeah. Okay. Yeah. Uh, um, are you aware of any palpitations, like your heart beating faster or more prominently than normal? Um, yeah, it's, it's beating a bit faster now. I think that's'cause I'm a little bit stressed, um, about the situation, but I haven't noticed it, um, beating faster than usual, um, uh, today.\n\nSo I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry about it. In the house with you at the moment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can they can access you. Yeah. Alright. Yep. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about ten cigarettes a day. Yeah. How long have you been smoking for?\n\nUh, for the past fifteen years. Fifteen years. Okay. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes or something like that? Yeah, I have high blood, uh, blood pressure, but, um, not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. All right. Um, now, anyone in your wider family, in your family, sorry, in your parents, did- Yes. Did either of them have any heart problems or heart attacks or anything like that? Um, yes, so my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he had, he had that heart attack?\n\nUm, he was about my age. Right. So just under six around sixty. Yes. Around sixty. Yes. Okay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about per week, probably about seven or eight pints a week. Okay. Is that a beer you're talking about? Oh, yeah. Yes. Okay. Um, I can't tell from the video. Are you overweight? Um, yes, I'm overweight. Yeah. Right. Yeah. Okay. All right. Um, uh, now, um, you're-- do you normally live alone? Uh, yeah, I live alone, uh, at the moment. Yeah. Uh, it's just me in the house. Sure. Okay, and, and, uh, are you working at the moment?\n\nYeah, yeah, I, I work. Yeah. Right. What do you work as? Um, I work as a restaurant owner, so I own a sushi shop. Right. Okay. Yeah. All right. Um, so, um, the, the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we-- that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come, okay? Okay. Yeah, thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG.\n\nAnd then decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause your heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital.\n\nOkay. Detail you've just told me because, um, we we may need to consider aspirin despite therapy. Okay. Um, all right. Um, now in terms of, um, what happens from here, the team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. Um, okay. What I'm going to do is we'll stay on the line for the time being. Okay. Until they come. And then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right. Okay. Okay. Sure. Okay. Yeah. Thank you. Now we'll we'll end the consultation now for the purposes. Yeah. Is that okay? Okay. Okay. Thank you very much. Take care. Thanks. Bye.\n\nThey keep bye.","marks":[[0,0,"Hi",false],[59,65,"Resor",false],[71,81,".",false],[99,121,"That's the same thing. OK",false],[253,256,"Jim",true],[283,287,"nineteen fifty eight",false],[300,303,"eighth",false],[393,400,"Yeah. Does",false],[511,511,"or",false],[544,550,"about",false],[564,576,"Six OK",false],[586,600,"All right.",false],[674,685,"you are OK",false],[701,701,"Yep.",false],[950,959,"someone",false],[1388,1407,"OK.",false],[1548,1552,"OK OK. Mmm",false],[1560,1564,"We're gonna",false],[1596,1599,"to help",false],[1649,1658,"OK.",false],[1927,1929,"into",false],[1954,1961,"in your",false],[2314,2319,"during",false],[2343,2357,"Sure OK. And",false],[2444,2449,"",false],[2526,2531,"you know.",false],[2603,2633,"OK. Can",false],[2789,2801,"that's 'cause",false],[2915,2917,"and I did",false],[3063,3072,"Who's",false],[3108,3108,"Yeah. OK thank you. 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OK",false],[6721,6731,"",false],[6746,6755,"Thank you.",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Chest pressure onset ~2 hours prior while gardening, central."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiates to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Nausea (no vomiting), diaphoresis, SOB."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Reports palpitations, attributes to stress\"."],["The note captures: This is the first similar episode.","yes","\"Denies previous episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"smoker 10/day x 15 yrs\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","HTN and overweight captured; low baseline physical activity omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of MI ~60; mother with heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","partial","Aspirin allergy and informing hospital captured, but reaction described as \"throat swelling\", which was not said."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; advised to keep front door open."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute cardiac event (MI)\"; counselled re possibility of MI."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance called for urgent transport\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","ECG by ambulance team; destination determined based on ECG findings."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Clinician to remain on line until ambulance arrival\"."]],"claims":[["Aspirin (allergic reaction, mild throat swelling...)","Patient said only \"I swell up a bit\"; no throat involvement was mentioned."]],"note":"Subjective\n\n- Sudden onset chest discomfort approx. 2 hours prior while gardening\n\n- Central chest pressure sensation, \"like someone sitting on chest\"\n\n- Symptoms ongoing\n\n- Associated nausea (no vomiting), diaphoresis, SOB\n\n- Radiates to left arm and shoulder\n\n- Denies previous episodes\n\n- No strenuous activity at onset (kneeling)\n\n- Reports palpitations, attributes to stress\n\n- PMHx: HTN\n\n- Allergies: Aspirin (allergic reaction, mild throat swelling, not life-threatening)\n\n- Social: smoker 10/day x 15 yrs; alcohol 7-8 pints beer/week; lives alone; works as restaurant owner (sushi shop)\n\n- FHx: father died of MI ~age 60; mother with heart problems\n\n\n\n\nObjective\n\n- Appears overweight\n\n- Reports palpitations\n\n\n\n\nAssessment\n\n- Suspected acute cardiac event (MI)\n\n\n\n\nPlan\n\n- Ambulance called for urgent transport to hospital\n\n- Advised to keep front door open for ambulance access\n\n- Clinician to remain on line until ambulance arrival\n\n- Counselled re possibility of MI and need for hospital assessment\n\n- Advised to inform hospital staff of aspirin allergy details\n\n- ECG to be performed by ambulance team\n\n- Destination hospital to be determined by ambulance based on ECG findings and patient condition","review":95.30263157894737,"saved":240.69736842105263,"clean":false,"effort":13.333333333333334,"sig":[["partial","Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","Throat swelling implies airway angioedema, which misstates the aspirin allergy severity and affects whether aspirin is given."]],"mb":48.273045,"latency":25.01,"signable":120.31263157894738}],"freed":[{"label":"Run 1","wer":24.663677130044842,"text":"Hi there, good morning. Hi, good morning. I'm Doctor Dean Mazur from GP at Hand, nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n  Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\n  That's great, thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old, 51 years old, is that correct?\n  Yeah, around that, yeah, about 60, yeah. Okay, perfect.\n  Alright, so nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So how can I help you today?\n  Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but like a pressure on my chest, feels like someone sitting on my chest, and I've noticed a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\n  Right, okay. Now, do you have these symptoms right now, or have they gone off now? No, they're still present. Okay, so you've still got the chest discomfort right now? Yes. Okay. We're probably going to have to call an ambulance for you. Okay, so what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Give a bit more information to the ambulance team when they arrive, okay? So just to double-check, where exactly in the chest is the pain?\n  It's in the middle of my chest, over my pecs, but not necessarily to one side, and it's quite a diffuse pain.\n  Right. Is it spreading anywhere else, like down to your arm, up to your jaw, in the neck, anywhere like that?\n  Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well.\n  Right, okay. Do you remember what you were doing at the time?\n  Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. I wasn't doing any physical exercise. Okay.\n  And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\n  No, I don't. I generally don't do much activity at all.\n Unknown: Yeah.\n  Have you had this before? No, this is the 1st time actually.\n  Right, okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n  Yeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n  Sir, I know you're stressed. We've got an ambulance coming on the way, okay?\n Unknown: Yeah.\n  We'll take care of everything, so don't worry. Is anyone in the house with you at the moment?\n  No, no one's in the house at the moment.\n  Okay. And is your front door open?\n  Yes, it's open.\n  Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you.\n Unknown: Yeah.\n  All right. Are you a smoker at all?\n  Yeah, I smoke a fair bit. I smoke about 10 cigarettes a day.\n  How long have you been smoking for?\n  For the past 15 years.\n  Do you have high blood pressure or high cholesterol or diabetes?\n  Yeah, I have high blood pressure but not diabetes.\n  Have you ever had your cholesterol checked? All right, now in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that?\n  Yes, so my father died of a heart attack and my mother had some heart problems.\n  Okay, I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\n  He was about my age.\n  Right, so just around 60?\n  Yes, around 60, yes.\n  All right, do you drink much alcohol?\n  Yeah, I drink about per week, probably about 7 or 8 pints a week.\n  Okay, is that a beer you're talking about?\n  Of beer, yes.\n  Okay, I can't tell from the video, are you overweight?\n  Yes, I'm overweight, yeah. Right, okay, all right.\n  Now, do you normally live alone?\n  Yeah, I live alone at the moment, yeah, it's just me and the house.\n  Sure, okay, and are you working at the moment?\n  Yeah, yeah, I work, yeah.\n  What do you work as?\n  I work as a restaurant owner, so I own a sushi shop.\n  Right, okay.\n  Yeah.\n  The symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay. So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay, yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that, okay? Okay. And what, can I just double check, do you have any allergies to any medication?\n  Yes, actually, I have an allergy to aspirin.\n  Right, okay.\n  Yeah, and no other allergies.\n  What's the nature of that allergy to aspirin? Does it cause you heartburn, or is it like an allergic reaction?\n  Yeah, it's an allergic reaction, so I swallow a bit, but nothing life-threatening. I sometimes even have it, and it's a mild reaction to it.\n  It's very important that you communicate that to the hospital detail you've just told me because we may need to consider aspirin despite the allergy. All right, now in terms of what happens from here, that team will assess you and then they may take you into one hospital or another based on... about what the ECG looks like and what kind of treatment you might need. Okay.\n  Okay.\n  What I'm going to do is we'll stay on the line for the time being. Okay. Until they come and then once they come then I'll hand over to them I'll explain what's going on.\n  All right. Okay. Okay. Sure. Okay. Thank you.\n  We'll end the conversation now for the purposes.\n  Yeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[58,63,"Resor",false],[69,79,".",false],[98,123,"That's the same thing. OK",false],[253,256,"Jim",true],[282,286,"nineteen fifty eight uh",false],[294,297,"eighth",false],[379,379,"um Yeah. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Central chest pressure starting \"while gardening a couple of hours ago\" with light activity."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"He notes the symptoms are still present.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates down his left arm and into his left shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea without vomiting, diaphoresis, and shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"heart has been beating faster than usual\" during the episode."],["The note captures: This is the first similar episode.","yes","\"this is the first episode\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Current smoker, 10 cigarettes per day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension and overweight in assessment; low activity documented in history and social history."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father MI ~60 deceased, mother heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Aspirin allergy, which is a mild allergic reaction, to be communicated to emergency team\"; swelling noted."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door advice captured, but patient being alone is not documented."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"highly concerning for acute coronary syndrome requiring immediate evaluation\" - not stated as confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance transport arranged for immediate evaluation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","Pre-hospital ECG plus \"Hospital destination to be determined based on ECG findings\"."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","\"Continue monitoring symptoms until emergency team arrival\" does not state the clinician stays on the line or hands over."]],"claims":[],"note":"Subjective\nTim Gowers, a 60-year-old male with a history of hypertension, presents with acute onset chest discomfort with associated nausea, diaphoresis, and shortness of breath.\n\nThe patient reports that while gardening a couple of hours ago, he began experiencing a pressure-like sensation in the middle of his chest, described as \"feels like someone sitting on my chest,\" not localized to one side and quite diffuse. He notes the symptoms are still present. He reports the chest discomfort radiates down his left arm and into his left shoulder. He was engaged in light activity, kneeling down while gardening, and was not performing any strenuous exercise at the time of onset. He also reports associated nausea without vomiting, diaphoresis, and shortness of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He denies having experienced these symptoms before; this is the first episode. He reports generally not doing much physical activity.\n\nMedical History  \n- Hypertension\n\nAllergies  \n- Aspirin (swelling)\n\nFamily History  \n- Father: MI at age 60, deceased  \n- Mother: Heart problems\n\nSocial History  \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years  \n- Alcohol: 7-8 pints of beer per week  \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n60-year-old male with hypertension and family history of cardiac disease, presenting with acute onset chest pressure, dyspnea, diaphoresis, and nausea while gardening.\n\nAcute chest pain  \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the center of chest over the pectoral area, associated with dyspnea, diaphoresis, nausea, and left arm and shoulder pain. Symptoms began while gardening with minimal exertion and are currently ongoing. Patient has significant cardiac risk factors including hypertension, 15-year smoking history with 10 cigarettes daily, family history of cardiac disease with father dying of heart attack at similar age and mother having heart problems, and being overweight. Clinical presentation is highly concerning for acute coronary syndrome requiring immediate evaluation and management.  \nPlan:  \n- Emergency ambulance transport arranged for immediate evaluation  \n- Pre-hospital ECG to be performed by emergency team  \n- Patient advised to keep front door open for emergency access  \n- Continue monitoring symptoms until emergency team arrival  \n- Aspirin allergy, which is a mild allergic reaction, to be communicated to emergency team for consideration in treatment decisions  \n- Hospital destination to be determined based on ECG findings and required treatment needs\n","review":162.25,"saved":173.75,"clean":false,"effort":6.666666666666667,"sig":[],"mb":14.329352,"latency":48.16,"signable":198.34199999999998},{"label":"Run 2","wer":24.663677130044842,"text":"Hi there, good morning. Hi, good morning. I'm Doctor Dean Mazur from GP at Hand, nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n  Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\n  That's great, thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old, 51 years old, is that correct?\n  Yeah, around that, yeah, about 60, yeah. Okay, perfect.\n  Alright, so nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So how can I help you today?\n  Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but like a pressure on my chest, feels like someone sitting on my chest, and I've noticed a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\n  Right, okay. Now, do you have these symptoms right now, or have they gone off now? No, they're still present. Okay, so you've still got the chest discomfort right now? Yes. Okay. We're probably going to have to call an ambulance for you. Okay, so what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Give a bit more information to the ambulance team when they arrive, okay? So just to double-check, where exactly in the chest is the pain?\n  It's in the middle of my chest, over my pecs, but not necessarily to one side, and it's quite a diffuse pain.\n  Right. Is it spreading anywhere else, like down to your arm, up to your jaw, in the neck, anywhere like that?\n  Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well.\n  Right, okay. Do you remember what you were doing at the time?\n  Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. I wasn't doing any physical exercise. Okay.\n  And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\n  No, I don't. I generally don't do much activity at all.\n Unknown: Yeah.\n  Have you had this before? No, this is the 1st time actually.\n  Right, okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n  Yeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n  Sir, I know you're stressed. We've got an ambulance coming on the way, okay?\n Unknown: Yeah.\n  We'll take care of everything, so don't worry. Is anyone in the house with you at the moment?\n  No, no one's in the house at the moment.\n  Okay. And is your front door open?\n  Yes, it's open.\n  Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you.\n Unknown: Yeah.\n  All right. Are you a smoker at all?\n  Yeah, I smoke a fair bit. I smoke about 10 cigarettes a day.\n  How long have you been smoking for?\n  For the past 15 years.\n  Do you have high blood pressure or high cholesterol or diabetes?\n  Yeah, I have high blood pressure but not diabetes.\n  Have you ever had your cholesterol checked? All right, now in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that?\n  Yes, so my father died of a heart attack and my mother had some heart problems.\n  Okay, I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\n  He was about my age.\n  Right, so just around 60?\n  Yes, around 60, yes.\n  All right, do you drink much alcohol?\n  Yeah, I drink about per week, probably about 7 or 8 pints a week.\n  Okay, is that a beer you're talking about?\n  Of beer, yes.\n  Okay, I can't tell from the video, are you overweight?\n  Yes, I'm overweight, yeah. Right, okay, all right.\n  Now, do you normally live alone?\n  Yeah, I live alone at the moment, yeah, it's just me and the house.\n  Sure, okay, and are you working at the moment?\n  Yeah, yeah, I work, yeah.\n  What do you work as?\n  I work as a restaurant owner, so I own a sushi shop.\n  Right, okay.\n  Yeah.\n  The symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay. So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay, yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that, okay? Okay. And what, can I just double check, do you have any allergies to any medication?\n  Yes, actually, I have an allergy to aspirin.\n  Right, okay.\n  Yeah, and no other allergies.\n  What's the nature of that allergy to aspirin? Does it cause you heartburn, or is it like an allergic reaction?\n  Yeah, it's an allergic reaction, so I swallow a bit, but nothing life-threatening. I sometimes even have it, and it's a mild reaction to it.\n  It's very important that you communicate that to the hospital detail you've just told me because we may need to consider aspirin despite the allergy. All right, now in terms of what happens from here, that team will assess you and then they may take you into one hospital or another based on... about what the ECG looks like and what kind of treatment you might need. Okay.\n  Okay.\n  What I'm going to do is we'll stay on the line for the time being. Okay. Until they come and then once they come then I'll hand over to them I'll explain what's going on.\n  All right. Okay. Okay. Sure. Okay. Thank you.\n  We'll end the conversation now for the purposes.\n  Yeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[58,63,"Resor",false],[69,79,".",false],[98,123,"That's the same thing. OK",false],[253,256,"Jim",true],[282,286,"nineteen fifty eight uh",false],[294,297,"eighth",false],[379,379,"um Yeah. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure starting a couple of hours earlier while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","States symptoms are still present/ongoing."],["The note captures: Pain radiates to the left arm and shoulder.","yes","Documents radiation to the left arm and shoulder."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Documents nausea without vomiting, sweating and shortness of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","Documents heart beating faster during the episode."],["The note captures: This is the first similar episode.","yes","States this is the first episode."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","Documents 10 cigarettes/day for 15 years."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Documents hypertension, overweight and low baseline activity."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Documents father died of heart attack around 60 and mother's heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Documents aspirin allergy with mild swelling and need to tell the hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door advice captured but patient being alone omitted."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","Frames heart attack/ACS as possible and to be excluded, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Documents ambulance arranged urgently."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Pre-hospital ECG and \"Hospital assessment and management based on ECG findings\" noted, but destination decision not explicit."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","no","No mention of clinician remaining on the line until ambulance arrival."]],"claims":[],"note":"Subjective\nTim Gowers, a approximately 60-year-old male with a history of hypertension, presents with acute onset chest discomfort while gardening. He reports that while kneeling and gardening a couple of hours ago, he began experiencing a pressure sensation in the middle of his chest, described as \"feeling like someone sitting on my chest.\" The pain is diffuse, located over the pectoral area, and radiates down the left arm and into the left shoulder. He reports being sweaty and short of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He states the symptoms are still present. He denies vomiting. He denies having had these symptoms before.\n\nThe patient reports generally not doing much physical activity. He was not engaged in any strenuous activity at the time of onset.\n\nMedical History  \n- Hypertension\n\nAllergies  \n- Aspirin (swelling, mild allergic reaction)\n\nFamily History  \n- Father: Heart attack at age 60, deceased  \n- Mother: Heart problems\n\nSocial History  \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years  \n- Alcohol: 7-8 pints of beer per week  \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n60-year-old male with hypertension and family history of cardiac disease, presenting with acute onset chest pressure and shortness of breath.\n\nAcute chest pain  \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the center of chest, associated with nausea, diaphoresis, and shortness of breath. Symptoms began while gardening and are ongoing. Pain radiates to left arm and shoulder. Patient has multiple cardiac risk factors including hypertension, smoking history of 10 cigarettes daily for 15 years, family history of cardiac disease with father dying of heart attack at similar age and mother having heart problems, male gender, and being overweight. Clinical presentation is concerning for acute coronary syndrome and requires immediate evaluation to rule out myocardial infarction.  \nPlan:  \n- Emergency ambulance transport arranged for immediate evaluation  \n- Pre-hospital ECG to be performed by paramedic team  \n- Patient advised to keep front door open for emergency access  \n- Aspirin allergy to be communicated to emergency team for consideration in treatment decisions  \n- Hospital assessment and management based on ECG findings\n","review":180.6315789473684,"saved":155.3684210526316,"clean":false,"effort":13.333333333333334,"sig":[],"mb":14.210836,"latency":46.956,"signable":214.4165789473684},{"label":"Run 3","wer":24.663677130044842,"text":"and all of that stuff is very different.\n  Hi there, good morning. Hi, good morning. I'm Doctor Dean Mazur from GP at Hand, nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n  Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\n  That's great, thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old, 51 years old, is that correct?\n  Yeah, yeah, around that, yeah, about 60, yeah. Okay, perfect.\n  Alright, so, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So, how can I help you today?\n  Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but like a pressure on my chest, feels like someone sitting on my chest, and I've noticed a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\n  Right, okay. Now, do you have these symptoms right now, or have they gone off now? No, they're still present. Okay, so you've still got the chest discomfort right now? Yes. Okay. We're probably going to have to call an ambulance for you. Okay, so what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Sure. Give a bit more information to the ambulance team when they arrive, okay? Sure. So just to double-check, where exactly in the chest is the pain?\n  It's in the middle of my chest, over my pecs, but not necessarily to one side. It's quite a diffuse pain.\n  Right. Is it spreading anywhere else, like down to your arm, up to your jaw, in your neck, anywhere like that?\n  Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well.\n  Right, okay. Do you remember what you were doing at the time?\n  Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. I wasn't doing any physical exercise. Okay.\n  And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\n  No, I don't. I generally don't do much activity at all.\n Unknown: Yeah.\n  Have you had this before? No, this is the 1st time actually.\n  Right, okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n  Yeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n  Sir, I know you're stressed. We've got an ambulance coming on the way, okay?\n Unknown: Yeah.\n  We'll take care of everything, so don't worry. Is anyone in the house with you at the moment?\n  No, no one's in the house at the moment.\n  Okay. And is your front door open?\n  Yes, it's open.\n  Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you.\n Unknown: Yeah.\n  All right. Are you a smoker at all?\n  Yeah, I smoke a fair bit. I smoke about 10 cigarettes a day.\n  How long have you been smoking for?\n  For the past 15 years.\n  Do you have high blood pressure or high cholesterol or diabetes?\n  Yeah, I have high blood pressure but not diabetes.\n  Have you ever had your cholesterol checked? All right, now in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that?\n  Yes, so my father died of a heart attack and my mother had some heart problems.\n  Okay, I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\n  He was about my age.\n  Right, so just under 6, around 60? Yes, around 60, yes. All right. Do you drink much alcohol?\n  Yeah, I drink about per week, probably about 7 or 8 pints a week.\n  Okay. Is that a beer you're talking about?\n  Oh, yeah. Yes. Okay.\n  I can't tell from the video. Are you overweight?\n  Yes, I'm overweight. Yeah. Right. All right.\n  Now, do you normally live alone?\n  Yeah, I live alone at the moment, yeah, it's just me and the house.\n  Sure, OK, and are you working at the moment?\n  Yeah, yeah, I work, yeah.\n  What do you work as?\n  I work as a restaurant owner, so I own a sushi shop.\n  Right, OK.\n  Yeah.\n  The symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but that's our number one priority to exclude that.\n  Okay.\n  So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay, yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then you'll decide where to take you after that, okay? Okay. Can I just double-check, do you have any allergies to any medication?\n  Yes, actually, I have an allergy to aspirin.\n  Right, okay.\n  Yeah, and no other allergies.\n  What's the nature of that allergy to aspirin? Does it cause you heartburn, or is it like an allergic reaction?\n  Yeah, it's an allergic reaction, so I swallow a bit, but nothing life-threatening. I sometimes even have it, and it's a mild reaction to it.\n  Okay, all right. It's very important that you communicate that to the hospital. detail you've just told me because we may need to consider aspirin despite the allergy. All right, now in terms of what happens from here, that team will assess you and then they may take you into one hospital or another based on how bad, what the ECG looks like and what kind of treatment you might need. What I'm going to do is we'll stay on the line for the time being. Until they come and then once they come then I'll hand over to them. I'll explain what's going on.\n  All right, okay Okay, sure. Okay.\n  Thank you We'll end the conversation now for the purposes yeah, okay.\n  Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye...","marks":[[0,40,"Hi",false],[101,106,"Resor",false],[112,122,".",false],[141,166,"That's the same thing. OK",false],[296,299,"Jim",true],[325,329,"nineteen fifty eight uh",false],[337,340,"eighth",false],[422,422,"um Yeah. Does that",false],[471,473,"fifty one fifty one",false],[500,500,"or",false],[551,555,"Six OK",false],[568,575,"All right.",false],[588,588,"see",false],[644,655,"you are OK",false],[671,671,"Yep.",false],[975,975,"not",false],[1117,1117,"those",false],[1282,1290,"gonna",false],[1344,1352,"gonna",false],[1363,1371,"gonna",false],[1441,1449,"gonna",false],[1480,1484,"OK OK. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure starting a couple of hours earlier while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","States symptoms are still present/ongoing."],["The note captures: Pain radiates to the left arm and shoulder.","yes","Documents radiation to the left arm and shoulder."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Documents nausea without vomiting, sweating and shortness of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","Documents heart beating faster during the episode."],["The note captures: This is the first similar episode.","yes","States this is the first episode."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","Documents 10 cigarettes/day for 15 years."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Hypertension and low activity documented but overweight status omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Documents father died of heart attack around 60 and mother's heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","partial","Aspirin allergy and hospital communication noted, but nature (swelling/mild reaction) omitted: \"Aspirin (allergic reaction)\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door advice captured but that the patient is alone is omitted."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","Frames heart attack/ACS as possible and to be excluded, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Documents ambulance arranged urgently."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Pre-hospital ECG noted but not that the hospital/destination decision depends on it."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","Documents clinician staying on the line until ambulance arrival."]],"claims":[],"note":"Subjective\nTim Gowers, a approximately 60-year-old male with a history of hypertension, presents with acute onset chest discomfort with associated nausea, diaphoresis, and shortness of breath.\n\nThe patient reports that while gardening a couple of hours ago, he began experiencing a pressure sensation on his chest, described as \"feels like someone sitting on my chest,\" located in the middle of his chest over his pectoral area. He notes the pain is diffuse and not lateralized to one side. He reports the discomfort radiates down his left arm and into his left shoulder. He was engaged in light activity, kneeling down while gardening, and was not performing any strenuous exercise at the time of onset. He reports associated nausea without vomiting, diaphoresis, and shortness of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He denies having experienced these symptoms before; this is the first episode. He states the symptoms are still present. He does not normally engage in much physical activity. He denies diabetes.\n\nMedical History  \n- Hypertension\n\nAllergies  \n- Aspirin (allergic reaction)\n\nFamily History  \n- Father: Heart attack at age 60, deceased  \n- Mother: Heart problems\n\nSocial History  \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years  \n- Alcohol: 7-8 pints of beer per week  \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n60-year-old male with hypertension and family history of cardiac disease, presenting with acute chest discomfort, pressure sensation, and associated symptoms while gardening.\n\nAcute chest pain  \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the middle of chest over the pectoral area, diffuse in nature, with radiation to left arm and shoulder. Symptoms began while gardening, a non-strenuous activity, and are currently ongoing. Associated symptoms include nausea without vomiting, diaphoresis, and shortness of breath. Patient reports feeling his heart beating faster, though attributes this to stress. This is the first episode of these symptoms. Given the clinical presentation with chest pressure, radiation to left arm, associated autonomic symptoms such as nausea, diaphoresis, and dyspnea, and significant cardiovascular risk factors including hypertension, 15-year smoking history with 10 cigarettes daily, family history of cardiac disease with father dying of heart attack around age 60 and mother having heart problems, the symptoms are highly concerning for acute coronary syndrome. The clinical picture warrants immediate evaluation to rule out myocardial infarction.  \nPlan:  \n- Emergency ambulance transport arranged for immediate evaluation  \n- Pre-hospital ECG to be performed by ambulance team  \n- Patient advised to keep front door open for emergency access  \n- Clinician to remain on line until ambulance arrival to provide support and handover  \n- Hospital team to be informed of aspirin allergy to guide treatment decisions\n","review":204.61842105263156,"saved":131.38157894736844,"clean":false,"effort":13.333333333333334,"sig":[["partial","Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","Allergy severity (mild swelling, non-life-threatening) omitted, which is the detail the hospital needs to decide on giving aspirin despite the allergy."]],"mb":14.228993,"latency":50.174,"signable":242.69442105263155},{"label":"Run 4","wer":24.663677130044842,"text":"and all of that stuff is very different.\n  Hi there, good morning. Hi, good morning. I'm Doctor Dean Mazur from GP at Hand, nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n  Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\n  That's great, thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old, 51 years old, is that correct?\n  Yeah, yeah, around that, yeah, about 60, yeah. Okay, perfect.\n  Alright, so, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So, how can I help you today?\n  Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but like a pressure on my chest, feels like someone sitting on my chest, and I've noticed a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\n  Right, okay. Now, do you have these symptoms right now, or have they gone off now? No, they're still present. Okay, so you've still got the chest discomfort right now? Yes. Okay. We're probably going to have to call an ambulance for you. Okay, so what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Sure. Give a bit more information to the ambulance team when they arrive, okay? Sure. So just to double-check, where exactly in the chest is the pain?\n  It's in the middle of my chest, over my pecs, but not necessarily to one side. It's quite a diffuse pain.\n  Right. Is it spreading anywhere else, like down to your arm, up to your jaw, in your neck, anywhere like that?\n  Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well.\n  Right, okay. Do you remember what you were doing at the time?\n  Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. I wasn't doing any physical exercise. Okay.\n  And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\n  No, I don't. I generally don't do much activity at all.\n Unknown: Yeah.\n  Have you had this before? No, this is the 1st time actually.\n  Right, okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n  Yeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n  Sir, I know you're stressed. We've got an ambulance coming on the way, okay?\n Unknown: Yeah.\n  We'll take care of everything, so don't worry. Is anyone in the house with you at the moment?\n  No, no one's in the house at the moment.\n  Okay. And is your front door open?\n  Yes, it's open.\n  Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you.\n Unknown: Yeah.\n  All right. Are you a smoker at all?\n  Yeah, I smoke a fair bit. I smoke about 10 cigarettes a day.\n  How long have you been smoking for?\n  For the past 15 years.\n  Do you have high blood pressure or high cholesterol or diabetes?\n  Yeah, I have high blood pressure but not diabetes.\n  Have you ever had your cholesterol checked? All right, now in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that?\n  Yes, so my father died of a heart attack and my mother had some heart problems.\n  Okay, I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\n  He was about my age.\n  Right, so just under 6, around 60? Yes, around 60, yes. All right. Do you drink much alcohol?\n  Yeah, I drink about per week, probably about 7 or 8 pints a week.\n  Okay. Is that a beer you're talking about?\n  Oh, yeah. Yes. Okay.\n  I can't tell from the video. Are you overweight?\n  Yes, I'm overweight. Yeah. Right. All right.\n  Now, do you normally live alone?\n  Yeah, I live alone at the moment, yeah, it's just me and the house.\n  Sure, OK, and are you working at the moment?\n  Yeah, yeah, I work, yeah.\n  What do you work as?\n  I work as a restaurant owner, so I own a sushi shop.\n  Right, OK.\n  Yeah.\n  The symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but that's our number one priority to exclude that.\n  Okay.\n  So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay, yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then you'll decide where to take you after that, okay? Okay. Can I just double-check, do you have any allergies to any medication?\n  Yes, actually, I have an allergy to aspirin.\n  Right, okay.\n  Yeah, and no other allergies.\n  What's the nature of that allergy to aspirin? Does it cause you heartburn, or is it like an allergic reaction?\n  Yeah, it's an allergic reaction, so I swallow a bit, but nothing life-threatening. I sometimes even have it, and it's a mild reaction to it.\n  Okay, all right. It's very important that you communicate that to the hospital. detail you've just told me because we may need to consider aspirin despite the allergy. All right, now in terms of what happens from here, that team will assess you and then they may take you into one hospital or another based on how bad, what the ECG looks like and what kind of treatment you might need. What I'm going to do is we'll stay on the line for the time being. Until they come and then once they come then I'll hand over to them. I'll explain what's going on.\n  All right, okay Okay, sure. Okay.\n  Thank you We'll end the conversation now for the purposes yeah, okay.\n  Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye...","marks":[[0,40,"Hi",false],[101,106,"Resor",false],[112,122,".",false],[141,166,"That's the same thing. OK",false],[296,299,"Jim",true],[325,329,"nineteen fifty eight uh",false],[337,340,"eighth",false],[422,422,"um Yeah. Does that",false],[471,473,"fifty one fifty one",false],[500,500,"or",false],[551,555,"Six OK",false],[568,575,"All right.",false],[588,588,"see",false],[644,655,"you are OK",false],[671,671,"Yep.",false],[975,975,"not",false],[1117,1117,"those",false],[1282,1290,"gonna",false],[1344,1352,"gonna",false],[1363,1371,"gonna",false],[1441,1449,"gonna",false],[1480,1484,"OK OK. Mmm",false],[1492,1496,"We're gonna",false],[1526,1526,"to help the",false],[1551,1551,"when they",false],[1583,1595,"just to double check um",false],[1675,1675,"uh yeah my",false],[1688,1688,"not",false],[1795,1797,"into",false],[1814,1818,"the",false],[1838,1846,"anything",false],[1870,1870,"it's um",false],[2177,2182,"during",false],[2206,2211,"Sure OK. And",false],[2298,2303,"",false],[2376,2390,"um you know.",false],[2435,2438,"first",false],[2463,2468,"OK. Can",false],[2574,2574,"Um yeah. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure beginning \"while gardening a couple of hours ago\" during light activity."],["The note captures: Chest discomfort remains present during the consultation.","yes","States \"He states the symptoms are still present\" and \"currently ongoing\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates down his left arm and into his left shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"associated nausea without vomiting, diaphoresis, and shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"heart has been beating faster than usual\" during the episode, attributed to stress."],["The note captures: This is the first similar episode.","yes","\"He denies having experienced these symptoms before.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Current smoker, 10 cigarettes per day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, \"being overweight, and sedentary lifestyle\" listed as risk factors."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father MI ~age 60 deceased and mother heart problems documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy (swelling) recorded and \"Hospital team to be informed of aspirin allergy\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door advice captured, but the note does not state the patient is alone."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"highly concerning for acute coronary syndrome requiring immediate evaluation\" - suspected, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance transport arranged for immediate evaluation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Pre-hospital ECG mentioned, but the destination decision based on ECG findings is omitted."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Clinician to remain on phone line until ambulance arrival\"."]],"claims":[["68-year-old male","Transcript gives born 1958, \"fifty one\" or \"about sixty\"; 68 has no support anywhere."]],"note":"Subjective\nTim Gowers, a 60-year-old male with a history of hypertension, presents with acute onset chest discomfort, nausea, diaphoresis, and shortness of breath.\n\nThe patient reports that while gardening a couple of hours ago, he began experiencing a pressure-like sensation in the middle of his chest, described as \"feels like someone sitting on my chest.\" He notes the pain is diffuse and located over the pectoral area, not isolated to one side. The discomfort radiates down his left arm and into his left shoulder. He was engaged in light activity, kneeling down while gardening, and was not performing any strenuous exercise at the time of onset. He reports associated nausea without vomiting, diaphoresis, and shortness of breath. He notes his heart has been beating faster than usual, which he attributes to stress about the situation. He states the symptoms are still present. He denies having experienced these symptoms before.\n\nThe patient reports he does not do much physical activity normally. He denies diabetes.\n\nMedical History  \n- Hypertension\n\nAllergies  \n- Aspirin (swelling)\n\nFamily History  \n- Father: MI at age 60, deceased  \n- Mother: Heart problems\n\nSocial History  \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years  \n- Alcohol: 7-8 pints of beer per week  \n- Exercise: Reports generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n68-year-old male with hypertension and smoking history, presenting with acute chest discomfort.\n\nAcute chest pain  \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the middle of chest over the pectoral area, associated with nausea, diaphoresis, and shortness of breath. Symptoms began while gardening and are currently ongoing. Pain radiates to the left arm and shoulder. Significant cardiovascular risk factors include hypertension, 15-year smoking history at 10 cigarettes daily, family history of cardiac disease with father dying of heart attack at approximately age 60 and mother having heart problems, being overweight, and sedentary lifestyle. Clinical presentation is highly concerning for acute coronary syndrome requiring immediate evaluation and management.  \nPlan:  \n- Emergency ambulance transport arranged for immediate evaluation  \n- Pre-hospital ECG to be performed by ambulance team  \n- Patient advised to keep front door open for emergency access  \n- Clinician to remain on phone line until ambulance arrival  \n- Hospital team to be informed of aspirin allergy before any medication administration  \n- Consideration of aspirin administration despite allergy may be needed based on clinical situation\n","review":166.78947368421052,"saved":169.21052631578948,"clean":false,"effort":16.666666666666664,"sig":[["fabrication","68-year-old male","Age given as 68 in the assessment conflicts with the ~60 agreed in the consult and with the note's own 60, a wrong demographic identifier."]],"mb":14.235571,"latency":51.329,"signable":205.94347368421052},{"label":"Run 5","wer":24.663677130044842,"text":"and all of that stuff is very different.\n  Hi there, good morning. Hi, good morning. I'm Doctor Dean Mazur from GP at Hand, nice to see you. Nice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\n  Yeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\n  That's great, thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old, 51 years old, is that correct?\n  Yeah, yeah, around that, yeah, about 60, yeah. Okay, perfect.\n  Alright, so, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah. Okay, fantastic. So, how can I help you today?\n  Yeah, I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago, and I felt not exactly a pain, but like a pressure on my chest, feels like someone sitting on my chest, and I've noticed a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\n  Right, okay. Now, do you have these symptoms right now, or have they gone off now? No, they're still present. Okay, so you've still got the chest discomfort right now? Yes. Okay. We're probably going to have to call an ambulance for you. Okay, so what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Sure. Give a bit more information to the ambulance team when they arrive, okay? Sure. So just to double-check, where exactly in the chest is the pain?\n  It's in the middle of my chest, over my pecs, but not necessarily to one side. It's quite a diffuse pain.\n  Right. Is it spreading anywhere else, like down to your arm, up to your jaw, in your neck, anywhere like that?\n  Yeah, it's mainly in my left arm. It's feeling a little bit painful, and in my shoulder as well.\n  Right, okay. Do you remember what you were doing at the time?\n  Yeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and yeah, wasn't running or anything. I wasn't doing any physical exercise. Okay.\n  And how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\n  No, I don't. I generally don't do much activity at all.\n Unknown: Yeah.\n  Have you had this before? No, this is the 1st time actually.\n  Right, okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\n  Yeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n  Sir, I know you're stressed. We've got an ambulance coming on the way, okay?\n Unknown: Yeah.\n  We'll take care of everything, so don't worry. Is anyone in the house with you at the moment?\n  No, no one's in the house at the moment.\n  Okay. And is your front door open?\n  Yes, it's open.\n  Okay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you.\n Unknown: Yeah.\n  All right. Are you a smoker at all?\n  Yeah, I smoke a fair bit. I smoke about 10 cigarettes a day.\n  How long have you been smoking for?\n  For the past 15 years.\n  Do you have high blood pressure or high cholesterol or diabetes?\n  Yeah, I have high blood pressure but not diabetes.\n  Have you ever had your cholesterol checked? All right, now in your wider family, in your family, sorry, in your parents, did either of them have any heart problems or heart attacks or anything like that?\n  Yes, so my father died of a heart attack and my mother had some heart problems.\n  Okay, I'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\n  He was about my age.\n  Right, so just under 6, around 60? Yes, around 60, yes. All right. Do you drink much alcohol?\n  Yeah, I drink about per week, probably about 7 or 8 pints a week.\n  Okay. Is that a beer you're talking about?\n  Oh, yeah. Yes. Okay.\n  I can't tell from the video. Are you overweight?\n  Yes, I'm overweight. Yeah. Right. All right.\n  Now, do you normally live alone?\n  Yeah, I live alone at the moment, yeah, it's just me and the house.\n  Sure, OK, and are you working at the moment?\n  Yeah, yeah, I work, yeah.\n  What do you work as?\n  I work as a restaurant owner, so I own a sushi shop.\n  Right, OK.\n  Yeah.\n  The symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but that's our number one priority to exclude that.\n  Okay.\n  So the ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay, yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then you'll decide where to take you after that, okay? Okay. Can I just double-check, do you have any allergies to any medication?\n  Yes, actually, I have an allergy to aspirin.\n  Right, okay.\n  Yeah, and no other allergies.\n  What's the nature of that allergy to aspirin? Does it cause you heartburn, or is it like an allergic reaction?\n  Yeah, it's an allergic reaction, so I swallow a bit, but nothing life-threatening. I sometimes even have it, and it's a mild reaction to it.\n  Okay, all right. It's very important that you communicate that to the hospital. detail you've just told me because we may need to consider aspirin despite the allergy. All right, now in terms of what happens from here, that team will assess you and then they may take you into one hospital or another based on how bad, what the ECG looks like and what kind of treatment you might need. What I'm going to do is we'll stay on the line for the time being. Until they come and then once they come then I'll hand over to them. I'll explain what's going on.\n  All right, okay Okay, sure. Okay.\n  Thank you We'll end the conversation now for the purposes yeah, okay.\n  Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye...","marks":[[0,40,"Hi",false],[101,106,"Resor",false],[112,122,".",false],[141,166,"That's the same thing. OK",false],[296,299,"Jim",true],[325,329,"nineteen fifty eight uh",false],[337,340,"eighth",false],[422,422,"um Yeah. Does that",false],[471,473,"fifty one fifty one",false],[500,500,"or",false],[551,555,"Six OK",false],[568,575,"All right.",false],[588,588,"see",false],[644,655,"you are OK",false],[671,671,"Yep.",false],[975,975,"not",false],[1117,1117,"those",false],[1282,1290,"gonna",false],[1344,1352,"gonna",false],[1363,1371,"gonna",false],[1441,1449,"gonna",false],[1480,1484,"OK OK. Mmm",false],[1492,1496,"We're gonna",false],[1526,1526,"to help the",false],[1551,1551,"when they",false],[1583,1595,"just to double check um",false],[1675,1675,"uh yeah my",false],[1688,1688,"not",false],[1795,1797,"into",false],[1814,1818,"the",false],[1838,1846,"anything",false],[1870,1870,"it's um",false],[2177,2182,"during",false],[2206,2211,"Sure OK. And",false],[2298,2303,"",false],[2376,2390,"um you know.",false],[2435,2438,"first",false],[2463,2468,"OK. Can",false],[2574,2574,"Um yeah. It's",false],[2622,2629,"'cause",false],[2727,2727,"um and I did",false],[2737,2740,"So",false],[2808,2829,"OK So um",false],[2871,2871,"don't",false],[2879,2888,"Who's",false],[2924,2924,"Yeah. OK thank you. Uh",false],[3040,3040,"we'll",false],[3158,3161,"could",false],[3175,3182,"",false],[3192,3202,"yeah . Alright. Um so um uh",false],[3353,3353,"Fifteen years OK. Um",false],[3419,3419,"or anything Yeah.",false],[3446,3446,"uh blood",false],[3518,3518,"No. OK",true],[3534,3534,"anyone",false],[3549,3555,"in",false],[3860,3864,"he had the",false],[3925,3926,"sixty",false],[3960,3970,"Yeah OK alright. Um",false],[4113,4115,"yeah Ohh.",false],[4221,4231,"OK. Alright. Um uh",false],[4505,4510,"Alright. Um so um the",false],[4668,4674,"we that it's",false],[4783,4791,"gonna",false],[4847,4857,"OK.",false],[4901,4909,"gonna",false],[4955,4955,"OK yeah. Thank you.",false],[4966,4972,"",false],[5010,5021,"OK OK. OK no. And um what what uh",false],[5185,5185,"Sure. Uh",false],[5232,5232,"Do you does it",false],[5339,5346,"swell up um",true],[5366,5383,"life threatening. Um I've",false],[5418,5418,"it's a it's",false],[5531,5537,"you",false],[5612,5621,"OK OK. Ohh OK. Um alright um",false],[5829,5829,"OK Uh huh. Um",false],[5998,6018,"alright OK. OK. OK OK",false],[6071,6078,"after",false],[6098,6111,"that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Pressure on chest beginning \"while gardening a couple of hours ago\", kneeling, not strenuous; middle of chest."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"The symptoms are still present.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates to his left arm and left shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea without vomiting, diaphoresis, and shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"heart has been beating a bit faster than usual\"."],["The note captures: This is the first similar episode.","yes","\"He denies having experienced these symptoms before.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"10 cigarettes per day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, \"being overweight, and sedentary lifestyle\" listed."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father MI ~60 deceased, mother heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","partial","Allergy (swelling) and communication to hospital captured, but plan reframed as \"alternative antiplatelet therapy\" rather than possibly giving aspirin despite allergy."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door advice captured, but patient being alone is not documented."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"highly concerning for acute coronary syndrome requiring immediate evaluation\" - suspected, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance transport arranged for immediate cardiac evaluation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Pre-hospital ECG mentioned but destination decision based on ECG not explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Clinician to remain on call until emergency team arrival\"."]],"claims":[["Aspirin allergy communicated for consideration of alternative antiplatelet therapy if indicated","Transcript says \"we may need to consider aspirin despite allergy\"; alternative antiplatelet therapy was never discussed."]],"note":"Subjective\nTim Gowers, a 60-year-old male with a history of hypertension, presents with acute onset chest discomfort, nausea, diaphoresis, and shortness of breath.\n\nThe patient reports that while gardening a couple of hours ago, he began experiencing a pressure sensation on his chest, described as \"feeling like someone sitting on my chest.\" He was kneeling down at the time and was not engaged in any strenuous physical activity. The chest discomfort is located in the middle of his chest, over the pectoral area, and is diffuse in nature. The discomfort radiates to his left arm and left shoulder. He reports associated nausea without vomiting, diaphoresis, and shortness of breath. The symptoms are still present. His heart has been beating a bit faster than usual, which he attributes to stress about the situation. He denies having experienced these symptoms before.\n\nThe patient reports he does not do much physical activity normally. He denies diabetes. He reports being overweight.\n\nMedical History  \n- Hypertension\n\nAllergies  \n- Aspirin (swelling)\n\nFamily History  \n- Father: MI at age 60, deceased  \n- Mother: Heart problems\n\nSocial History  \n- Tobacco: Current smoker, 10 cigarettes per day for 15 years  \n- Alcohol: 7-8 pints of beer per week  \n- Exercise: Generally not doing much physical activity\n\nObjective\nN/A\n\nAssessment & Plan\n51-year-old male with hypertension and family history of cardiac disease, presenting with acute onset chest pressure, dyspnea, diaphoresis, and nausea while gardening.\n\nAcute chest pain  \nAssessment: Patient presents with acute onset chest discomfort described as pressure sensation in the center of chest, associated with dyspnea, diaphoresis, nausea, and left arm and shoulder pain. Symptoms began while gardening with minimal exertion and are currently ongoing. Patient has multiple cardiac risk factors including hypertension, smoking history of 10 cigarettes daily for 15 years, family history of cardiac disease with father dying of heart attack at similar age and mother having heart problems, being overweight, and sedentary lifestyle. Clinical presentation is highly concerning for acute coronary syndrome requiring immediate evaluation and management.  \nPlan:  \n- Emergency ambulance transport arranged for immediate cardiac evaluation  \n- Pre-hospital ECG to be performed by emergency team  \n- Patient advised to keep front door open for emergency access  \n- Clinician to remain on call until emergency team arrival  \n- Aspirin allergy to be communicated to hospital team for consideration of alternative antiplatelet therapy if indicated\n","review":180.63157894736844,"saved":155.36842105263156,"clean":false,"effort":16.666666666666664,"sig":[["partial","Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","Plan says alternative antiplatelet therapy when the clinician said aspirin may be given despite the mild allergy, which changes the medication plan."]],"mb":14.245076,"latency":51.993,"signable":220.51357894736844}],"cliniscripts":[{"label":"Run 1","wer":16.965620328849027,"text":"Thank you for asking. It's very difficult.\nHi there, good morning. Hi, good morning. Um, I'm Dr.\nDean Merzer from GP at Home. Nice to see you.\nNice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. Um, my name is Dean Gowers. And I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so— Yeah.\nSo that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect. All right. Yeah. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah.\nOkay, fantastic. So, um, how can I help you today? Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago.\nAnd I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest.\nUm, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\nRight, okay. Now, do you have those— these symptoms right now, or have they gone off now?\nUm, no, they're still present. Okay.\nSo you've still got the chest discomfort right now? Yes.\nOkay. Um, we're probably going to have to call an ambulance for you. Okay. To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Yeah, sure. It's going to be a bit more information to the— the ambulance team when they— when they arrive, okay? Um. Sure. So just to— just to double-check, um, where exactly in the chest is the pain?\nUm, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit— um, uh, painful, and— and in my shoulder as well. Right, okay.\nDo you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening.\nSo nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Sure. Okay.\nA-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything? No, I don't.\nI— I generally don't do much activity at all. Okay. Um, yeah.\nHave you had this before?\nNo, this is the first time, actually. Right, okay.\nYeah. Can you— um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nUm, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed.\nUm, about the situation, but I haven't noticed it, um, beating, faster than usual.\nUm, today.\nSo I— I know you're stressed, but we've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't— don't worry. Okay. Thank you for being in the house with you at the moment. Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open? Uh, yes, it's open.\nOkay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit. So I smoke about 10 cigarettes, uh, a day. Um, yeah. Uh, how long have you been smoking for? Uh, for the past 15 years. 15 years. Okay. Um. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\nYeah, I have high blood— uh, blood pressure, but, um, not diabetes.\nOkay. Have you ever had your cholesterol checked? No. Okay. Okay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did. Yes.\nDid either of them have any heart problems or heart attacks or anything like that? Um, yes. So my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack? Um, he was about my age.\nRight. So a— a just under 6, around 60. Yes, around 60, yes. Yeah.\nOkay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week. Okay.\nIs that a— a beer you're talking about?\nOh, beer, yes. Okay. Um, I— I can't tell from the video. Are you overweight? Um, yes, I'm overweight, yeah.\nRight. Yeah. Okay. All right.\nUm, uh, now, um, you're— do you normally live alone? Uh, yeah, I live alone, uh, at the moment, yeah. Uh, it's just me in the house.\nSure. Okay. And— and, uh, are you working at the moment? Yeah, yeah, I— I work, yeah.\nRight. What do you work as? Um, I work as a restaurant owner.\nSo I own a sushi shop. Right, okay. Yeah. All right. Um, so um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay? Okay. So I'm not saying you definitely have a heart attack, but we— that— so our number one priority to exclude that, okay? Okay. So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay? Okay. Yeah. Yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and\ndo an ECG, and then. Okay. They'll decide where to take you after that, okay? Okay, yeah. And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\nYes, actually. I have, um, an allergy to aspirin.\nRight, okay. Yeah, and no other allergies. Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction? Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening.\nUm, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it. Okay. All right.\nYeah. It's very important that you communicate that to the hospital. Uh.\nOkay. That detail you've just told me, because, um, we— we may need to consider aspirin despite. Oh, okay. Allergy, okay? Um. Okay. All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay? Okay. Um, what I'm going to do is we'll stay on the line for the time being.\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure.\nOkay. Yeah, thank you.\nIs it now? We'll— we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Okay, thanks. Bye. Thank you, bye.","marks":[[0,42,"Hi",false],[102,108,"Resor",false],[114,125,".",false],[143,168,"That's the same thing. 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Cholesterol levels are unknown.\n- Patient drinks approximately 7-8 pints of beer per week and is overweight.\n- Family history includes father's death from a heart attack around age 60 and mother's heart problems.\n\nA (Assessment):\n- The patient's described symptoms are indicative of a possible myocardial infarction (heart attack).\n- The primary concern is to exclude acute cardiac event given the chest discomfort, associated symptoms, and significant risk factors.\n- Differential diagnoses include other causes of chest pain, which require further investigation.\n\nP (Plan):\n- An ambulance has been called to transport the patient to the hospital for further assessment and management.\n- The doctor will remain on the line with the patient until the ambulance team arrives.\n- The patient has an allergy to aspirin, which causes mild swelling, and this information needs to be communicated to the hospital team, as aspirin may still be considered despite the allergy.\n- The ambulance team will perform an ECG on arrival to guide further treatment and hospital destination.\n- The doctor will hand over patient details to the ambulance crew upon their arrival.\n","review":113.03947368421053,"saved":222.96052631578948,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":23.343009,"latency":24.412,"signable":123.03747368421054},{"label":"Run 2","wer":17.41405082212257,"text":"Thank you for asking. It's very difficult.\nHi there, good morning. Hi, good morning. Um, I'm Dr.\nDean Merzer from GP at Home. Nice to see you.\nNice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. Um, my name is Tim Gowers. And I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so— Yeah.\nSo that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect. All right. Yeah. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah.\nOkay, fantastic. So, um, how can I help you today? Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago.\nAnd I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest.\nUm, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\nRight, okay. Now, do you have those— these symptoms right now, or have they gone off now?\nUm, no, they're still present. Okay.\nSo you've still got the chest discomfort right now? Yes.\nOkay. Um, we're probably going to have to call an ambulance for you. Okay. To take you to the hospital. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Yeah, sure. It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um. Sure. So just to— just to double-check, um, where exactly in the chest is the pain?\nUm, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side. Okay. I mean, it's quite a diffuse pain. Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit— um, uh, painful and— and in my shoulder as well. Right, okay.\nDo you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening.\nSo nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Sure. Okay.\nA-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything? No, I don't.\nI— I generally don't do much activity at all. Okay. Um, yeah. Have you had this before?\nNo, this is the first time, actually. Right, okay.\nYeah. Okay. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nUm, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed. Um, about the situation, but I haven't noticed it, um, beating faster than usual. Okay. Um, today.\nSo I— I know you're stressed, but we've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't— don't worry. Okay. Thank you for being in the house with you at the moment. Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open? Uh, yes, it's open.\nOkay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit. So I smoke about 10 cigarettes, uh, a day. Um, yeah. Uh, how long have you been smoking for? Uh, for the past 15 years. 15 years. Okay. Um. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\nYeah, I have high blood— uh, blood pressure, but, um, not diabetes.\nOkay. Have you ever had your cholesterol checked? No.\nOkay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did. Yes.\nDid either of them have any heart problems or heart attacks or anything like that? Um, yes. So my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack? Um, he was about my age.\nRight. So a— a just under six— around 16. Yes, around 60, yes. Yeah.\nOkay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about— per week, probably about 7 or 8 pints a week. Okay.\nIs that a— a beer you're talking about?\nA beer, yes. Okay. Um, I— I can't tell from the video. Are you overweight? Um, yes, I'm overweight, yeah.\nRight. Yeah. Okay. All right.\nUm, uh, now, um, you're— do you normally live alone? Uh, yeah, I live alone, uh, at the moment, yeah. Uh, it's just me in the house.\nSure. Okay. A-and, uh, are you working at the moment? Yeah, yeah, I— I work, yeah.\nRight. W-what do you work as? Um, I work as a restaurant owner.\nSo I own a sushi shop. Right, okay. Yeah.\nAll right. Um, so um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay? Okay. So I'm not saying you definitely have a heart attack, but we— that it's our number-one priority to exclude that, okay?\nOkay. Yeah. So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay? Okay. Yeah. Yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then. Okay. They'll decide where to take you after that, okay? Okay, yeah. And, um, what— what, uh, can I just double-check? Do you have, um, any allergies to any medication?\nYes, actually. I have, um, an allergy to aspirin.\nRight, okay. Yeah, and no other allergies. Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction? Yeah, uh, it's an allergic reaction. So I swell up, um, a bit, but, um, nothing life-threatening.\nUm, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it. Okay. All right. Yeah. It's very important that you communicate that to the hospital. Uh.\nOkay. That detail you've just told me, because, um, we— we may need to consider aspirin despite. Oh, okay. Allergy, okay? Um. Okay. All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay? Okay. Um. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. A-until they come, and then, um, once they come, then I'll hand\nover to them. I'll explain what's going on. All right? Okay. Okay, sure.\nOkay. Yeah, thank you.\nIs it now? We— we'll, we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Okay, thanks. Bye. Thank you, bye.","marks":[[0,42,"Hi",false],[102,108,"Resor",false],[114,125,".",false],[143,168,"That's the same thing. 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OK OK",false],[6984,7004,"",false],[7033,7040,"after",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure starting a couple of hours earlier while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","States symptoms are still present/ongoing."],["The note captures: Pain radiates to the left arm and shoulder.","yes","Documents radiation to the left arm and shoulder."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Documents nausea without vomiting, sweating and shortness of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","Documents heart beating faster during the episode."],["The note captures: This is the first similar episode.","yes","States this is the first episode."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","Documents 10 cigarettes/day for 15 years."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Documents hypertension, overweight and low baseline activity."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Documents father died of heart attack around 60 and mother's heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Documents aspirin allergy with mild swelling and need to tell the hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door opened for emergency access noted, but patient being alone omitted."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","Frames heart attack/ACS as possible and to be excluded, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Documents ambulance arranged urgently."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","Documents ambulance ECG and destination/treatment decision based on it."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","Documents clinician staying on the line until ambulance arrival."]],"claims":[],"note":"S (Subjective):\n- The patient, Tim Gowers, born August 8, 1958 (60 years old), reports new onset chest discomfort for the past couple of hours.\n- Symptoms began while gardening and include a pressure sensation on the chest (\"someone's sitting on my chest\"), nausea (no vomiting), sweating, and shortness of breath.\n- The discomfort is located in the middle of the chest, described as diffuse, and radiates to the left arm and shoulder. Symptoms are currently ongoing.\n- They report their heart beating faster, which they attribute to stress; this is the first time experiencing these symptoms.\n- Relevant social history includes smoking 10 cigarettes daily for 15 years, consuming 7-8 pints of beer weekly, being overweight, and generally having low physical activity.\n- Medical history includes high blood pressure; no history of diabetes, and cholesterol has never been checked. Family history is significant for a father who died of a heart attack around age 60 and a mother with heart problems.\n- The patient reports an allergy to aspirin, causing mild, non-life-threatening swelling.\n\nO (Objective):\n- The patient appears stressed during the interaction, reporting their heart beating faster.\n- The patient confirms they are in a private place and has opened their front door for emergency access.\n- No other objective findings were documented from a physical examination or vital signs.\n\nA (Assessment):\n- The patient's reported symptoms are indicative of a possible heart attack.\n- The primary diagnostic priority is to exclude an acute coronary syndrome.\n\nP (Plan):\n- An ambulance has been dispatched to transport the patient to the hospital for further evaluation and management.\n- The doctor will remain on the line with the patient until the emergency medical services arrive.\n- The ambulance team will perform an ECG and assess the patient to determine the appropriate hospital destination and treatment.\n- The patient has been instructed to communicate their aspirin allergy to the hospital staff upon arrival, given the potential need for aspirin despite the allergy.\n- Further investigations and treatment will be decided by the ambulance team and hospital based on clinical assessment and ECG findings.\n","review":123.61842105263158,"saved":212.38157894736844,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":23.334279,"latency":31.515,"signable":137.62542105263157},{"label":"Run 3","wer":16.517189835575486,"text":"Thank you for asking. It's very difficult.\nHi there, good morning. Hi, good morning. Um, I'm Dr.\nDean Mercer from GP at Home. Nice to see you.\nNice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. Um, my name is Dean Gowers. And I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so— Yeah.\nSo that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect. All right. Yeah. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah.\nOkay, fantastic. So, um, how can I help you today? Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago.\nAnd I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest.\nUm, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\nRight, okay. Now, do you have those— these symptoms right now, or have they gone off now?\nUm, no, they're still present. Okay.\nSo you've still got the chest discomfort right now? Yes.\nOkay. Um, we're probably going to have to call an ambulance for you.\nOkay. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Yeah, sure. It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um. Sure. So just to— just to double-check, um, where exactly in the chest is the pain?\nUm, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, and the neck, anything like that? Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit, um, uh, painful and— and in my shoulder as well. Right, okay.\nDo you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening.\nSo nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Sure. Okay.\nA-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything? No, I don't.\nI— I generally don't do much activity at all. Okay. Um, yeah. Have you had this before?\nNo, this is the first time, actually. Right, okay.\nYeah. Okay. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nUm, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed. Um, about the situation, but I haven't noticed it, um, beating faster than usual. Okay. Um, today.\nSo I— I know you're stressed, but we've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't— don't worry. Okay. Thank you for being in the house with you at the moment. Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open? Uh, yes, it's open.\nOkay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah. How— how long have you been smoking for? Uh, for the past 15 years. 15 years. Okay. Um. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\nYeah, I have high blood— uh, blood pressure, but, um, not diabetes.\nOkay. Have you ever had your cholesterol checked? No.\nOkay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did. Yes.\nDid either of them have any heart problems or heart attacks or anything like that? Um, yes, so my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack? Um, he was about my age.\nRight. So a— a just under 6, around 60. Yes, around 60, yes. Yeah.\nOkay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about— per week, probably about 7 or 8 pints a week. Okay.\nIs that a— a beer you're talking about?\nOh, beer, yes. Okay. Um, I— I can't tell from the video. Are you overweight? Um, yes, I'm overweight, yeah.\nRight. Yeah. Okay. All right.\nUm, uh, now, um, you're— do you normally live alone? Uh, yeah, I live alone, uh, at the moment, yeah. Uh, it's just me in the house.\nSure. Okay. And— and, uh, are you working at the moment? Yeah, yeah, I— I work, yeah.\nRight. What do you work as? Um, I work as a restaurant owner.\nSo I own a sushi shop. Right, okay. Yeah. All right. Um, so um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay? Okay. So I'm not saying you definitely have a heart attack, but we— that it's our number one priority to exclude that, okay? Okay. So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay? Okay. Yeah. Yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and\ndo an ECG, and then. Okay. They'll decide where to take you after that, okay? Okay, yeah. And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\nYes, actually. I have, um, an allergy to aspirin.\nRight, okay. Yeah, and no other allergies. Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction? Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening.\nUm, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it. Okay. All right.\nYeah. It's very important that you communicate that to the hospital.\nOkay. Uh, detail you've just told me, because, um, we— we may need to consider aspirin despite. Oh, okay. An allergy, okay? Um. Okay. All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay? Okay. Um, what I'm going to do is we'll stay on the line for the time being.\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them, and I'll explain what's going on. All right? Okay. Okay, sure.\nOkay. Yeah, thank you.\nIs it now? We'll— we'll end the conversation now for the purposes of. Yeah. Is that okay? That's okay. Okay, thank you very much. Oh, thank you. Thanks. Bye. Thank you, bye.","marks":[[0,42,"Hi",false],[102,108,"Resor",false],[114,125,".",false],[143,168,"That's the same thing. 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OK OK",false],[6949,6965,"",false],[6994,7001,"after",false],[7079,7093,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure starting a couple of hours earlier while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","States symptoms are still present/ongoing."],["The note captures: Pain radiates to the left arm and shoulder.","yes","Documents radiation to the left arm and shoulder."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Documents nausea without vomiting, sweating and shortness of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","partial","Muddled: \"Reports increased heart rate due to stress, not noticing it faster than usual today\" partly contradicts the current-episode palpitations."],["The note captures: This is the first similar episode.","yes","States this is the first episode."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history is not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Only general inactivity documented; hypertension and overweight omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history is not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Documents aspirin allergy with mild swelling and need to tell the hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","partial","Front door open for ambulance access noted, but patient being alone omitted."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","Frames heart attack/ACS as possible and to be excluded, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Documents ambulance arranged urgently."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","Documents ambulance ECG and destination/treatment decision based on it."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","Documents clinician staying on the line until ambulance arrival."]],"claims":[],"note":"S (Subjective):\n- Patient, Dean Gowers, born August 8, 1958 (65 years old), presented with chest discomfort that started a couple of hours prior while gardening.\n- Described as a pressure in the middle of their chest, feeling like \"someone's sitting on my chest,\" diffuse, and radiating to the left arm and shoulder.\n- Associated symptoms include nausea (no vomiting), sweating, and shortness of breath. Symptoms are still present.\n- Denies prior similar episodes. Reports increased heart rate due to stress, not noticing it faster than usual today.\n- Reports general inactivity, does not walk or run much.\n\nO (Objective):\n- Patient confirmed full name and date of birth.\n- Patient appeared to be in a private place for the consultation.\n- Patient's front door is open for ambulance access.\n- Patient acknowledged stress regarding the situation.\n\nA (Assessment):\n- Symptoms are indicative of the possibility of a heart attack.\n- Exclusion of acute coronary syndrome is the number one priority.\n\nP (Plan):\n- An ambulance has been called for the patient.\n- The doctor will stay on the line with the patient until the ambulance team arrives.\n- The ambulance team will perform an ECG and decide on the next course of action and hospital transfer.\n- Patient to communicate allergy to aspirin (swelling, mild reaction) to the hospital team, noting aspirin may still be considered despite the allergy.\n","review":154.2763157894737,"saved":181.7236842105263,"clean":false,"effort":23.333333333333332,"sig":[["missing","Smoking approximately ten cigarettes daily for fifteen years.","Smoking 10/day for 15 years is a major cardiac risk factor absent from the note."],["partial","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension (past medical history) and overweight omitted from a suspected-ACS note."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Family history of father dying of MI around 60 and maternal heart disease omitted."]],"mb":23.136117,"latency":21.11,"signable":163.2633157894737},{"label":"Run 4","wer":16.517189835575486,"text":"Thank you for asking. It's very difficult.\nHi there, good morning. Hi, good morning. Um, I'm Dr.\nDean Mercer from GP at Home. Nice to see you.\nNice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. Um, my name is Dean Gowers. And I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so— Yeah.\nSo that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect. All right. Yeah. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah.\nOkay, fantastic. So, um, how can I help you today? Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago.\nAnd I felt not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest.\nUm, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\nRight, okay. Now, do you have those— these symptoms right now, or have they gone off now?\nUm, no, they're still present. Okay.\nSo you've still got the chest discomfort right now? Yes.\nOkay. Um, we're probably going to have to call an ambulance for you.\nOkay. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Yeah, sure. It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um. Sure. So just to— just to double-check, um, where exactly in the chest is the pain?\nUm, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side. Okay. Um, and it's quite a diffuse pain. Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, and the neck, anything like that? Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit— um, uh, painful and— and in my shoulder as well. Right, okay.\nDo you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening.\nSo nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Sure. Okay.\nA-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything? No, I don't.\nI— I generally don't do much activity at all. Okay. Um, yeah. Have you had this before?\nNo, this is the first time, actually. Right, okay.\nYeah. Okay. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nUm, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed. Um, about the situation, but I haven't noticed it, um, beating faster than usual. Okay. Um, today.\nSo I— I know you're stressed, but we've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't— don't worry. Okay. Thank you for being in the house with you at the moment. Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open? Uh, yes, it's open.\nOkay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah. How— how long have you been smoking for? Uh, for the past 15 years. 15 years. Okay. Um. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\nYeah, I have high blood— uh, blood pressure, but, um, not diabetes.\nOkay. Have you ever had your cholesterol checked? No.\nOkay. All right. Um, now, anyone in your wider fam— in your family, sorry, in your parents, did. Yes.\nDid either of them have any heart problems or heart attacks or anything like that? Um, yes, so my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack? Um, he was about my age.\nRight. So a— a just under 6, around 60. Yes, around 60, yes. Yeah.\nOkay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about— per week, probably about 7 or 8 pints a week. Okay.\nIs that a— a beer you're talking about?\nA beer, yes. Okay.\nUm, I— I can't tell from the video. Are you overweight? Um, yes, I'm overweight, yeah.\nRight. Yeah. Okay. All right.\nUm, uh, now, um, you're— do you normally live alone? Uh, yeah, I live alone, uh, at the moment, yeah. Uh, it's just me in the house.\nSure. Okay. And— and, uh, are you working at the moment? Yeah, yeah, I— I work, yeah.\nRight. What do you work as? Um, I work as a restaurant owner, so I own a sushi shop. Right, okay. Yeah.\nAll right. Um, so um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack, okay? Okay. So I'm not saying you definitely have a heart attack, but we— that it's our number-one priority to exclude that, okay?\nOkay. Yeah. So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay? Okay. Okay. Yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG, and then. Okay. They'll decide where to take you after that, okay? Okay. Yeah. And, um, what— what, uh, can I just double-check? Do you have, um, any allergies to any medication?\nYes, actually. I have, um, an allergy to aspirin.\nRight, okay. Yeah, and no other allergies. Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction? Yeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening.\nUm, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it. Okay. All right.\nYeah. It's very important that you communicate that to the hospital. Uh.\nOkay. That detail you've just told me, because, um, we— we may need to consider aspirin despite. Oh, okay. Allergy, okay? Um. Okay. All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need, okay? Okay. Um. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. Uh, until they come, and then, um, once they come, then I'll hand\nover to them. I'll explain what's going on. All right? Okay, okay, sure.\nOkay. Yeah, thank you.\nIs it now? We'll— we'll end the conversation now for the purposes. Yeah. Is that okay? That's okay. Okay, thank you very much. Okay, thanks. Bye. Thank you, bye.","marks":[[0,42,"Hi",false],[102,108,"Resor",false],[114,125,".",false],[143,168,"That's the same thing. 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They deny significant physical activity normally.\n\nO (Objective):\n- The patient's reported age is 60 years old.\n- The patient reports smoking approximately 10 cigarettes per day for the past 15 years.\n- The patient reports a history of high blood pressure but denies diabetes. Cholesterol has not been checked.\n- The patient reports consuming about 7-8 pints of beer per week.\n- The patient states they are overweight and live alone.\n\nA (Assessment):\n- The patient's symptoms are indicative of a possible cardiac event, specifically a heart attack.\n- Differential diagnosis includes acute coronary syndrome given the nature, location, and radiation of chest pain, associated symptoms, and risk factors.\n- Significant family history includes father dying of a heart attack around age 60 and mother having heart problems.\n- Patient reports an allergy to aspirin, causing mild swelling, which is important for treatment consideration.\n\nP (Plan):\n- An ambulance has been called for immediate assessment and transport.\n- The patient is advised to keep the front door open for ambulance access and to wait in the hallway.\n- The doctor will remain on the line with the patient until the ambulance arrives.\n- Ambulance team will perform an ECG and determine the appropriate hospital for transfer.\n- Patient is instructed to communicate their aspirin allergy to the ambulance team and hospital staff, noting the nature of the reaction.\n","review":113.55263157894737,"saved":222.44736842105263,"clean":false,"effort":6.666666666666667,"sig":[],"mb":23.244731,"latency":21.893,"signable":123.52263157894737},{"label":"Run 5","wer":16.89088191330344,"text":"Thank you for asking. It's very difficult.\nHi there, good morning. Hi, good morning. Um, I'm Dr.\nDean Mercer from GP at Home. Nice to see you.\nNice to see you too. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. Um, my name is Dean Gowers. And I was born in 1958, uh, on the 8th of August. That's great. Thank you so much for that. Um, you look a lot younger, so— Yeah.\nSo that, that would make you roughly about 50 years old, 51, 51 years old. Is that— is that correct? Yeah, yeah, around that. Yeah, about 60, yeah. 60. Okay, perfect. All right. Yeah. So, um, nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am, yeah.\nOkay, fantastic. So, um, how can I help you today? Um, yeah, I was— I was having, um, a bit of chest discomfort, so I was doing some gardening, um, a couple of hours ago.\nAnd I felt n-not exactly a pain, but, um, like a— a pressure on my chest, um, feels like someone's sitting on my chest.\nUm, and I've noticed, um, a bit of nausea, not— no vomiting, but, um, I'm pretty sweaty, um, short of breath, and it kind of feels like someone's sitting on my chest.\nRight, okay. Now, do you have those— these symptoms right now, or have they gone off now?\nUm, no, they're still present. Okay.\nSo you've still got the chest discomfort right now? Yes.\nOkay. Um, we're probably going to have to call an ambulance for you.\nOkay. Okay? So what I'm going to do is I'm going to task my colleague next to me to sort that out. While we do that, I'm going to ask you a few more questions, okay? Yeah, sure. It'll be a bit more information to the— the ambulance team when they— when they arrive, okay? Um. Sure. So just to— just to double-check, um, where exactly in the chest is the pain?\nUm, it's in the, uh, middle of my chest. Um, over, uh, yeah, my— my pecs, so, um, yeah, but not— not necessarily to one side. Okay. I mean, it's quite a diffuse pain. Right. I-is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah, it's— it's, um, mainly in my left arm. Uh, it's feeling a little bit— um, uh, painful and— and in my shoulder as well. Right, okay.\nDo you remember what you were doing at the time? Uh, yeah, so it started, uh, just when I was gardening.\nSo nothing that was too strenuous, um, I was just kneeling down and, uh, yeah, wasn't running or anything. It wasn't doing any physical exercise. Sure. Okay.\nA-and how much activity do you do normally? Do you walk a lot, or do you run, or do you go to— do anything? No, I don't.\nI— I generally don't do much activity at all. Okay. Um, yeah. Have you had this before?\nNo, this is the first time, actually. Right, okay.\nYeah. Okay. Um, are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nUm, yeah, it's— it's beating a bit faster now. I think that's because I'm a little bit stressed. Um, about the situation, but I haven't noticed it, um, beating faster than usual. Okay. Um, today.\nSo I— I know you're stressed, but we've got an ambulance coming on the way. Okay? Yeah. So, um, we'll take care of everything. So don't— don't worry. Okay. Thank you for being in the house with you at the moment. Uh, no, no one's in the house at the moment. Okay. Um, and is your front door open? Uh, yes, it's open.\nOkay. So maybe we'll— we'll speak maybe in the hallway to the front door. Have the front door open so that in case, um, people need access, they can— they can access you. Yeah. All right. Yeah. Um, so, um, uh, are you a smoker at all? Uh, yeah, I smoke, um, a fair bit, so I smoke about 10 cigarettes, uh, a day. Um, yeah. Uh, how long have you been smoking for? Uh, for the past 15 years. 15 years. Okay. Um. Yeah. Do you have, um, high blood pressure or high cholesterol or diabetes, anything?\nYeah, I have high blood— uh, blood pressure, but, um, not diabetes.\nOkay. Have you ever had your cholesterol checked? No.\nOkay. All right. Um, now, anyone in your wider family— in your family, sorry, in your parents, did. Yes.\nDid either of them have any heart problems or heart attacks or anything like that? Um, yes, so my, um, father died of a heart attack. Okay. Um, and my mother had some heart problems. Okay. Um, I'm sorry to hear about your father. Can you remember what age roughly he was when he— he had that heart attack? Um, he was about my age.\nRight. So a— a just under 6— around 60. Yes, around 60, yes. Yeah.\nOkay. All right. Um, do you drink much alcohol? Um, yeah, I drink, um, about per week, probably about 7 or 8 pints a week. Okay.\nIs that a— a beer you're talking about?\nA beer, yes. Okay. Um, I— I can't tell from the video. Are you overweight? Um, yes, I'm overweight, yeah.\nRight. Yeah. Okay. All right.\nUm, uh, now, um, you're— do you normally live alone? Uh, yeah, I live alone, uh, at the moment, yeah. Uh, it's just me in the house.\nSure. Okay. And, and, uh, are you working at the moment? Yeah, yeah, I— I work, yeah.\nRight. What do you work as? Um, I work as a restaurant owner.\nSo I own a sushi shop. Right, okay. Yeah. All right. Um, so um, the— the symptoms that you've described to me, um, they indicate the possibility of, um, a heart attack. Okay? Okay. So I'm not saying you definitely have a heart attack, but we— that it's our number one priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay? Okay. Yeah. Yeah, thank you. When they come, what they'll do is they're going to put some stickers on your chest and\ndo an ECG, and then. Okay. They'll decide where to take you after that. Okay? Okay. And, um, what— what, uh, can I just double-check, do you have, um, any allergies to any medication?\nYes, actually. I have, um, an allergy to aspirin.\nRight, okay. Yeah, and no other allergies. Sure. Uh, what's the nature of that allergy to aspirin? Do you— does it— does it cause you heartburn, or is it like a, a allergic reaction?\nYeah, uh, it's an allergic reaction, so I swell up, um, a bit, but, um, nothing life-threatening.\nUm, I've— I sometimes even have it, and it's— it's a— it's a mild reaction to it. Okay. All right.\nYeah. It's very important that you communicate that to the hospital. Uh.\nOkay. As detailed as you've just told me, because, um, we— we may need to consider aspirin despite. Oh, okay. An allergy. Okay? Um. Okay. All right. Um, now, in terms of, um, what happens from here, the ambulance team will assess you, and then they may take you in to one hospital or another based on how bad— what— what the ECG looks like and what kind of treatment you might need. Okay? Okay. Um, what I'm going to do is we'll stay on the line for the time being.\nOkay. Uh, until they come, and then, um, once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay, sure.\nOkay. Yeah, thank you.\nIs it now? We'll— we'll end the conversation now for the purposes of. Yeah. Is that okay? That's okay. Okay, thank you very much. Oh, thank you. Thanks. Bye. Thank you, bye.","marks":[[0,42,"Hi",false],[102,108,"Resor",false],[114,125,".",false],[143,168,"That's the same thing. 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OK OK",false],[6944,6960,"",false],[6989,6996,"after",false],[7074,7088,"",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Captures central chest pressure starting a couple of hours earlier while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","States symptoms are still present/ongoing."],["The note captures: Pain radiates to the left arm and shoulder.","yes","Documents radiation to the left arm and shoulder."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Documents nausea without vomiting, sweating and shortness of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","Documents heart beating faster during the episode."],["The note captures: This is the first similar episode.","yes","States this is the first episode."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","Documents 10 cigarettes/day for 15 years."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Documents hypertension, overweight and low baseline activity."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Documents father died of heart attack around 60 and mother's heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Documents aspirin allergy with mild swelling and need to tell the hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Documents patient alone and front door open for ambulance access."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","Frames heart attack/ACS as possible and to be excluded, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Documents ambulance arranged urgently."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","Documents ambulance ECG and destination/treatment decision based on it."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","Documents clinician staying on the line until ambulance arrival."]],"claims":[],"note":"S (Subjective):\n- Patient, Dean Gowers, born August 8, 1958 (60 years old), reports chest discomfort that started a couple of hours ago while gardening.\n- Symptoms include pressure on the chest, feeling \"someone's sitting on my chest,\" nausea (no vomiting), sweating, and shortness of breath.\n- Symptoms are currently present, described as diffuse pain in the middle of the chest, over the pectorals, and radiating to the left arm and shoulder.\n- Patient denies previous similar episodes and reports no significant physical activity normally.\n- Patient reports feeling heart beating faster now due to stress, but not faster than usual prior to the current situation.\n\nO (Objective):\n- Patient is a known smoker (10 cigarettes/day for 15 years).\n- Patient reports a history of high blood pressure. Cholesterol status is unknown as it has never been checked.\n- Family history is significant for heart problems: father died of a heart attack around age 60, and mother had heart problems.\n- Patient reports drinking 7-8 pints of beer per week and acknowledges being overweight.\n- Patient lives alone and works as a restaurant owner (sushi shop).\n\nA (Assessment):\n- The patient's reported symptoms are indicative of a possible cardiac event, specifically a heart attack.\n- Differential diagnosis includes other causes of chest discomfort.\n- The age, risk factors (smoking, hypertension, overweight, family history), and symptom presentation suggest a high index of suspicion for acute coronary syndrome.\n\nP (Plan):\n- Emergency services (ambulance) have been dispatched for immediate assessment and transport.\n- The doctor will remain on the line with the patient until the ambulance arrives.\n- Patient's front door is open for access by emergency personnel.\n- Patient to communicate allergy to aspirin (swelling, mild reaction) to the hospital team, noting that aspirin may still be considered depending on clinical need.\n- Ambulance team will perform an ECG and determine the appropriate hospital for further management.\n","review":95.6842105263158,"saved":240.31578947368422,"clean":true,"effort":0.0,"sig":[],"mb":23.134455,"latency":24.672,"signable":105.6452105263158}],"lyrebird":[{"label":"Run 1","wer":20.47832585949178,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Meza from GP at Han. Nice to see you. Nice to see you too. Okay. Great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah. Sure. My name is Tim Gowers, and I was born in 19 58 on the eighth of August. That's great. Thank you so much for that. You look a lot younger, so\n\nYeah. So that that would make you roughly about 50 years old, 51 51 years old. Is that is that correct? Yeah. Yeah. Around that. Yeah. That's 60. Yeah. 60. Okay. Perfect. Alright. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes. I am. Yep. Okay. Fantastic. So how can I help you today? Yeah. I was I was having a bit of chest discomfort, so I was doing some gardening a couple of hours\n\nAgo, and I felt not exactly a pain, but, like, a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed, a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kinda feels like someone's sitting on my chest. Right. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're\n\nStill present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you. To take a look. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they when they arrive. Okay? Sure. So just to double check, wearing\n\nExactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So yeah. But not not necessarily to 1 side. Okay. It's quite a diffuse pain. Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah. It's it's mainly my left arm. It's feeling a little bit painful in in in my shoulder as well. Right.\n\nOkay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And how much activity do you do normally? Do you walk a lot, or do you run, or do you do to do anything? No. I don't. I I generally don't do much activity at all. Yeah. Have you had this before? No.\n\nThis is the first time, actually. Right. Okay. Yeah. Are you aware of any palpitations, like your heart beating faster or more prominently than normal? Yeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. In the house with you at\n\nMoment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can they can access you. Yeah. Alright. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about 10 cigarettes a day.\n\nYeah. How long have been smoking for? For the past 15 years. 15 years. Okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes? Yeah. I have high blood blood pressure, but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. Alright. Now anyone in your wider fam in your family, sorry, in your parents, did Yes. Either of them have any heart problems or heart attacks or anything like that?\n\nYes. So my father died of a heart attack, and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack? He was about my age. Right. So just under 6 around 60? Yeah. Around 60. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about 7 or 8 pints.\n\nA week. Okay. Is that a a beer you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah.\n\nWhat do you work as? I work as a restaurant owner. So I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay? So I'm not saying you definitely have a heart attack, but we that it's our number 1 priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the\n\nWith you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then we'll decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause\n\nYour heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital Okay. Detail you've just told me because we we may need to consider aspirin despite the allergy. Okay? Okay. Alright. Now in\n\nIn terms of what happens from here, the team will assess you, and then they may take you into 1 hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line for the time being Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay. Okay. Sure. Okay. Yeah. Thank you.\n\nIs it not? We we'll we'll end the conversation now for the purposes. Yeah. Is that okay? Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[59,63,"Resor",false],[69,79,".",false],[97,123,"That's the same thing. OK",false],[250,253,"Jim",true],[280,285,"nineteen fifty eight uh",false],[387,389,"Does",false],[483,483,"or",false],[516,526,"about sixty",false],[533,542,"Six OK",false],[552,560,"All right.",false],[571,571,"see",false],[627,638,"you are OK",false],[654,654,"Yep.",false],[667,677,"Yeah. 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Thank you.",false],[5039,5044,"",false],[5082,5093,"OK OK. OK no.",false],[5348,5352,"you",false],[5437,5444,"swell up um",true],[5557,5571,"OK all right.",false],[5647,5653,"you",false],[5731,5742,"OK OK. Ohh OK. Um",false],[5960,5971,"OK Uh huh. Um",false],[6196,6215,"",false],[6243,6250,"after",false],[6279,6290,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"acute central chest pressure x 2 hours\"; \"Onset during gardening (minimal exertion)\"."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consultation\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Pain radiating to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), diaphoresis, dyspnoea\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"tachycardic during consult (attributed to stress)\" captures faster heartbeat now."],["The note captures: This is the first similar episode.","yes","\"First episode of this nature\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"current smoker (10 cigarettes/day x 15 years)\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and \"Sedentary lifestyle, no regular physical activity\" all listed."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of myocardial infarction at approximately age 60, mother with cardiac disease\"."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Mild swelling reaction recorded and \"Aspirin allergy communicated as critical information for hospital team\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Notes patient alone and \"advised to remain near open front door for ambulance access\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome\", not stated as confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance dispatched immediately\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","Ambulance ECG documented, but hospital/destination decision based on ECG findings is not explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","States clinician remained on line until arrival, but omits the planned handover to ambulance crew."]],"claims":[["hypertension (on treatment)","Transcript only says \"I have high blood pressure\"; no treatment or medication was discussed."]],"note":"SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 21/09/2026\n\nTime: 2:39 am\n\n\n\n\nSubjective:\n\n66-year-old male presenting with acute central chest pressure x 2 hours\n\nOnset during gardening (minimal exertion)\n\nDescribes sensation as \"someone sitting on chest\"\n\nPain radiating to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, dyspnoea\n\nSymptoms ongoing at time of consultation\n\nDenies palpitations prior to episode, though tachycardic during consult (attributed to stress)\n\nFirst episode of this nature\n\nSedentary lifestyle, no regular physical activity\n\nCardiovascular risk factors: current smoker (10 cigarettes/day x 15 years), alcohol consumption 7-8 pints beer/week, overweight, hypertension (on treatment)\n\nFamily history: father died of myocardial infarction at approximately age 60, mother with cardiac disease\n\nCholesterol never checked\n\nLives alone, works as restaurant owner (sushi shop)\n\nAspirin allergy: mild swelling, non-life-threatening (patient reports occasional use despite reaction)\n\n\n\n\nObjective:\n\nPatient alone at home during consultation\n\nAppeared distressed\n\nVital signs not formally documented during telehealth consultation\n\n\n\n\nAssessment:\n\nSuspected acute coronary syndrome\n\nHigh-risk presentation: central chest pressure with radiation, associated autonomic symptoms, multiple cardiovascular risk factors, strong family history\n\n\n\n\nPlan:\n\nEmergency ambulance dispatched immediately\n\nPatient advised to remain near open front door for ambulance access\n\nECG to be performed by ambulance crew on arrival\n\nHospital transfer for urgent assessment and management\n\nAspirin allergy communicated as critical information for hospital team (mild reaction, may require consideration despite allergy)\n\nClinician remained on line with patient until ambulance arrival\n\nFurther management as per hospital protocol including consideration of acute coronary syndrome pathway\n\n\n\n\nTreating Clinician","review":129.80263157894737,"saved":206.19736842105263,"clean":false,"effort":16.666666666666664,"sig":[["fabrication","hypertension (on treatment)","Treatment for hypertension was never discussed, so the note invents a medication status that affects medicines reconciliation."]],"mb":16.772039,"latency":21.429,"signable":151.23163157894737},{"label":"Run 2","wer":31.913303437967116,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor Dean Meza from GP at hand. Nice to see you. Nice to see you too. Okay. Great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah. Sure. My name is Tim Gowers, and I was born in 19 58 on the eighth of August. That's great. Thank you so much for that. You look a lot younger, so\n\nStill present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you. To take a look. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they when they arrive. Okay? Sure. So just to double check, wearing\n\nExactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So yeah. But not not necessarily to 1 side. Okay. It's quite a diffuse pain. Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah. It's it's mainly my left arm. It's feeling a little bit painful in in in my shoulder as well. Right.\n\nOkay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And how much activity do you do normally? Do you walk a lot, or do you run, or do you do do anything? No. I don't. I I generally don't do much activity at all. Yeah. Have you had this before? No.\n\nThis is the first time, actually. Right. Okay. Yeah. Are you aware of any palpitations, like your heart beating faster or more prominently than normal? Yeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. Can get in the house with you?\n\nMoment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, can they can access you. Yeah. Alright. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about 10 cigarettes a day.\n\nYeah. How long have you been smoking for? For the past 15 years. 15 years. Okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes? Yeah. I have high blood blood pressure, but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. Alright. Now anyone in your wider fam in your family, sorry, in your parents, did Yes. Either of them have any heart problems or heart attacks or anything like that?\n\nYes. So my father died of a heart attack, and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack? He was about my age. Right. So just under 6 around 60? Yes. Around 60. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about 7 or 8 pints.\n\nA week. Okay. Is that a a beer you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Okay. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And are you working at the moment? Yeah. Yeah. I I work. Yeah.\n\nWhat do you work as? I work as a restaurant owner. So I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay? So I'm not saying you definitely have a heart attack, but we that it's our number 1 priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the\n\nWith you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then we'll decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause\n\nYour heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital Okay. Detail you've just told me because we we may need to consider aspirin despite the biology. Okay? Okay. Alright. Now in\n\nIn terms of what happens from here, the team will assess you, and then they may take you into 1 hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line for the time being Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay. Okay. Sure. Okay. Yep. Thank you.\n\nIsoniazid","marks":[[0,0,"Hi",false],[58,62,"Resor",false],[68,79,".",false],[97,123,"That's the same thing. OK",false],[250,253,"Jim",true],[280,285,"nineteen fifty eight uh",false],[379,379,"um Yeah. Does that that would make you roughly about fifty years old fifty one fifty one years old. Is that is that correct or Yeah yeah around that. Yeah about sixty yeah. Six OK perfect. All right. So um nice to see see you this morning. Are you in a private place where you are OK to speak freely Yep. Yes I am. Yeah. OK fantastic So um how can I help you today Um yeah. I was I was having um a bit of chest discomfort. So I was doing some gardening um a couple of hours ago. And I felt not exactly a pain but um like a a pressure on my chest um feels like someone sitting on my chest. Um and I've noticed um a bit of nausea not no vomiting but um I'm pretty sweaty um short of breath and it kind of feels like someone's sitting on my chest. Right OK. Now do you have those these symptoms right now or have they gone off now Um no they're",true],[521,541,"OK.",false],[682,686,"OK OK. Mmm",false],[694,698,"We're gonna",false],[728,728,"to help",false],[813,820,"um where",false],[1036,1038,"into",false],[1067,1070,"your",false],[1416,1421,"during",false],[1445,1456,"Sure OK. And",false],[1546,1548,"",false],[1617,1622,"um you know.",false],[1695,1706,"OK. 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Bye.",true]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","partial","\"Onset during gardening\" and central location captured but the timing (a couple of hours earlier) is omitted."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Currently experiencing ongoing chest discomfort at time of consultation\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to left arm and left shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","no","Nausea, sweating and breathlessness are not documented anywhere in the note."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Tachycardia present, patient attributes to stress\"."],["The note captures: This is the first similar episode.","yes","\"First episode of this nature\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","partial","10/day for 15 years stated correctly but mislabelled as \"15 pack-year\" (actually ~7.5 pack-years)."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and sedentary lifestyle listed as risk factors."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of MI aged ~60; mother with cardiac disease."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Mild swelling reaction and \"to be communicated to hospital team\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Lives alone, currently no one else in house\" and advised to remain near open front door."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible acute coronary syndrome\" with urgent hospital assessment."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance called during consultation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","ECG by ambulance crew captured but the destination decision based on ECG findings is not explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","States \"Clinician remained on video consultation until ambulance arrival\" as completed rather than a plan; intent captured but asserted as done."]],"claims":[["Tachycardia noted on examination","No examination occurred; the patient only self-reported his heart \"beating a bit faster now\"."],["15 pack-year smoking history","Transcript gives ten cigarettes a day for fifteen years, which is about 7.5 pack-years; 15 pack-years is a wrong measurement."]],"note":"SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 22/09/2026\n\nTime: 6:18 am\n\n\n\n\nSubjective:\n\n68-year-old male presenting with central chest pain radiating to left arm and shoulder\n\nOnset during gardening, no strenuous activity at time of onset\n\nFirst episode of this nature\n\nPain described as diffuse, central chest location over pectoral region, not lateralised\n\nRadiation to left arm and left shoulder\n\nTachycardia present, patient attributes to stress regarding current situation\n\nNo palpitations noted prior to presentation\n\nSedentary lifestyle with minimal regular physical activity\n\nCurrently experiencing ongoing chest discomfort at time of consultation\n\n\n\n\nObjective:\n\nPatient appeared stressed during consultation\n\nTachycardia noted on examination\n\nPatient overweight on visual assessment\n\nLives alone, currently no one else in house\n\nFront door accessible for emergency services\n\n\n\n\nAssessment:\n\nPossible acute coronary syndrome\n\nSignificant cardiac risk factors present:\n\n15 pack-year smoking history (10 cigarettes per day for 15 years)\n\nHypertension\n\nOverweight\n\nSedentary lifestyle\n\nStrong family history: father died of myocardial infarction aged approximately 60 years, mother with cardiac disease\n\nAlcohol consumption 7-8 pints beer per week\n\nCholesterol status unknown\n\nAspirin allergy: mild allergic reaction with swelling, non-life-threatening, patient reports occasional use despite reaction\n\n\n\n\nPlan:\n\nEmergency ambulance called during consultation\n\nPatient advised to remain near front door with door open for emergency services access\n\nECG to be performed by ambulance crew on arrival\n\nHospital transfer for urgent assessment and further investigation\n\nAspirin allergy documented and to be communicated to hospital team for consideration of use despite allergy given clinical indication\n\nClinician remained on video consultation until ambulance arrival\n\nHandover to ambulance crew arranged\n\n\n\n\nTreating Clinician\n\nGP at Hand","review":187.2763157894737,"saved":148.7236842105263,"clean":false,"effort":36.666666666666664,"sig":[["partial","Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","Onset about two hours ago is lost; in ongoing suspected ACS the symptom-onset time drives reperfusion decisions."],["missing","Associated nausea without vomiting, sweating and breathlessness.","Nausea, sweating and breathlessness, the key associated ACS features, are entirely absent."],["fabrication","Tachycardia noted on examination","Invents tachycardia on examination when no exam occurred and the patient only self-reported a faster heartbeat."]],"mb":14.125145,"latency":37.016,"signable":224.2923157894737},{"label":"Run 3","wer":20.40358744394619,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Meza from GP at Han. Nice to see you. Nice to see you too. Okay. Great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah. Sure. My name is Tim Gowers, and I was born in 19 58 on the eighth of August. That's great. Thank you so much for that. You look a lot younger, so I'm\n\nYeah. So that that would make you roughly about 50 years old, 51 51 years old. Is that is that correct? Yeah. Yeah. Around that. Yeah. That's 60. Yeah. 60. Okay. Perfect. Alright. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes. I am. Yep. Okay. Fantastic. So how can I help you today? Yeah. I was I was having a bit of chest discomfort, so I was doing some gardening a couple of hours\n\nAgo, and I felt not exactly a pain, but, like, a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed, a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kinda feels like someone's sitting on my chest. Right. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're\n\nStill present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you. To take a look. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they when they arrive. Okay? Sure. So just to double check, wearing\n\nExactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So yeah. But not not necessarily to 1 side. Okay. It's quite a diffuse pain. Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah. It's it's mainly my left arm. It's feeling a little bit painful and and in my shoulder as well. Right.\n\nOkay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And how much activity do you do normally? Do you walk a lot, or do you run, or do you go to do anything? No. I don't. I I generally don't do much activity at all. Yeah. Have you had this before? No.\n\nThis is the first time, actually. Right. Okay. Yeah. Are you aware of any palpitations, like your heart beating faster or more prominently than normal? Yeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. The house with you at\n\nMoment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can they can access you. Yeah. Alright. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about 10 cigarettes a day.\n\nYeah. How long have you been smoking for? For the past 15 years. 15 years. Okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes? Yeah. I have high blood blood pressure, but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. Alright. Now anyone in your wider fam in your family, sorry, in your parents, did Yes. Either of them have any heart problems or heart attacks or anything like that?\n\nYes. So my father died of a heart attack, and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack? He was about my age. Right. So just under 6 around 60? Yeah. Around 60. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about 7 or 8 pints.\n\nA week. Okay. Is that a a beer you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah.\n\nWhat do you work as? I work as a restaurant owner. So I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay? So I'm not saying you definitely have a heart attack, but we that it's our number 1 priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the\n\nWith you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then we'll decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it\n\nYour heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital Okay. Detail you've just told me because we we may need to consider aspirin despite the biology. Okay? Okay. Alright. Now in\n\nIn terms of what happens from here, the team will assess you, and then they may take you into 1 hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line for the time being Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay. Okay. Sure. Okay. Yeah. Thank you.\n\nIs it not? We we'll we'll end the conversation now for the purposes. Yeah. Is that okay? Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[59,63,"Resor",false],[69,79,".",false],[97,123,"That's the same thing. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Central chest pressure x 2 hours, onset during gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consultation\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Pain radiating to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Nausea (no vomiting), diaphoresis, dyspnoea."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Palpitations noted during consult, attributed to stress\"."],["The note captures: This is the first similar episode.","yes","\"First episode of this nature\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"smoker 10 cigarettes/day x 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight, minimal regular physical activity."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of MI around 60; mother with cardiac disease."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy (mild swelling) to be communicated to hospital team."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; advised to remain near open front door."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","no","Assessment states \"Acute coronary syndrome\" as a definite diagnosis rather than a possibility to exclude."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance dispatched during consultation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","ECG by ambulance crew captured, but destination decision based on ECG not described."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","States clinician \"remained on line... until ambulance arrival\" as completed, and omits the planned handover."]],"claims":[["Assessment: Acute coronary syndrome","Transcript explicitly says \"I'm not saying you definitely have a heart attack\"; diagnosis stated as definite."]],"note":"SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 22/09/2026\n\nTime: 4:35 pm\n\n\n\n\nSubjective:\n\n68-year-old male presenting with acute central chest pressure x 2 hours\n\nOnset during gardening (non-strenuous activity, kneeling)\n\nDescribes sensation as \"someone sitting on chest\"\n\nPain radiating to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, dyspnoea\n\nSymptoms ongoing at time of consultation\n\nPalpitations noted during consult, attributed to stress\n\nFirst episode of this nature\n\nMinimal regular physical activity\n\nRisk factors: smoker 10 cigarettes/day x 15 years, hypertension, overweight, alcohol consumption 7-8 pints beer/week\n\nFamily history: father died of MI around age 60, mother with cardiac disease\n\nLives alone, works as restaurant owner\n\nAllergy: aspirin (mild swelling, non-life-threatening)\n\n\n\n\nObjective:\n\nPatient appeared distressed\n\nSymptoms present during consultation\n\nVital signs not formally documented\n\n\n\n\nAssessment:\n\nAcute coronary syndrome\n\n\n\n\nPlan:\n\nEmergency ambulance dispatched during consultation\n\nECG to be performed by ambulance crew on arrival\n\nHospital transfer arranged for urgent assessment and management\n\nAspirin allergy documented and to be communicated to hospital team for consideration of use despite allergy\n\nPatient advised to remain near front door with door open for ambulance access\n\nClinician remained on line with patient until ambulance arrival","review":144.1184210526316,"saved":191.8815789473684,"clean":false,"effort":20.0,"sig":[["missing","Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","Records ACS as a confirmed diagnosis when the clinician explicitly said it was only suspected."]],"mb":16.537867,"latency":19.39,"signable":163.5084210526316},{"label":"Run 4","wer":20.47832585949178,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Meza from GP at Han. Nice to see you. Nice to see you too. Okay. Great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah. Sure. My name is Tim Gowers, and I was born in 19 58 on the eighth of August. That's great. Thank you so much for that. You look a lot younger, so\n\nYeah. So that that would make you roughly about 50 years old, 51 51 years old. Is that is that correct? Yeah. Yeah. Around that. Yeah. That's 60. Yeah. 60. Okay. Perfect. Alright. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes. I am. Yep. Okay. Fantastic. So how can I help you today? Yeah. I was I was having a bit of chest discomfort, so I was doing some gardening a couple of hours\n\nAgo, and I felt not exactly a pain, but, like, a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed, a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kinda feels like someone's sitting on my chest. Right. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're\n\nStill present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you. To take a look. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they when they arrive. Okay? Sure. So just to double check, wearing\n\nExactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So yeah. But not not necessarily to 1 side. Okay. It's quite a diffuse pain. Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah. It's it's mainly my left arm. It's feeling a little bit painful in in in my shoulder as well. Right.\n\nOkay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And how much activity do you do normally? Do you walk a lot, or do you run, or do you do to do anything? No. I don't. I I generally don't do much activity at all. Yeah. Have you had this before? No.\n\nThis is the first time, actually. Right. Okay. Yeah. Are you aware of any palpitations, like your heart beating faster or more prominently than normal? Yeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. In the house with you at\n\nMoment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can they can access you. Yeah. Alright. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about 10 cigarettes a day.\n\nYeah. How long have you been smoking for? For the past 15 years. 15 years. Okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes? Yeah. I have high blood blood pressure, but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. Alright. Now anyone in your wider fam in your family, sorry, in your parents, did Yes. Either of them have any heart problems or heart attacks or anything like that?\n\nYes. So my father died of a heart attack, and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack? He was about my age. Right. So just under 6 around 60? Yeah. Around 60. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about 7 or 8 pints.\n\nA week. Okay. Is that a a beer you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah.\n\nWhat do you work as? I work as a restaurant owner. So I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay? So I'm not saying you definitely have a heart attack, but we that it's our number 1 priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the\n\nWith you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then we'll decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause\n\nYour heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital Okay. Detail you've just told me because we we may need to consider aspirin despite the allergy. Okay? Okay. Alright. Now in\n\nIn terms of what happens from here, the team will assess you, and then they may take you into 1 hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line for the time being Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay. Okay. Sure. Okay. Yep. Thank you.\n\nIs it not? We we'll we'll end the conversation now for the purposes. Yeah. Is that okay? Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[59,63,"Resor",false],[69,79,".",false],[97,123,"That's the same thing. OK",false],[250,253,"Jim",true],[280,285,"nineteen fifty eight uh",false],[387,389,"Does",false],[483,483,"or",false],[516,526,"about sixty",false],[533,542,"Six OK",false],[552,560,"All right.",false],[571,571,"see",false],[627,638,"you are OK",false],[654,654,"Yep.",false],[667,677,"Yeah. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"acute central chest pressure x 2 hours\", onset during gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consultation\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Pain radiating to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), diaphoresis, dyspnoea\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Palpitations noted during consult (patient attributes to stress)\"."],["The note captures: This is the first similar episode.","yes","\"First episode of this nature\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Current smoker: 10 cigarettes/day x 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and sedentary lifestyle listed as risk factors."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of MI around age 60, mother with cardiac disease\"."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Aspirin: mild swelling reaction (non-life-threatening...)\" and allergy to be communicated to ambulance/hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Lives alone\"; \"advised to remain near front door (door left open for paramedic access)\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome\", not presented as confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance dispatched during consultation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","\"ECG to be performed by paramedics\" captured, but hospital transfer is stated as definite rather than a destination decision based on the ECG."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","no","No mention that the clinician will stay on the line until the ambulance arrives and hand over."]],"claims":[["Hypertension (on treatment)","Patient only said \"I have high blood pressure\"; no treatment or medication for it is mentioned anywhere."]],"note":"SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 22/09/2026\n\nTime: 8:24 pm\n\n\n\n\nSubjective:\n\n68-year-old male presenting with acute central chest pressure x 2 hours\n\nOnset during gardening (non-strenuous activity, kneeling)\n\nDescribes sensation as \"someone sitting on chest\"\n\nPain radiating to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, dyspnoea\n\nSymptoms ongoing at time of consultation\n\nPalpitations noted during consult (patient attributes to stress)\n\nFirst episode of this nature\n\nMinimal regular physical activity\n\nLives alone, currently no one else in house\n\nOccupation: restaurant owner (sushi shop)\n\n\n\n\nObjective:\n\nPatient appeared distressed\n\nVital signs not formally documented during telehealth consultation\n\nPatient reported tachycardia during consultation\n\n\n\n\nAssessment:\n\nSuspected acute coronary syndrome\n\nHigh-risk features: central chest pressure radiating to left arm, associated autonomic symptoms, positive family history, multiple cardiovascular risk factors\n\n\n\n\nRisk Factors:\n\nCurrent smoker: 10 cigarettes/day x 15 years\n\nHypertension (on treatment)\n\nOverweight\n\nCholesterol never checked\n\nSedentary lifestyle\n\nAlcohol consumption: 7-8 pints beer/week\n\nStrong family history: father died of MI around age 60, mother with cardiac disease\n\n\n\n\nPast Medical History:\n\nHypertension\n\nOverweight\n\n\n\n\nAllergies:\n\nAspirin: mild swelling reaction (non-life-threatening, patient reports sometimes still takes it)\n\n\n\n\nPlan:\n\nEmergency ambulance dispatched during consultation\n\nPatient advised to remain near front door (door left open for paramedic access)\n\nECG to be performed by paramedics on arrival\n\nHospital transfer for urgent assessment and management\n\nAspirin allergy communicated to ambulance/hospital team for consideration of use despite allergy given clinical indication\n\nFurther management as per hospital protocol including consideration of acute coronary syndrome pathway\n\n\n\n\nTreating Clinician","review":145.43421052631578,"saved":190.56578947368422,"clean":false,"effort":20.0,"sig":[["fabrication","Hypertension (on treatment)","Invents antihypertensive treatment; a medication history that does not exist could mislead ED medication reconciliation."]],"mb":16.520099,"latency":18.252,"signable":163.6862105263158},{"label":"Run 5","wer":20.553064275037368,"text":"Hi there. Good morning. Hi. Good morning. I'm Doctor. Dean Meza from GP at Han. Nice to see you. Nice to see you too. Okay. Great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah. Sure. My name is Tim Gowers, and I was born in 19 58 on the eighth of August. That's great. Thank you so much for that. You look a lot younger, so\n\nYeah. So that that would make you roughly about 50 years old, 51 51 years old. Is that is that correct? Yeah. Yeah. Around that. Yeah. That's 60. Yeah. 60. Okay. Perfect. Alright. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes. I am. Yep. Okay. Fantastic. So how can I help you today? Yeah. I was I was having a bit of chest discomfort, so I was doing some gardening a couple of hours\n\nAgo, and I felt not exactly a pain, but, like, a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed, a bit of nausea. No vomiting, but I'm pretty sweaty, short of breath, and it kinda feels like someone's sitting on my chest. Right. Okay. Now do you have those these symptoms right now, or have they gone off now? No. They're\n\nStill present. Okay. So you've still got the chest discomfort right now? Yes. Okay. We're probably gonna have to call an ambulance for you. To take a look. Okay? So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they when they arrive. Okay? Sure. So just to double check, wearing\n\nExactly in the chest is the pain? It's in the middle of my chest over, yeah, my my pecs. So yeah. But not not necessarily to 1 side. Okay. It's quite a diffuse pain. Right. Is it spreading anywhere else, like down to your arm, up to the jaw, in the neck, anything like that? Yeah. It's it's mainly my left arm. It's feeling a little bit painful in in in my shoulder as well. Right.\n\nOkay. Do you remember what you were doing at the time? Yeah. So it started just when I was gardening. So nothing that was too strenuous. I was just kneeling down and, yeah, wasn't running or anything. It wasn't doing any physical exercise. Cool. Okay. And how much activity do you do normally? Do you walk a lot, or do you run, or do you do to do anything? No. I don't. I I generally don't do much activity at all. Yeah. Have you had this before? No.\n\nThis is the first time, actually. Right. Okay. Yeah. Are you aware of any palpitations, like your heart beating faster or more prominently than normal? Yeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today. So I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. The house with you at\n\nMoment? No. No one's in the house at the moment. Okay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can they can access you. Yeah. Alright. So are you a smoker at all? Yeah. I smoke a fair bit. So I smoke about 10 cigarettes a day.\n\nYeah. How long have you been smoking for? For the past 15 years. 15 years. Okay. Yeah. Do you have high blood pressure or high cholesterol or diabetes? Yeah. I have high blood blood pressure, but not diabetes. Okay. Have you ever had your cholesterol checked? No. Okay. Alright. Now anyone in your wider fam in your family, sorry, in your parents, did Yes. Either of them have any heart problems or heart attacks or anything like that?\n\nYes. So my father died of a heart attack, and my mother had some heart problems. Okay. I'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack? He was about my age. Right. So just under 6 around 60? Yeah. Around 60. Yes. Okay. Alright. Do you drink much alcohol? Yeah. I drink about per week, probably about 7 or 8 pints.\n\nA week. Okay. Is that a a beer you're talking about? Oh, yeah. Yes. Okay. I I can't tell from the video. Are you overweight? Yes. I'm overweight. Yeah. Right. Yeah. Alright. Now you're do you normally live alone? Yeah. I live alone at the moment. Yeah. It's just me in the house. Sure. Okay. And and are you working at the moment? Yeah. Yeah. I I work. Yeah.\n\nWhat do you work as? I work as a restaurant owner. So I own a sushi shop. Right. Okay. Yeah. Alright. So the the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay? So I'm not saying you definitely have a heart attack, but we that it's our number 1 priority to exclude that. Okay? Okay. So ambulance team will be with you very shortly. I'm gonna stay on the\n\nWith you until they come. Okay? Okay. Yeah. Thank you. When they come, what they'll do is they're gonna put some stickers on your chest and do an ECG, and then we'll decide where to take you after that. Okay? Okay. And what what can I just double check? Do you have any allergies to any medication? Yes. Actually, I have an allergy to aspirin. Right. Okay. Yeah. And no other allergies. Sure. What's the nature of that allergy to aspirin? Do you does it does it cause\n\nYour heartburn, or is it like a allergic reaction? Yeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it. Okay. Alright. It's very important that you communicate that to the hospital Okay. Detail you've just told me because we we may need to consider aspirin despite the biology. Okay? Okay. Alright. Now in\n\nIn terms of what happens from here, the team will assess you, and then they may take you into 1 hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line for the time being Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay. Okay. Sure. Okay. Yep. Thank you.\n\nIs it not? We we'll we'll end the conversation now for the purposes. Yeah. Is that okay? Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[59,63,"Resor",false],[69,79,".",false],[97,123,"That's the same thing. OK",false],[250,253,"Jim",true],[280,285,"nineteen fifty eight uh",false],[387,389,"Does",false],[483,483,"or",false],[516,526,"about sixty",false],[533,542,"Six OK",false],[552,560,"All right.",false],[571,571,"see",false],[627,638,"you are OK",false],[654,654,"Yep.",false],[667,677,"Yeah. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset 2 hours prior to consultation whilst gardening (minimal exertion)\", central pressure sensation."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consultation\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiating to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), diaphoresis, dyspnoea\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"Patient noted tachycardia, attributed to stress regarding situation\"."],["The note captures: This is the first similar episode.","yes","\"No prior episodes of similar symptoms\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"10 cigarettes/day x 15 years\" is stated, though mislabelled as 15 pack-years."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Risk factors list hypertension, overweight and sedentary lifestyle."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father deceased from MI at approximately age 60, mother with cardiac disease\"."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"mild allergic reaction (swelling)\" and \"Allergy information to be communicated to hospital team\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Patient alone at home\" and \"advised to remain near front door with door open for paramedic access\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Acute coronary syndrome (suspected)\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Emergency ambulance dispatched during consultation\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"ECG to be performed by paramedics\" and \"Disposition dependent on ECG findings\"."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","\"Clinician remained on line with patient until paramedic arrival\" is framed as completed and omits the planned handover."]],"claims":[["15 pack-year smoking history","Transcript gives 10 cigarettes/day for 15 years, which is about 7.5 pack-years; 15 pack-years is a wrong measurement."]],"note":"SOAP Notes\n\n\n\n\nPatient: Tim Gowers\n\nDate of Birth: 08/08/1958\n\nDate of Consultation: 22/09/2026\n\nTime: 6:55 pm\n\n\n\n\nSubjective:\n\n68-year-old male presenting with acute central chest discomfort\n\nOnset 2 hours prior to consultation whilst gardening (minimal exertion)\n\nDescribed as pressure sensation, diffuse, non-localised to either side\n\nRadiating to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, dyspnoea\n\nSymptoms ongoing at time of consultation\n\nPatient noted tachycardia, attributed to stress regarding situation\n\nNo prior episodes of similar symptoms\n\nSedentary lifestyle with minimal regular physical activity\n\nNo palpitations noted prior to onset\n\n\n\n\nObjective:\n\nPatient appeared distressed\n\nSymptoms present during consultation\n\nTachycardia noted by patient\n\nPatient alone at home at time of consultation\n\n\n\n\nAssessment:\n\nAcute coronary syndrome (suspected)\n\nRisk factors: 68-year-old male, 15 pack-year smoking history (10 cigarettes/day x 15 years), hypertension, overweight, sedentary lifestyle, significant family history (father deceased from MI at approximately age 60, mother with cardiac disease), alcohol consumption 7-8 pints beer/week\n\nCholesterol status unknown\n\nNo diabetes\n\n\n\n\nPlan:\n\nEmergency ambulance dispatched during consultation\n\nPatient advised to remain near front door with door open for paramedic access\n\nECG to be performed by paramedics on arrival\n\nHospital transfer arranged for further assessment and management\n\nAspirin allergy documented: mild allergic reaction (swelling), not life-threatening, patient occasionally tolerates despite reaction\n\nAllergy information to be communicated to hospital team for consideration of aspirin use despite allergy\n\nDisposition dependent on ECG findings and clinical assessment by paramedics\n\nClinician remained on line with patient until paramedic arrival\n\n\n\n\nTreating Clinician","review":113.15789473684211,"saved":222.8421052631579,"clean":false,"effort":13.333333333333334,"sig":[],"mb":16.681611,"latency":21.517,"signable":134.6748947368421}],"preve":[{"label":"Run 1","wer":20.92675635276532,"text":"Hi there. Good morning.\n\nHi. Good morning.\n\nI'm doctor Dean Meza from GP at Han. Nice to see you.\n\nNice to\n\nsee you.\n\nOkay. Great. So before we start your appointment,\n\ncould you please confirm your full name and date of birth?\n\nYeah. Sure. My name is\n\nTim Gowers, and I was born in 1958.\n\nOn the August 8.\n\nThat's great. Thank you so much for that.\n\nYou look a lot younger. So\n\nYeah.\n\nSo that that would make you roughly about 50 years old, fifty one one years old. Is that is that correct?\n\nYeah. Yeah. Around that. Yeah. That's 60. Yeah.\n\n60. Okay. Perfect.\n\nAlright. Yep. So nice to see you this morning.\n\nYou in a private place where you're okay to speak freely?\n\nYes. I am.\n\nYep. Okay. Fantastic. So how can I help you today?\n\nYeah. I was I was having a bit of\n\nchest discomfort, so I was doing some gardening\n\na couple of hours ago, and I felt\n\nnot exactly a pain, but, like, a a pressure on my chest.\n\nFeels like someone's sitting on my chest. And I've noticed\n\na bit of nausea, not no vomiting, but\n\nI'm pretty sweaty, short of breath,\n\nit kinda feels like someone's sitting on my chest.\n\nRight. Okay.\n\nNow do you have these these symptoms right now, or have they gone off now?\n\nNo. They're still present.\n\nOkay. So you've still got the chest discomfort right now?\n\nYes. Okay.\n\nWe're probably gonna have to call an ambulance for you.\n\nOkay.\n\nOkay? So what I'm gonna do is I'm gonna task my colleague next to me to\n\nsort that out. While we do that, I'm gonna ask you a few more\n\nquestions. Okay? Sure. Give a bit more information to the\n\nthe ambulance team when they when they arrive. Okay? Sure.\n\nSo just to just to double check, where exactly in the chest is the pain?\n\nIt's in the middle of my chest.\n\nOver, yeah, my my pecs. So\n\nyeah. But not not necessarily to one side.\n\nI mean, it's quite a diffuse pain.\n\nRight. Is it spreading anywhere else, like down to your arm\n\nup to the jaw, the neck, anything like that?\n\nYeah. It's it's mainly my left\n\narm. It's feeling a little bit painful.\n\nAnd and in my shoulder as well.\n\nRight. Okay.\n\nDo you remember what you were doing at the time?\n\nYeah. So it started\n\njust when I was gardening, so nothing that was too strenuous\n\nI was just kneeling down and\n\nyeah, wasn't running or anything. It wasn't during any physical exercise.\n\nCool. Okay.\n\nAnd how much activity do you do normally? Do you walk a lot, or do you run, or do you go to\n\nanything?\n\nI don't I I generally don't do much activity at all.\n\nYeah.\n\nHave you had this before?\n\nNo. This is the first time, actually.\n\nRight. Okay.\n\nCan\n\nare you aware of any palpitations that you're\n\nheart beating faster or more prominently than normal?\n\nYeah. It's it's beating a bit\n\nfaster now. I think that's because I'm a little bit stressed about the\n\nsituation, but I haven't noticed it beating faster than usual.\n\nToday.\n\nSo I know you're stressed,\n\nWe've got an ambulance coming on the way. Okay? Yeah. So\n\nwe'll take care of everything. So don't don't worry. We're getting in the house with you at the moment.\n\nNo. No one's in the house at the moment.\n\nOkay.\n\nAnd is your front door open?\n\nYes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front\n\nfront door. Have the front door open so that in case people need access, they could they can access you.\n\nYeah.\n\nAlright. So are you a smoker at all?\n\nYeah. I smoke a fair bit, so I smoke\n\nabout 10 cigarettes a\n\nday.\n\nYeah.\n\nHow long have been smoking for?\n\nFor the past\n\nfifteen years.\n\nFifteen years. Okay. Yeah. Do you have\n\nhigh blood pressure or high cholesterol or diabetes?\n\nYeah. I have high blood blood pressure, but not diabetes.\n\nOkay.\n\nHave you ever had your cholesterol\n\nchecked? No.\n\nOkay. Alright. Now anyone in your wider fam in your family, sorry, in your\n\nparents, did Yes. Did either of them have any heart problems or heart\n\nattacks or anything like that?\n\nYes. So my father died of a heart attack.\n\nAnd my mother had some heart problems.\n\nOkay.\n\nI'm sorry to hear about your father. Can you remember what age roughly he was when he he had that heart attack?\n\nHe was about my age.\n\nRight. So just under six around 60?\n\nYes. Around 60. Yes. Okay.\n\nAlright. Do you drink much alcohol?\n\nYeah. I drink\n\nabout per week, probably about seven or eight pints a week.\n\nOkay. Is that a a beer you're talking about? Oh, yeah.\n\nYes. Okay.\n\nI I can't tell from the video. Are you overweight?\n\nYes. I'm overweight. Yeah. Right.\n\nYep. Alright.\n\nNow you're do you normally live alone?\n\nYeah. I live alone at the moment. Yeah.\n\nIt's just me in the house.\n\nSure. Okay. And and are you working at the moment?\n\nYeah. Yeah. I I work. Yeah.\n\nWhat do you work\n\nas?\n\nI work as a restaurant owner. So I own a sushi shop.\n\nRight.\n\nOkay. Yeah.\n\nAlright.\n\nSo the the symptoms that you've described to me\n\nthey indicate the possibility of\n\na heart attack.\n\nOkay? Okay.\n\nSo\n\nI'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\nOkay?\n\nOkay. So\n\nambulance team will be with you very shortly. I'm gonna stay on the line with you. I\n\nuntil they come. Okay? Okay. Well, thank you. When they come,\n\nwhat they'll do is they're gonna put some stickers on your chest and do an ECG.\n\nAnd then Okay. Find where to take you after that.\n\nOkay?\n\nOkay.\n\nAnd what what\n\njust double check? Do you have any allergies to any medication?\n\nYes. Actually, I have an allergy to aspirin.\n\nRight. Okay.\n\nYeah. And no other allergies.\n\nSure. What's the nature of that allergy to aspirin? Do you does it\n\ndoes it cause you heartburn, or is it like a a allergic reaction?\n\nYeah. It's an allergic reaction, so I swallow.\n\nA bit, but nothing life threatening.\n\nI've I sometimes even have it, and it's it's a it's a mild reaction to it.\n\nOkay. Alright. It's very important that you communicate that\n\nto the hospital Okay. Detail you've just told me because\n\nwe we may need to consider aspirin despite the Oh, okay.\n\nOkay. Alright. Now in terms of what happens from here,\n\nthe team will assess you, and then they may take you into\n\none hospital or another based on how bad\n\nwhat the ECG looks like and what kind of treatment you might need. Okay?\n\nOkay.\n\nWhat I'm going to do is we'll stay on the line for the time being.\n\nOkay.\n\nUntil they come, and then\n\nonce they come, then I'll hand over to them. I'll explain what's going on. Alright?\n\nOkay.\n\nOkay. Sure.\n\nOkay.\n\nYep. Thank you.\n\nThat we we'll we'll end the conversation now for the purposes? Yeah.\n\nIs that okay?\n\nOkay. Thank you very much.\n\nOkay. Thanks. Bye.\n\nThank you. Bye.","marks":[[0,0,"Hi",false],[60,64,"Resor",false],[70,80,".",false],[99,123,"That's the same thing. OK",false],[253,256,"Jim",true],[283,288,"nineteen fifty eight uh",false],[296,296,"eighth of",false],[304,306,"",false],[386,388,"Does",false],[451,451,"fifty",false],[490,490,"or",false],[524,534,"about sixty",false],[542,551,"Six OK",false],[562,575,"All right.",false],[586,586,"see",false],[639,650,"you are OK",false],[666,666,"Yep.",false],[681,691,"Yeah. OK",false],[921,930,"someone",false],[1049,1054,"kind of",false],[1128,1133,"those",false],[1498,1502,"OK OK. Mmm",false],[1510,1514,"We're gonna",false],[1544,1544,"to help",false],[1785,1791,"um and",false],[1869,1871,"into",false],[1897,1900,"in your",false],[2286,2297,"Sure OK. And",false],[2385,2390,"do",false],[2400,2400,"No",false],[2457,2462,"um you know.",false],[2583,2594,"like your",false],[2709,2716,"'cause",false],[2816,2816,"um and I did",false],[2965,2978,"Who's",false],[3015,3015,"Yeah. OK thank you. Uh",false],[3173,3178,"",false],[3264,3272,"",false],[3291,3291,"yeah .",false],[3559,3559,"or anything Yeah.",false],[3678,3692,"OK all right. Um",false],[3718,3721,"in",false],[3763,3771,"",false],[4032,4032,"had",false],[4103,4106,"sixty",false],[4305,4307,"yeah Ohh.",false],[4415,4419,"OK.",false],[4434,4440,"um you",false],[5075,5103,"OK yeah. OK.",false],[5200,5200,"OK yeah. Thank you.",false],[5211,5221,"decide",false],[5253,5265,"OK OK. OK no.",false],[5280,5280,"uh can I",false],[5611,5619,"swell up um",true],[5735,5749,"OK all right.",false],[5826,5832,"you",false],[5898,5918,"allergy OK OK. Ohh OK. Um",true],[6137,6149,"OK Uh huh. Um",false],[6358,6369,"OK. Yeah",false],[6382,6395,"",false],[6423,6430,"after",false],[6460,6472,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset a couple of hours ago while gardening\"; \"Central chest pressure\"."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Ongoing at time of call\"; \"Current symptoms present: Yes\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates to left arm/shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"Nausea (no vomiting), diaphoresis, shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"feeling heart beating a bit faster due to stress\"."],["The note captures: This is the first similar episode.","yes","\"Previous episodes: First episode\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"~10 cigarettes/day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and low activity level all documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"Father died of MI ~age 60; mother had heart problems\"."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Swelling, mild allergy recorded and \"Advised to communicate aspirin allergy details to hospital\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Alone; front door open for access\" and advised to \"keep door open\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome/possible myocardial infarction\"; \"need to exclude heart attack\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Immediate ambulance assessment\"; ambulance arranged."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"Planned ECG by ambulance\"; \"Hospital conveyance as indicated by ECG/clinical status\"."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"remain on line\" and \"GP to hand over details to ambulance team upon arrival\"."]],"claims":[],"note":"Presenting Condition\n\nHx: Onset a couple of hours ago while gardening (kneeling, not strenuous)\n\nPain: Central chest pressure “someone sitting on chest”; diffuse, not one-sided\n\nNeuro signs: None mentioned\n\nReasons for visit: Acute chest discomfort with associated symptoms\n\nLocation: Mid chest over pectoral area\n\nSeverity context: Ongoing at time of call\n\nAssociated sx: Nausea (no vomiting), diaphoresis, shortness of breath, left arm and shoulder pain, feeling heart beating a bit faster due to stress\n\nAggravating/easing: Occurred during light activity; no easing reported\n\nPrevious episodes: First episode\n\nImpact: Emergency assistance required (ambulance arranged)\n\nProgression: Persisting since onset\n\n\n\n\nRadiology\n\nPlanned ECG by ambulance on arrival\n\n\n\n\nPast Medical History\n\nHypertension\n\nAllergy: Aspirin causes swelling (allergic reaction); mild, not life‑threatening per patient\n\n\n\n\nMedications\n\nNot discussed\n\n\n\n\nRed Flag/Screening Questions\n\nChest pain characteristics: Central, pressure-like; radiates to left arm/shoulder\n\nCurrent symptoms present: Yes\n\nPalpitations: Denies typical palpitations; reports faster beat due to stress\n\nDiabetes: Denies\n\nCholesterol checked: Never\n\nFamily history: Father died of MI ~age 60; mother had heart problems\n\nAllergies: Aspirin allergy with swelling\n\nLiving situation: Alone; front door open for access\n\nActivity level: Generally low\n\n\n\n\nSocial History\n\nSmoking: ~10 cigarettes/day for 15 years\n\nAlcohol: ~7–8 pints beer/week\n\nWeight: Overweight (visual confirmation by patient)\n\nLives alone\n\nOccupation: Restaurant owner (sushi shop)\n\n\n\n\nGoals\n\nImmediate exclusion of heart attack and urgent medical care\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Remote assessment; patient reports diaphoresis and SOB\n\nVitals/ECG: To be obtained by ambulance\n\n\n\n\nDiagnosis\n\nWorking dx: Suspected acute coronary syndrome/possible myocardial infarction\n\nPrognosis: Urgent assessment required; outcome pending hospital evaluation\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nExplained need to exclude heart attack as priority\n\nAdvised ambulance en route; keep door open; remain on line\n\nInformed about impending ECG and possible hospital transfer\n\nAdvised to communicate aspirin allergy details to hospital\n\n// Patient remained on call awaiting ambulance; symptoms ongoing\n\n\n\n\nPlan\n\nImmediate ambulance assessment with ECG\n\nHospital conveyance as indicated by ECG/clinical status\n\nGP to hand over details to ambulance team upon arrival\n\nNo further outpatient plan set pending emergency evaluation\n","review":107.05263157894737,"saved":228.94736842105263,"clean":true,"effort":0.0,"sig":[],"mb":13.037702,"signable":129.52463157894738},{"label":"Run 2","wer":42.152466367713004,"text":"Hi there. Good morning.\n\nHi. Good morning.\n\nI'm doctor Dean Meza from GP at Han. Nice to see you.\n\nNice to see you. Okay.\n\nGreat. So before we start your appointment, could you please\n\nconfirm your full name and date of birth?\n\nYeah. Sure. My name is Tim Gowers.\n\nAnd I was born in 1958.\n\nOn the August 8.\n\nThat's great. Thank you so much for that.\n\nYou look a lot younger. So\n\nYeah.\n\nSo that that would make you roughly about 50 years old, fifty one one years old. Is that is that correct?\n\nYeah. Yeah. Around that. Yeah. That's 60. Yeah. 60.\n\nOkay. Perfect.\n\nAlright. Yep. So nice to see you this morning. Are you in a private place where you're okay to\n\nspeak freely?\n\nYes. I am. Yep. Okay. Fantastic.\n\nSo how can I help you today?\n\nYeah. I was\n\nI was having a bit of chest discomfort\n\nSo I was doing some gardening a couple of hours ago,\n\nand I felt not exactly a pain, but\n\nlike, a a pressure on my chest\n\nIt feels like someone's sitting on my chest. And I've noticed\n\na bit of nausea. Not no vomiting, but\n\nI'm pretty sweaty, short of breath,\n\nit kinda feels like someone's sitting on my chest.\n\nRight. Okay.\n\nNow do you have those these symptoms right now, or have they gone off now?\n\nNo. They're still present.\n\nOkay. So you've still got the chest discomfort right now?\n\nYes. Okay.\n\nWe're probably gonna have to call an ambulance for you.\n\nTo take Okay.\n\nOkay? So what I'm gonna do is I'm gonna task my colleague next to me to\n\nsort that out. While we do that, I'm gonna ask you a few more\n\nquestions. Okay?\n\nSure. Give\n\na bit more information to the\n\nthe ambulance team when they when they arrive. Okay? Sure.\n\nSo just to just to double check, where exactly in the chest is the pain?\n\nIt's in the middle of my chest.\n\nOver, yeah, my my pecs. So\n\nyeah, but not not necessarily to one side.\n\nI mean, it's quite a diffuse pain.\n\nRight. Is it\n\nspreading anywhere else, like down to your arm, up to the jaw, the neck, anything like that?\n\nYeah. It's it's mainly my left\n\narm.\n\nIt's feeling a little bit painful.\n\nAnd and in my shoulder as well.\n\nRight. Okay.\n\nDo you remember what you were doing at the time?\n\nSo it\n\nstarted\n\njust when I was gardening, so nothing that was too strenuous\n\nI was just kneeling down and\n\nPalpitations, like your heart beating faster or more prominently than normal?\n\nYeah. It's it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today.\n\nSo I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah. So we'll take care of everything. So don't don't worry. Is anyone in the house with you at the moment?\n\nNo. No one's in the house at the moment.\n\nOkay. And is your front door open? Yes. It's open. Okay. So maybe we'll we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they could they can access you. Yeah. Alright. So are you a smoker at all?\n\nYeah. I smoke a fair bit. So I smoke about 10 cigarettes a day. Yeah.\n\nHow long have been smoking for?\n\nFor the past fifteen\n\nyears. Fifteen years. Okay.\n\nDo you have high blood pressure or high cholesterol or diabetes?\n\nYeah. I have high blood blood pressure, but not diabetes.\n\nOkay. Have you ever had your cholesterol\n\nchecked? No.\n\nOkay. Alright. Now anyone in your wider fam in your family, sorry, in your\n\nyour parents, did Yes. Did either of them have any heart problems or heart attacks? Something like that?\n\nYes. So my father died of a heart attack.\n\nWhat can I just double check? Do you have any allergies to any medication? Yes.\n\nActually, I have an allergy to aspirin.\n\nRight. Okay.\n\nYeah. And no other allergies.\n\nSure. What's the nature of that allergy to aspirin? Do you does it does it cause you heartburn, or is it like a allergic reaction?\n\nYeah. It's an allergic reaction, so I swallow a bit, but nothing life threatening. I've I sometimes even have it, and it's it's a it's a mild reaction to it.\n\nOkay. Alright. It's very important that you communicate that to the hospital Okay. Detail you just told me because we we may need to consider\n\nDespite Oh, okay. Biology. Okay? Alright. Now in terms of\n\nwhat happens from here, the team will assess you, and then\n\nthey may take you into one hospital or another based on\n\nhow bad what what the ECG looks like and what kind of treatment you might need. Okay?\n\nOkay. What I'm going to do is we'll stay on the line for the time being.\n\nOkay. Until they come, and then\n\nonce they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay.\n\nOkay. Sure. Okay. Yep. Thank you.\n\nIsn't that we we'll we'll end the conversation now for the purposes. Yeah. Is that okay?\n\nOkay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[60,64,"Resor",false],[70,80,".",false],[99,121,"That's the same thing. OK",false],[251,254,"Jim",true],[282,287,"nineteen fifty eight uh",false],[295,295,"eighth of",false],[303,305,"",false],[385,387,"Does",false],[450,450,"fifty",false],[489,489,"or",false],[523,533,"about sixty",false],[540,550,"Six OK",false],[561,574,"All right.",false],[585,585,"see",false],[641,652,"you are OK",false],[669,669,"Yep.",false],[683,693,"Yeah. OK",false],[925,934,"someone",false],[1053,1058,"kind of",false],[1348,1367,"OK.",false],[1510,1514,"OK OK. Mmm",false],[1523,1527,"We're gonna",false],[1558,1558,"to help",false],[1799,1805,"um and",false],[1884,1886,"into",false],[1912,1915,"in your",false],[2220,2220,"Uh yeah wasn't running or anything it wasn't during any physical exercise. Sure OK. And and how much activity do you do normally Do you walk a lot or do you run or do you do anything No I don't I I generally don't do much activity at all um you know. Have you had this before No this is the first time actually. Right OK. Can are you aware of any",true],[2358,2365,"'cause",false],[2463,2463,"um and I did",false],[2609,2618,"Who's",false],[2654,2654,"Yeah. OK thank you. Uh",false],[2895,2903,"",false],[2921,2921,"yeah .",false],[3178,3178,"or anything Yeah.",false],[3296,3310,"OK all right. Um",false],[3336,3339,"in",false],[3372,3376,"",false],[3386,3394,"",false],[3456,3465,"or anything",false],[3519,3519,"um and my mother had some heart problems. OK. Uh I'm sorry to hear about your father. Can you remember",true],[3525,3525,"age roughly he was when he had he had the heart attack Um he was about my age. Right so just under sixty around sixty. Yes around sixty yes. Yeah OK alright. Um do you drink much alcohol Um yeah I drink um about per week probably about seven or eight pints a week. OK is that a a beer you're talking about yeah Ohh. Yeah yes. Uh I I can't tell from the video are you overweight Um yes I'm overweight yeah. Right OK. Alright. Um uh now um you do you normally live alone Yeah. Uh yeah. I live alone uh at the moment. Yeah uh it's just me in the house. Sure OK and and uh are you working at the moment Yeah yeah I I work yeah. Right what do you work as Um I work as a restaurant owner. So I own a sushi shop. Right OK. Alright. Um so um the the symptoms that you've described to me Yeah. Um they indicate the possibility of um a heart attack. OK So I'm not saying you definitely have a heart attack but we that it's our number one priority to exclude that. OK. OK so ambulance team will be with you very shortly. I'm gonna stay on the line with you until they come. OK yeah. OK. when they come what they'll do is they're gonna put some stickers on your chest and do an ECG. OK yeah. Thank you. And then decide where to take you after that OK OK. OK no. And um what what uh",true],[3858,3865,"swell up um",true],[3979,3993,"OK all right.",false],[4120,4120,"aspirin",true],[4130,4153,"allergy OK OK. Ohh OK. Um",false],[4311,4315,"",false],[4378,4390,"OK Uh huh. Um",false],[4595,4605,"OK. Yeah",false],[4618,4637,"",false],[4665,4672,"after",false],[4701,4713,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","partial","\"Onset today while gardening; central chest pressure\" but timing of a couple of hours ago reduced to \"today\"."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of call\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), diaphoresis, shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"feels heart beating faster now due to stress\"."],["The note captures: This is the first similar episode.","no","That this is the first such episode is not documented."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"~10 cigarettes/day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Hypertension captured; overweight and low baseline activity omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","partial","Father's death from heart attack captured but age ~60 and mother's heart problems omitted."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy with swelling, non-life-threatening, and \"communicate aspirin allergy to hospital team\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"Lives alone at time of call; front door open for ambulance access\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome\" with urgent assessment."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"ambulance called for urgent assessment\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","\"possible ECG-guided management\" and transfer for ECG, but ambulance-performed ECG determining destination not clearly explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"remain on line until handover\" and GP to hand over on arrival."]],"claims":[],"note":"Presenting Condition\n\nOnset today while gardening; central chest pressure “like someone sitting on my chest”\n\nSymptoms ongoing at time of call\n\nRadiation to left arm and shoulder\n\nAssoc sx: nausea (no vomiting), diaphoresis, shortness of breath, feels heart beating faster now due to stress\n\nLocation: mid‑chest, diffuse, not lateralised\n\nContext: occurred with light activity (kneeling while gardening)\n\nReason for visit: acute chest discomfort\n\n\n\n\nRed Flag/Screening Questions\n\nCurrent chest discomfort: present\n\nRadiation: to left arm and shoulder\n\nPalpitations: reports feeling faster now due to stress; not faster than usual earlier today\n\nVomiting: denies; nausea present\n\nDyspnoea: present\n\nSweating: present\n\nFamily history of heart disease: father died of heart attack\n\nCV risk: smoker ~10 cigarettes/day for 15 years; history of high blood pressure\n\nDiabetes: denies\n\nAllergies: aspirin allergy causing swelling (non‑life‑threatening per patient)\n\n\n\n\nSocial History\n\nSmoking: ~10 cigarettes/day for 15 years\n\nLives alone at time of call; front door open for ambulance access\n\n\n\n\nPast Medical History\n\nHypertension\n\nFamily history: father died of myocardial infarction\n\nAllergies: aspirin (allergic reaction with swelling)\n\n\n\n\nMedications\n\nNot discussed\n\n\n\n\nGoals\n\nSeeks urgent assessment for chest discomfort\n\n\n\n\nObjective\n\n(Consent obtained)\n\nTelehealth triage; ambulance summoned for suspected acute coronary syndrome\n\n\n\n\nDiagnosis\n\nWorking dx: Suspected acute coronary syndrome based on central chest pressure with left arm/shoulder radiation, dyspnoea, diaphoresis, nausea, risk factors (HTN, smoking, family history)\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nkeep door open, wait for ambulance, remain on line until handover\n\ncommunicate aspirin allergy to hospital team\n\nEmergency activation: ambulance called for urgent assessment and possible ECG‑guided management\n\n// Ongoing chest discomfort at end of call; awaiting ambulance arrival\n\n\n\n\nPlan\n\nImmediate transfer to hospital via ambulance for ECG and cardiac workup\n\nGP to hand over to paramedics on arrival and provide clinical details\n","review":165.01315789473685,"saved":170.98684210526315,"clean":false,"effort":20.0,"sig":[["partial","Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","'Today' loses the roughly two-hour onset time that matters for reperfusion decisions in suspected ACS."]],"mb":9.424109,"signable":188.58715789473686},{"label":"Run 3","wer":20.40358744394619,"text":"Hi there. Good morning.\n\nHi. Good morning.\n\nI'm doctor Dean Meza from GP at Han. Nice to see you.\n\nNice to see you.\n\nGreat. So before we start your appointment, could you please confirm your\n\nfull name and date of birth?\n\nYeah. Sure. My name is Tim Gowers.\n\nI was born in 1958.\n\nOn the August 8. That's great. Thank you so much\n\nfor that.\n\nYou look a lot younger. So\n\nYeah.\n\nSo that that would make you roughly about 50 years old, fifty one one years old. Is that is that correct?\n\nYeah. Yeah. Around that. Yeah. That's 60. Yeah. 60.\n\nOkay. Perfect.\n\nAlright.\n\nYep. So nice to see you this morning. Are you in a private place where you're okay to\n\nspeak freely?\n\nYes. I am.\n\nYep. Okay. Fantastic.\n\nSo how can I help you today?\n\nYeah. I was\n\nI was having a bit of chest discomfort\n\nSo I was doing some gardening a couple of hours ago,\n\nand I felt not exactly a pain, but, like, a\n\na pressure on my chest. Feels like someone's sitting on my chest.\n\nAnd I've noticed a bit of nausea, not\n\nno vomiting, but I'm pretty sweaty.\n\nShort of breath, and it kinda feels like someone's sitting on my chest.\n\nRight.\n\nOkay. Now do you have these these symptoms right\n\nnow, or have they gone off now?\n\nNo. They're still present.\n\nOkay.\n\nSo you still got the chest discomfort right now?\n\nYes.\n\nOkay.\n\nWe're probably gonna have to call an ambulance for you.\n\nOkay.\n\nOkay? So what I'm gonna do is I'm gonna task my colleague next to me\n\nto sort that out. While we do that, I'm gonna ask you a few more questions. Okay?\n\nSure. Give\n\na bit more information to the the ambulance team when they when they arrive. Okay?\n\nSure.\n\nSo just to just to double check,\n\nwhere exactly in the chest is the pain?\n\nIt's\n\nin the middle of my chest.\n\nOver, yeah, my my pecs. So\n\nyeah. But not not necessarily to one side.\n\nI mean, it's quite diffuse pain.\n\nRight. Is it spreading anywhere else, like down to your arm?\n\nUp to the jaw, the neck, anything like\n\nthat? Yeah. It's it's\n\nmainly my left arm. It's feeling a little bit\n\npainful and and in my shoulder as well.\n\nRight. Okay. Do you remember what you were doing at the time?\n\nYes. So it started just when I was gardening.\n\nSo nothing that was too strenuous. I was just kneeling down and\n\nyeah, wasn't running or anything. It\n\nduring any physical exercise. Oh,\n\nokay. And how much\n\nactivity do you do normally? Do you walk a lot, or do you run, or do you go to\n\nanything? I don't I I generally don't do much activity at all.\n\nYeah. Have you had this before?\n\nNo. This is the first time, actually.\n\nRight. Okay.\n\nK.\n\nAre you aware of any palpitations, like your heart beating fast\n\nor more prominently than normal?\n\nYeah. It's it's beating a bit faster now. I think that's\n\nbecause I'm a little bit stressed about the situation, but I haven't noticed it\n\nbeating faster than usual.\n\nToday.\n\nSo I know you're stressed,\n\nWe've got an ambulance coming on the way. Okay? Yeah. So\n\nwe'll take care of everything. So don't don't worry. We're getting in the house with you at the moment.\n\nNo. No one's in the house at the moment.\n\nOkay.\n\nAnd is your front door open?\n\nYes. It's open.\n\nOkay. So maybe we'll we'll speak maybe in the hallway to the front door.\n\nHave the front door open so that in case people need access, they could they can access\n\nyou. Yeah.\n\nAlright. So\n\nare you a smoker at all?\n\nYeah. I smoke a fair bit, so I smoke\n\nabout 10 cigarettes a\n\nday.\n\nYeah. How long have been smoking for?\n\nFor the past\n\nfifteen years.\n\nFifteen years. Okay.\n\nYeah. Do\n\nyou have\n\nhigh blood pressure or high cholesterol or diabetes?\n\nYeah. I have high blood blood pressure, but not diabetes.\n\nOkay. Have you ever had your cholesterol checked?\n\nNo.\n\nOkay. Alright. Now anyone in your wider fam in your family, sorry, in your\n\nparents, did Yes. Did either of them have any heart problems or heart attack? Or anything like that?\n\nYes. So my father died of a heart attack.\n\nAnd my mother had some heart problems.\n\nOkay.\n\nI'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack?\n\nHe was about my age.\n\nRight. So around just under six around 60? Yes. Around 60. Yes. Okay.\n\nAlright. Do you drink much alcohol?\n\nYeah. I drink\n\nabout per week, probably about seven or eight pints a week.\n\nOkay. Is that a a beer you're talking about? Oh, yeah.\n\nYes. Okay.\n\nI I can't tell from the video. Are you overweight?\n\nYes. I'm overweight. Yeah. Right.\n\nYeah. Alright.\n\nNow you're do you normally live alone?\n\nYeah. I live alone at the moment. Yeah.\n\nIt's just me in the house.\n\nSure. Okay. And and are you working at the moment?\n\nYeah. Yeah. I I work. Yeah.\n\nWhat do you work as?\n\nI work as a restaurant owner. So I own a sushi shop.\n\nRight. Okay. Yeah. Alright.\n\nSo the the symptoms that you've described to me,\n\nthey indicate the possibility of\n\na heart attack.\n\nOkay? So\n\nI'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\nOkay? Okay.\n\nSo ambulance team will be with you very shortly. I'm gonna stay on the line with you. Okay?\n\nUntil they come. Okay? Okay.\n\nYep.\n\nThank you. When they come,\n\nwhat they'll do is they're gonna put some stickers on your chest and do an ECG,\n\nand then decide where to take you after that.\n\nOkay? Okay. And what what\n\nI just double check? Do you have any allergies to any medication?\n\nYes. Actually, I have an allergy to aspirin.\n\nRight. Okay.\n\nYeah. And no other allergies.\n\nSure. What's the nature of that allergy to aspirin? Do you does it\n\ndoes it cause you heartburn, or is it like a allergic reaction?\n\nYeah. It's an allergic reaction, so I swallow.\n\nA bit, but nothing life threatening.\n\nI've I sometimes even have it, and it's it's a it's a mild reaction to it.\n\nOkay. Alright. It's very important that you communicate that\n\nto the hospital Okay. Detail you just told me because\n\nwe we may need to consider aspirin despite the allergy. Okay?\n\nOkay. Alright. Now in terms of what happens from here,\n\nthe team will assess you, and then they may take you into\n\none hospital or another based on how bad what the ECG looks like.\n\nAnd what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line\n\nfor the time being\n\nOkay.\n\nUntil they come, and then\n\nonce they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay.\n\nOkay. Sure.\n\nOkay.\n\nYep. Thank you.\n\nThat we we'll we'll end the conversation now for the purposes. Yeah.\n\nIs that okay?\n\nOkay. Thank you very much.\n\nOkay. Thanks. Bye.\n\nThank you. Bye.","marks":[[0,0,"Hi",false],[60,64,"Resor",false],[70,80,".",false],[99,115,"That's the same thing. OK",false],[245,248,"Jim",true],[272,277,"nineteen fifty eight uh",false],[285,285,"eighth of",false],[293,295,"",false],[375,377,"Does",false],[440,440,"fifty",false],[479,479,"or",false],[513,523,"about sixty",false],[530,540,"Six OK",false],[551,565,"All right.",false],[576,576,"see",false],[632,643,"you are OK",false],[660,660,"Yep.",false],[675,685,"Yeah. OK",false],[915,924,"someone",false],[1047,1052,"kind of",false],[1126,1131,"those",false],[1225,1228,"you've",false],[1495,1499,"OK OK. Mmm",false],[1508,1512,"We're gonna",false],[1543,1543,"to help",false],[1786,1792,"um and",false],[1868,1870,"into",false],[1897,1900,"in your",false],[2244,2244,"wasn't",true],[2276,2286,"Sure OK. And",false],[2374,2379,"do",false],[2389,2389,"No",false],[2445,2450,"um you know.",false],[2524,2533,"OK. Can",false],[2594,2598,"faster",false],[2692,2699,"'cause",false],[2799,2799,"um and I did",false],[2948,2961,"Who's",false],[2998,2998,"Yeah. OK thank you. Uh",false],[3242,3250,"",false],[3269,3269,"yeah .",false],[3539,3539,"or anything Yeah.",false],[3657,3671,"OK all right. Um",false],[3697,3700,"in",false],[3742,3750,"",false],[3803,3809,"attacks",false],[4010,4010,"had",false],[4069,4075,"",false],[4087,4090,"sixty",false],[4288,4290,"yeah Ohh.",false],[4418,4424,"um you",false],[5053,5082,"OK yeah. OK.",false],[5178,5178,"OK yeah. Thank you.",false],[5228,5239,"OK OK. OK no.",false],[5253,5253,"uh can",false],[5584,5592,"swell up um",true],[5708,5722,"OK all right.",false],[5881,5893,"OK OK. Ohh OK. Um",false],[6113,6124,"OK Uh huh. Um",false],[6331,6342,"OK. Yeah",false],[6355,6368,"",false],[6396,6403,"after",false],[6433,6445,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","Central chest pressure onset a few hours ago while gardening."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Ongoing chest discomfort at time of consult\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","Nausea without vomiting, sweaty, short of breath."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"aware of faster heartbeat due to stress\"."],["The note captures: This is the first similar episode.","yes","\"Previous episodes: First episode\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"~10 cigarettes/day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","HTN, overweight, low activity level listed."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","Father died of MI ~60; mother with heart problems."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin allergy with mild swelling; importance of disclosing to EMS/hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; instructed to stay near open front door."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome/possible myocardial infarction\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","Immediate transfer via ambulance."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"What EMS will do (ECG, determine destination and treatment)\"."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"GP to remain on call until EMS arrival and handover details to crew\"."]],"claims":[],"note":"Presenting Condition\n\nMechanism/date: Onset a few hours ago while gardening (kneeling, not strenuous)\n\nPain type/intensity and neuro signs: Central chest pressure “like someone sitting on my chest”; diffuse; radiates to left arm and shoulder; short of breath; nausea without vomiting; sweaty; aware of faster heartbeat due to stress\n\nReasons for visit / chief complaints: Ongoing chest discomfort at time of consult\n\nDuration/timing/location/quality/severity/context: Mid‑chest pressure; started during light activity; still present\n\nPrevious episodes: First episode\n\nImpact on daily activities/work: At home alone; required ambulance activation\n\nAssociated symptoms: SOB, diaphoresis, nausea; left arm/shoulder pain; palpitations under stress\n\nAggravating/easing factors: Began with light activity; no easing reported\n\nContributing factors: Smoking, HTN, overweight, low activity level, family history of heart disease\n\n\n\n\nRadiology\n\nPlanned: ECG by ambulance on arrival per GP\n\n\n\n\nPast Medical History\n\nHypertension\n\nAspirin allergy: allergic reaction with swelling (mild; not life‑threatening)\n\n\n\n\nMedications\n\nNot discussed\n\n\n\n\nRed Flag/Screening Questions\n\nChest pain characteristics: central, pressure, radiates to left arm/shoulder — present\n\nCurrent symptoms: ongoing at time of call — present\n\nNausea without vomiting — present\n\nSOB — present\n\nPalpitations — denies persistent; notes stress‑related awareness\n\nFamily history of heart disease/MI — father died of MI ~age 60; mother with heart problems — present\n\nDiabetes — denies\n\nCholesterol check — never checked\n\nAllergies — aspirin allergy reported\n\n\n\n\nSocial History\n\nLives alone; front door open for ambulance access\n\nOccupation: restaurant owner (sushi shop)\n\nSmoking: ~10 cigarettes/day for 15 years\n\nAlcohol: ~7–8 pints/week\n\nOverweight; generally low activity\n\n\n\n\nSport & Exercise History\n\nGenerally does not do much activity\n\n\n\n\nGoals\n\nAcute: Assessment and exclusion/treatment of possible heart attack\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Patient on telehealth; appears sweaty per report; alone at home; door open for EMS\n\n\n\n\nDiagnosis\n\nWorking Dx: Suspected acute coronary syndrome/possible myocardial infarction\n\nPrognosis/recovery timeline: Urgent hospital assessment required; timeline pending ECG and hospital evaluation\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUrgency of possible heart attack and need for ambulance transport\n\nWhat EMS will do (ECG, determine destination and treatment)\n\nImportance of disclosing aspirin allergy details to EMS/hospital\n\nSafety: Kept on line until ambulance arrival; instructed to stay near open front door\n\n// Ongoing symptoms at end of call; ambulance en route; GP to hand over to EMS\n\n\n\n\nPlan\n\nImmediate transfer to ED via ambulance for ECG and further management\n\nGP to remain on call until EMS arrival and handover details to crew\n\nFurther plan contingent on hospital findings and treatment outcomes\n","review":126.94736842105263,"saved":209.05263157894737,"clean":true,"effort":0.0,"sig":[],"mb":13.160351,"signable":163.34636842105263},{"label":"Run 4","wer":20.47832585949178,"text":"Hi there. Good morning.\n\nHi. Good morning.\n\nI'm doctor Dean Meza from GP at Han. Nice to see you.\n\nNice to see you.\n\nGreat. So before we start your appointment, could you please confirm your\n\nfull name and date of birth?\n\nYeah. Sure. My name is Tim Gowers.\n\nI was born in 1958.\n\nOn the August 8. That's great. Thank you so much\n\nfor that.\n\nYou look a lot younger. So\n\nYeah.\n\nSo that that would make you roughly about 50 years old, fifty one one years old. Is that is that correct?\n\nYeah. Yeah. Around that. Yeah. That's 60. Yeah. 60.\n\nOkay. Perfect.\n\nAlright.\n\nYep. So nice to see you this morning. Are you in a private place where you're okay to\n\nspeak freely?\n\nYes. I am.\n\nYep. Okay. Fantastic.\n\nSo how can I help you today?\n\nYeah. I was\n\nI was having a bit of chest discomfort\n\nSo I was doing some gardening a couple of hours ago,\n\nand I felt not exactly a pain, but, like, a\n\na pressure on my chest. Feels like someone's sitting on my chest.\n\nAnd I've noticed a bit of nausea, not\n\nno vomiting, but I'm pretty sweaty.\n\nShort of breath, and it kinda feels like someone's sitting on my chest.\n\nRight.\n\nOkay. Now do you have these these symptoms right\n\nnow, or have they gone off now?\n\nNo. They're still present.\n\nOkay.\n\nSo you still got the chest discomfort right now?\n\nYes.\n\nOkay.\n\nWe're probably gonna have to call an ambulance for you.\n\nOkay.\n\nOkay? So what I'm gonna do is I'm gonna task my colleague next to me\n\nto sort that out. While we do that, I'm gonna ask you a few more questions. Okay?\n\nSure. Give\n\na bit more information to the the ambulance team when they when they arrive. Okay?\n\nSure.\n\nSo just to just to double check,\n\nwhere exactly in the chest is the pain?\n\nIt's\n\nin the middle of my chest.\n\nOver, yeah, my my pecs. So\n\nyeah. But not not necessarily to one side.\n\nI mean, it's quite diffuse pain.\n\nRight. Is it spreading anywhere else, like down to your arm?\n\nUp to the jaw, the neck, anything like\n\nthat? Yeah. It's it's\n\nmainly my left arm. It's feeling a little bit\n\npainful and and in my shoulder as well.\n\nRight. Okay. Do you remember what you were doing at the time?\n\nYes. So it started just when I was gardening.\n\nSo nothing that was too strenuous. I was just kneeling down and\n\nyeah, wasn't running or anything. It\n\nduring any physical exercise. Oh,\n\nokay. And how much\n\nactivity do you do normally? Do you walk a lot, or do you run, or do you go to\n\nanything? I don't I I generally don't do much activity at all.\n\nYeah. Have you had this before?\n\nNo. This is the first time, actually.\n\nRight. Okay.\n\nK.\n\nAre you aware of any palpitations, like your heart beating fast\n\nor more prominently than normal?\n\nYeah. It's it's beating a bit faster now. I think that's\n\nbecause I'm a little bit stressed about the situation, but I haven't noticed it\n\nbeating faster than usual.\n\nToday.\n\nSo I know you're stressed,\n\nWe've got an ambulance coming on the way. Okay? Yeah. So\n\nwe'll take care of everything. So don't don't worry. We're getting in the house with you at the moment.\n\nNo. No one's in the house at the moment.\n\nOkay.\n\nAnd is your front door open?\n\nYes. It's open.\n\nOkay. So maybe we'll we'll speak maybe in the hallway to the front door.\n\nHave the front door open so that in case people need access, they could they can access\n\nyou. Yeah.\n\nAlright. So\n\nare you a smoker at all?\n\nYeah. I smoke a fair bit, so I smoke\n\nabout 10 cigarettes a\n\nday.\n\nYeah. How long have been smoking for?\n\nFor the past\n\nfifteen years.\n\nFifteen years. Okay.\n\nYeah. Do\n\nyou have\n\nhigh blood pressure or high cholesterol or diabetes?\n\nYeah. I have high blood blood pressure, but not diabetes.\n\nOkay. Have you ever had your cholesterol checked?\n\nNo.\n\nOkay. Alright. Now anyone in your wider fam in your family, sorry, in your\n\nparents, did Yes. Did either of them have any heart problems or heart attack? Or anything like that?\n\nYes. So my father died of a heart attack.\n\nAnd my mother had some heart problems.\n\nOkay.\n\nI'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack?\n\nHe was about my age.\n\nRight. So around just under six around 60? Yes. Around 60. Yes. Okay.\n\nAlright. Do you drink much alcohol?\n\nYeah. I drink\n\nabout per week, probably about seven or eight pints a week.\n\nOkay. Is that a a beer you're talking about? Oh, yeah.\n\nYes. Okay.\n\nI I can't tell from the video. Are you overweight?\n\nYes. I'm overweight. Yeah. Right.\n\nYeah. Alright.\n\nNow you're do you normally live alone?\n\nYeah. I live alone at the moment. Yeah.\n\nIt's just me in the house.\n\nSure. Okay. And and are you working at the moment?\n\nYeah. Yeah. I I work. Yeah.\n\nWhat do you work as?\n\nI work as a restaurant owner. So I own a sushi shop.\n\nRight. Okay. Yeah. Alright.\n\nSo the the symptoms that you've described to me,\n\nthey indicate the possibility of\n\na heart attack.\n\nOkay? So\n\nI'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\nOkay? Okay.\n\nSo ambulance team will be with you very shortly. I'm gonna stay on the line with you. Okay?\n\nUntil they come. Okay? Okay.\n\nYep.\n\nThank you. When they come,\n\nwhat they'll do is they're gonna put some stickers on your chest and do an ECG,\n\nand then decide where to take you after that.\n\nOkay? Okay. And what what\n\nI just double check? Do you have any allergies to any medication?\n\nYes. Actually, I have an allergy to aspirin.\n\nRight. Okay.\n\nYeah. And no other allergies.\n\nSure. What's the nature of that allergy to aspirin? Do you does it\n\ndoes it cause you heartburn, or is it like a allergic reaction?\n\nYeah. It's an allergic reaction, so I swallow.\n\nA bit, but nothing life threatening.\n\nI've I sometimes even have it, and it's it's a it's a mild reaction to it.\n\nOkay. Alright. It's very important that you communicate that\n\nto the hospital Okay. Detail you just told me because\n\nwe we may need to consider aspirin despite the allergy. Okay?\n\nOkay. Alright. Now in terms of what happens from here,\n\nthe team will assess you, and then they may take you into\n\none hospital or another based on how bad what the ECG looks like.\n\nAnd what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line\n\nfor the time being\n\nOkay.\n\nUntil they come, and then\n\nonce they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay.\n\nOkay. Sure.\n\nOkay.\n\nYep. Thank you.\n\nIsn't that we we'll we'll end the conversation now for the purposes. Yeah.\n\nIs that okay?\n\nOkay. Thank you very much.\n\nOkay. Thanks. Bye.\n\nThank you. Bye.","marks":[[0,0,"Hi",false],[60,64,"Resor",false],[70,80,".",false],[99,115,"That's the same thing. OK",false],[245,248,"Jim",true],[272,277,"nineteen fifty eight uh",false],[285,285,"eighth of",false],[293,295,"",false],[375,377,"Does",false],[440,440,"fifty",false],[479,479,"or",false],[513,523,"about sixty",false],[530,540,"Six OK",false],[551,565,"All right.",false],[576,576,"see",false],[632,643,"you are OK",false],[660,660,"Yep.",false],[675,685,"Yeah. OK",false],[915,924,"someone",false],[1047,1052,"kind of",false],[1126,1131,"those",false],[1225,1228,"you've",false],[1495,1499,"OK OK. Mmm",false],[1508,1512,"We're gonna",false],[1543,1543,"to help",false],[1786,1792,"um and",false],[1868,1870,"into",false],[1897,1900,"in your",false],[2244,2244,"wasn't",true],[2276,2286,"Sure OK. And",false],[2374,2379,"do",false],[2389,2389,"No",false],[2445,2450,"um you know.",false],[2524,2533,"OK. Can",false],[2594,2598,"faster",false],[2692,2699,"'cause",false],[2799,2799,"um and I did",false],[2948,2961,"Who's",false],[2998,2998,"Yeah. OK thank you. Uh",false],[3242,3250,"",false],[3269,3269,"yeah .",false],[3539,3539,"or anything Yeah.",false],[3657,3671,"OK all right. Um",false],[3697,3700,"in",false],[3742,3750,"",false],[3803,3809,"attacks",false],[4010,4010,"had",false],[4069,4075,"",false],[4087,4090,"sixty",false],[4288,4290,"yeah Ohh.",false],[4418,4424,"um you",false],[5053,5082,"OK yeah. OK.",false],[5178,5178,"OK yeah. Thank you.",false],[5228,5239,"OK OK. OK no.",false],[5253,5253,"uh can",false],[5584,5592,"swell up um",true],[5708,5722,"OK all right.",false],[5881,5893,"OK OK. Ohh OK. Um",false],[6113,6124,"OK Uh huh. Um",false],[6331,6342,"OK. Yeah",false],[6355,6374,"",false],[6402,6409,"after",false],[6439,6451,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Chest pressure started a couple of hours ago while gardening\"; \"diffuse central chest.\""],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Symptoms ongoing at time of consult.\""],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation to left arm and shoulder.\""],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea (no vomiting), diaphoresis, shortness of breath.\""],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"aware of faster heartbeat due to stress today.\""],["The note captures: This is the first similar episode.","yes","\"Denies prior similar episodes.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smokes ~10 cigarettes/day for 15 years.\""],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and low activity documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of MI around age 60; mother had heart problems.\""],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","Aspirin swelling, mild; advised to inform paramedics of allergy and reaction."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","Lives alone; \"ensured front door open for ambulance access.\""],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome/possible myocardial infarction.\""],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"urgent ambulance arranged.\""],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"explained need for ECG and possible hospital transfer.\""],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","Handover plan captured, but asserts \"GP stayed on line until ambulance arrival\" as completed, which the transcript does not show."]],"claims":[["Patient remained symptomatic; GP stayed on line until ambulance arrival","Transcript only states the clinician will stay on the line until the ambulance comes; the ambulance's arrival is never described."]],"note":"Presenting Condition\n\nChest pressure started a couple of hours ago while gardening (kneeling, not strenuous)\n\nPain described as pressure “someone sitting on chest,” diffuse central chest\n\nRadiation to left arm and shoulder\n\nAssociated symptoms: nausea (no vomiting), diaphoresis, shortness of breath\n\nSymptoms ongoing at time of consult\n\nDenies prior similar episodes\n\nLow baseline activity level\n\n\n\n\nRadiology\n\nAmbulance to perform ECG on arrival as per GP plan\n\n\n\n\nPast Medical History\n\nHypertension\n\nAllergies:\n\nAspirin allergy causing swelling (mild; not life‑threatening)\n\n\n\n\nMedications\n\nNot discussed\n\n\n\n\nRed Flag/Screening Questions\n\nPalpitations: aware of faster heartbeat due to stress today\n\nDiabetes: denies\n\nCholesterol check: never checked\n\nFamily history: father died of MI around age 60; mother had heart problems\n\n\n\n\nSocial History\n\nSmokes ~10 cigarettes/day for 15 years\n\nAlcohol: ~7–8 pints/week (beer)\n\nOverweight (self‑reported)\n\nLives alone\n\nOccupation: restaurant owner (sushi shop)\n\n\n\n\nSport & Exercise History\n\nGenerally does not do much activity\n\n\n\n\nGoals\n\nSeeks assessment and management of acute chest symptoms\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: patient reported ongoing central chest pressure with SOB and diaphoresis during call\n\n\n\n\nDiagnosis\n\nWorking Dx: Suspected acute coronary syndrome/possible myocardial infarction\n\nPrognosis: Urgent assessment required\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nurgent ambulance arranged\n\nexplained need for ECG and possible hospital transfer\n\nadvised to inform paramedics of aspirin allergy and nature of reaction\n\nSafety: ensured front door open for ambulance access\n\n// Patient remained symptomatic; GP stayed on line until ambulance arrival\n\n\n\n\nPlan\n\nImmediate transfer via ambulance for ECG and hospital assessment\n\nGP to hand over details to paramedics upon arrival\n","review":110.94736842105263,"saved":225.05263157894737,"clean":false,"effort":10.0,"sig":[],"mb":13.016281,"signable":133.24936842105262},{"label":"Run 5","wer":20.553064275037368,"text":"Hi there. Good morning.\n\nHi. Good morning.\n\nI'm doctor Dean Meza from GP at Han. Nice to see you.\n\nNice to see you.\n\nGreat. So before we start your appointment, could you please confirm your\n\nfull name and date of birth?\n\nYeah. Sure. My name is Tim Gowers.\n\nI was born in 1958.\n\nOn the August 8. That's great. Thank you so much\n\nfor that.\n\nYou look a lot younger. So\n\nYeah.\n\nSo that that would make you roughly about 50 years old, fifty one one years old. Is that is that correct?\n\nYeah. Yeah. Around that. Yeah. That's 60. Yeah. 60.\n\nOkay. Perfect.\n\nAlright.\n\nYep. So nice to see you this morning. Are you in a private place where you're okay to\n\nspeak freely?\n\nYes. I am.\n\nYep. Okay. Fantastic.\n\nSo how can I help you today?\n\nYeah. I was\n\nI was having a bit of chest discomfort\n\nSo I was doing some gardening a couple of hours ago,\n\nand I felt not exactly a pain, but, like, a\n\na pressure on my chest. Feels like someone's sitting on my chest.\n\nAnd I've noticed a bit of nausea, not\n\nno vomiting, but I'm pretty sweaty.\n\nShort of breath, and it kinda feels like someone's sitting on my chest.\n\nRight.\n\nOkay. Now do you have these these symptoms right\n\nnow, or have they gone off now?\n\nNo. They're still present.\n\nOkay.\n\nSo you still got the chest discomfort right now?\n\nYes.\n\nOkay.\n\nWe're probably gonna have to call an ambulance for you.\n\nTo take Okay.\n\nSo what I'm gonna do is I'm gonna task my colleague next to me\n\nto sort that out. While we do that, I'm gonna ask you a few more questions. Okay?\n\nSure. Give\n\na bit more information to the the ambulance team when they when they arrive. Okay?\n\nSure.\n\nSo just to just to double check,\n\nwhere exactly in the chest is the pain?\n\nIt's\n\nin the middle of my chest.\n\nOver, yeah, my my pecs. So\n\nyeah. But not not necessarily to one side.\n\nI mean, it's quite diffuse pain.\n\nRight. Is it spreading anywhere else, like down to your arm?\n\nUp to the jaw, the neck, anything like\n\nthat? Yeah. It's it's\n\nmainly my left arm. It's feeling a little bit\n\npainful and and in my shoulder as well.\n\nRight. Okay. Do you remember what you were doing at the time?\n\nYes. So it started just when I was gardening.\n\nSo nothing that was too strenuous. I was just kneeling down and\n\nyeah, wasn't running or anything. It\n\nduring any physical exercise. Oh,\n\nokay. And how much\n\nactivity do you do normally? Do you walk a lot, or do you run, or do you go to\n\nanything? I don't I I generally don't do much activity at all.\n\nYeah. Have you had this before?\n\nNo. This is the first time, actually.\n\nRight. Okay.\n\nK.\n\nAre you aware of any palpitations, like your heart beating fast\n\nor more prominently than normal?\n\nYeah. It's it's beating a bit faster now. I think that's\n\nbecause I'm a little bit stressed about the situation, but I haven't noticed it\n\nbeating faster than usual.\n\nToday.\n\nSo I know you're stressed,\n\nWe've got an ambulance coming on the way. Okay? Yeah. So\n\nwe'll take care of everything. So don't don't worry. We're getting in the house with you at the moment.\n\nNo. No one's in the house at the moment.\n\nOkay.\n\nAnd is your front door open?\n\nYes. It's open.\n\nOkay. So maybe we'll we'll speak maybe in the hallway to the front door.\n\nHave the front door open so that in case people need access, they could they can access\n\nyou. Yeah.\n\nAlright. So\n\nare you a smoker at all?\n\nYeah. I smoke a fair bit, so I smoke\n\nabout 10 cigarettes a\n\nday.\n\nYeah. How long have been smoking for?\n\nFor the past\n\nfifteen years.\n\nFifteen years. Okay.\n\nYeah. Do\n\nyou have\n\nhigh blood pressure or high cholesterol or diabetes?\n\nYeah. I have high blood blood pressure, but not diabetes.\n\nOkay. Have you ever had your cholesterol checked?\n\nNo.\n\nOkay. Alright. Now anyone in your wider fam in your family, sorry, in your\n\nparents, did Yes. Did either of them have any heart problems or heart attack? Or anything like that?\n\nYes. So my father died of a heart attack.\n\nAnd my mother had some heart problems.\n\nOkay.\n\nI'm sorry to hear about your father. Can you remember what age roughly he was when he he had the heart attack?\n\nHe was about my age.\n\nRight. So around just under six around 60? Yes. Around 60. Yes. Okay.\n\nAlright. Do you drink much alcohol?\n\nYeah. I drink\n\nabout per week, probably about seven or eight pints a week.\n\nOkay. Is that a a beer you're talking about? Oh, yeah.\n\nYes. Okay.\n\nI I can't tell from the video. Are you overweight?\n\nYes. I'm overweight. Yeah. Right.\n\nYeah. Alright.\n\nNow you're do you normally live alone?\n\nYeah. I live alone at the moment. Yeah.\n\nIt's just me in the house.\n\nSure. Okay. And and are you working at the moment?\n\nYeah. Yeah. I I work. Yeah.\n\nWhat do you work as?\n\nI work as a restaurant owner. So I own a sushi shop.\n\nRight. Okay. Yeah. Alright.\n\nSo the the symptoms that you've described to me,\n\nthey indicate the possibility of\n\na heart attack.\n\nOkay? So\n\nI'm not saying you definitely have a heart attack, but we that it's our number one priority to exclude that.\n\nOkay? Okay. So\n\nambulance team will be with you very shortly. I'm gonna stay on the line with you. Okay?\n\nUntil they come. Okay? Okay.\n\nYep.\n\nThank you. When they come,\n\nwhat they'll do is they're gonna put some stickers on your chest and do an ECG,\n\nand then decide where to take you after that.\n\nOkay? Okay. And what what\n\nI just double check? Do you have any allergies to any medication?\n\nYes. Actually, I have an allergy to aspirin.\n\nRight. Okay.\n\nYeah. And no other allergies.\n\nSure. What's the nature of that allergy to aspirin? Do you does it\n\ndoes it cause you heartburn, or is it like a allergic reaction?\n\nYeah. It's an allergic reaction, so I swallow.\n\nA bit, but nothing life threatening.\n\nI've I sometimes even have it, and it's it's a it's a mild reaction to it.\n\nOkay. Alright. It's very important that you communicate that\n\nto the hospital Okay. Detail you just told me because\n\nwe we may need to consider aspirin despite the allergy. Okay?\n\nOkay. Alright. Now in terms of what happens from here,\n\nthe team will assess you, and then they may take you into\n\none hospital or another based on how bad what the ECG looks like.\n\nAnd what kind of treatment you might need. Okay? Okay. What I'm going to do is we'll stay on the line\n\nfor the time being\n\nOkay.\n\nUntil they come, and then\n\nonce they come, then I'll hand over to them. I'll explain what's going on. Alright? Okay.\n\nOkay. Sure.\n\nOkay.\n\nYep. Thank you.\n\nIsn't that we we'll we'll end the conversation now for the purposes. Yeah.\n\nIs that okay?\n\nOkay. Thank you very much.\n\nOkay. Thanks. Bye.\n\nThank you. Bye.","marks":[[0,0,"Hi",false],[60,64,"Resor",false],[70,80,".",false],[99,115,"That's the same thing. OK",false],[245,248,"Jim",true],[272,277,"nineteen fifty eight uh",false],[285,285,"eighth of",false],[293,295,"",false],[375,377,"Does",false],[440,440,"fifty",false],[479,479,"or",false],[513,523,"about sixty",false],[530,540,"Six OK",false],[551,565,"All right.",false],[576,576,"see",false],[632,643,"you are OK",false],[660,660,"Yep.",false],[675,685,"Yeah. OK",false],[915,924,"someone",false],[1047,1052,"kind of",false],[1126,1131,"those",false],[1225,1228,"you've",false],[1342,1355,"OK.",false],[1497,1501,"OK OK. Mmm",false],[1510,1514,"We're gonna",false],[1545,1545,"to help",false],[1788,1794,"um and",false],[1870,1872,"into",false],[1899,1902,"in your",false],[2246,2246,"wasn't",true],[2278,2288,"Sure OK. And",false],[2376,2381,"do",false],[2391,2391,"No",false],[2447,2452,"um you know.",false],[2526,2535,"OK. Can",false],[2596,2600,"faster",false],[2694,2701,"'cause",false],[2801,2801,"um and I did",false],[2950,2963,"Who's",false],[3000,3000,"Yeah. OK thank you. Uh",false],[3244,3252,"",false],[3271,3271,"yeah .",false],[3541,3541,"or anything Yeah.",false],[3659,3673,"OK all right. Um",false],[3699,3702,"in",false],[3744,3752,"",false],[3805,3811,"attacks",false],[4012,4012,"had",false],[4071,4077,"",false],[4089,4092,"sixty",false],[4290,4292,"yeah Ohh.",false],[4420,4426,"um you",false],[5055,5084,"OK yeah. OK.",false],[5180,5180,"OK yeah. Thank you.",false],[5230,5241,"OK OK. OK no.",false],[5255,5255,"uh can",false],[5586,5594,"swell up um",true],[5710,5724,"OK all right.",false],[5883,5895,"OK OK. Ohh OK. Um",false],[6115,6126,"OK Uh huh. Um",false],[6333,6344,"OK. Yeah",false],[6357,6376,"",false],[6404,6411,"after",false],[6441,6453,"OK Yeah that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Chest pressure started a few hours ago while gardening\"; central chest."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Current status: symptoms ongoing during call\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"Radiation: to left arm and left shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","yes","\"nausea without vomiting, diaphoresis, shortness of breath\"."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","yes","\"perceived faster heartbeat due to stress\"."],["The note captures: This is the first similar episode.","yes","\"First episode; no prior similar events\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smoking: ~10 cigarettes/day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","yes","Hypertension, overweight and \"Generally low activity\" documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","yes","\"father died of MI ~age 60; mother had heart problems\"."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"aspirin allergy causing swelling (mild...)\" and communicate details to ambulance/hospital."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","yes","\"lives alone; no one else at home\" and \"advised to stay near open front door\"."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Suspected acute coronary syndrome/possible myocardial infarction\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"ambulance called and en route\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","\"advised about ECG and hospital pathway\" is vague and does not state the destination depends on ECG findings."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"clinician remained on line until arrival\" and \"Handover to paramedics\"."]],"claims":[],"note":"Presenting Condition\n\nChest pressure started a few hours ago while gardening; feels like “someone sitting on my chest”\n\nPain location: central chest, diffuse over pecs\n\nRadiation: to left arm and left shoulder\n\nCurrent status: symptoms ongoing during call\n\nAssociated: nausea without vomiting, diaphoresis, shortness of breath, perceived faster heartbeat due to stress\n\nFirst episode; no prior similar events\n\nReason for visit: acute chest discomfort assessment and urgent assistance\n\n\n\n\nPast Medical History\n\nHypertension\n\nAllergies: aspirin allergy causing swelling (mild, not life‑threatening)\n\n\n\n\nRed Flag/Screening Questions\n\nPalpitations: denies unusual tachycardia today (feels faster due to stress)\n\nDiabetes: denies\n\nCholesterol check: never checked\n\nFamily history: father died of MI ~age 60; mother had heart problems\n\nSocial supports at time of event: lives alone; no one else at home\n\nAccess: front door open for ambulance\n\n\n\n\nSocial History\n\nSmoking: ~10 cigarettes/day for 15 years\n\nAlcohol: ~7–8 pints beer/week\n\nOverweight (patient-reported)\n\nLives alone\n\nOccupation: restaurant owner (sushi shop)\n\n\n\n\nSport & Exercise History\n\nGenerally low activity; does not do much exercise\n\n\n\n\nGoals\n\nImmediate: urgent assessment to rule out/diagnose heart attack\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: patient reports active chest pressure with SOB and diaphoresis during call\n\nContext: symptoms began with light activity (gardening), non‑exertional strenuous\n\n\n\n\nDiagnosis\n\nWorking Dx: Suspected acute coronary syndrome/possible myocardial infarction\n\nPrognosis: urgent hospital assessment required\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nexplained concern for possible heart attack and need for urgent assessment\n\nadvised about ECG and hospital pathway\n\nemphasised importance of communicating aspirin allergy details to ambulance/hospital\n\nLogistics:\n\nambulance called and en route\n\nclinician remained on line until arrival\n\nadvised to stay near open front door for access\n\n\n\n\nPlan\n\nImmediate transfer to ED via ambulance for ECG and further management\n\nHandover to paramedics with history, vitals context, and aspirin allergy details\n","review":107.27631578947368,"saved":228.7236842105263,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":13.518402,"signable":129.5723157894737}],"patientnotes":[{"label":"Run 1","wer":23.393124065769804,"text":"Hi there. Good morning.\nHi, Good morning. I'm Dr. Dean Moser from GP at HAN. Nice to see you. Nice to see you. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure.\nMy name is Tim Gowers and I was born in 1958 on the 8th of August.\nThat's great. Thank you so much for that. You look a lot younger, so. That would make you roughly about 50 years old. 51. 51 years old, is that correct?\nYeah, yeah, around that. Yeah. That's 60. Yeah.\nAll right. So nice to see you. See this morning. Are you in a private place where you're okay to speak freely? Yes, I am.\nYeah.\nOkay, fantastic. So how can I help you today?\nYeah, I was having a bit of chest discomfort, so I was doing some gardening a couple.\nOf hours ago and I felt not exactly a pain but like a pressure on my chest. Feels like someone's sitting on my chest and I've noticed a bit of nausea, not no vomiting, but I'm pretty sweaty, short of breath and it kind of feels like someone's sitting on my chest.\nRight. Okay. Now do you have these symptoms right now or have they gone off now? No, they're still present.\nOkay,\nso you've still got the chest discomfort right now? Yes. Okay, we're probably gonna have to call an ambulance for you. Okay. Okay. So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they arrive. Okay, sure. So just to double check.\nWhere exactly in the chest is the pain?\nIt's in the middle of my chest over my pec. So. Yeah, but not necessarily to one side. It's quite a diffuse pain.\nIs it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that?\nYeah, it's mainly in my left arm. It's feeling a little bit painful and in my shoulder as well.\nRight, okay. Do you remember what you were doing at the time?\nYeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and. Yeah, wasn't running or anything. It was during any physical exercise. Okay,\nand how much activity do you do normally? Do you walk a lot or do you run or do you go to.\nNo, I generally don't do much activity at all.\nHave you had this before.\nNo, this is\nthe first time, actually. Right. Okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nYeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today,\nso I know you're stressed. We've got an ambulance coming on the way. Okay. So we'll take care of everything, so don't worry. In the house with you at the\nMemantine, no one's in the house at the moment.\nOkay. And is your front door open?\nYes, it's open.\nOkay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can access you. Yeah.\nAll right.\nSo are you a smoker at all?\nYeah, I smoke a fair bit, so I smoke about 10 cigarettes.\nA day? Yeah.\nHow long have we been smoking for?\nFor the past 15 years. 15 years, okay. Yeah.\nDo you have high blood pressure or high cholesterol? Diabetes?\nYeah, I have high blood blood pressure, but not diabetes.\nOkay. Have you ever had your cholesterol checked?\nNo.\nOkay. All right. Now, anyone in your wider family. In your family. Sorry, in your parents, did. Yes. Either of them have any heart problems or heart attacks or anything like\nthat? Yes. So my father died of a heart attack and my mother had some heart problems. Okay.\nI'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\nHe was about my age.\nRight. So just under six?\nAround 60? Around 60, yes. Okay. All right.\nDo you drink much alcohol?\nYeah, I drink per week.\nProbably about seven or eight pints a week.\nOkay. Is that\na beer you're talking about? Oh, beer, yes.\nOkay. I can't tell from the video. Are you overweight?\nYes, I'm overweight, yeah. All right.\nNow, do you normally live alone?\nYeah, I live alone at the moment. Yeah. It's just me in the house. Sure. Okay.\nAnd are you working at the moment?\nYeah, yeah, I work, yeah. What do you work as? I work as a restaurant owner, so I own a sushi shop.\nRight. Okay.\nYeah.\nAll right, so the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay.\nAmbulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay? Okay. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that. Okay? And what? Can I just double check? Do you have any allergies to any medication?\nYes, actually I have an allergy to Aspirin.\nRight, okay. Yeah. And no other allergies? Sure. What's the nature of that allergy to Aspirin? Does it cause you heartburn or is it like a reaction?\nYeah, it's an allergic reaction. So I swallow a bit but nothing life threatening. I sometimes even have it and it's a mild reaction to it.\nOkay. It's very important that you communicate that to the hospital. Okay. Detail you've just told me because we may need to consider Aspirin despite the.\nOkay. All right. Now, in terms of what happens from here, team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. All right?\nOkay. Okay. Sure. Okay. Thank you.\nWe'll end the conversation now for the purposes.\nYeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,60,"Resor",false],[66,76,".",false],[94,115,"That's the same thing. OK",false],[243,246,"Jim",true],[272,276,"nineteen fifty eight uh",false],[284,287,"eighth",false],[368,368,"um Yeah. Does that",false],[450,450,"or",false],[483,493,"about sixty",false],[499,499,"Six OK perfect.",false],[582,593,"you are OK",false],[609,609,"Yep.",false],[847,856,"someone",false],[1052,1052,"those",false],[1408,1412,"OK OK. Mmm",false],[1420,1424,"We're gonna",false],[1454,1454,"to help",false],[1483,1483,"when they",false],[1608,1612,"my pecs",false],[1626,1626,"not",false],[1724,1726,"into",false],[1751,1758,"in your",false],[1795,1795,"it's um",false],[2092,2095,"wasn't",true],[2126,2130,"Sure OK. And",false],[2216,2222,"do anything",false],[2225,2225,"I don't I",false],[2269,2269,"um you know.",false],[2341,2346,"OK. Can",false],[2450,2450,"Um yeah. It's",false],[2498,2505,"'cause",false],[2603,2603,"um and I did",false],[2728,2728,"don't",false],[2735,2735,"Who's",false],[2765,2774,"moment Yeah. OK thank you. Uh no",true],[2878,2878,"we'll",false],[2997,3000,"could",false],[3019,3029,"yeah . Alright. Um",false],[3260,3260,"or",false],[3270,3270,"or anything Yeah.",false],[3427,3434,"in",false],[3740,3744,"he had the",false],[3801,3804,"sixty",false],[3813,3826,"sixty.",false],[3833,3849,"around sixty yes. Yeah OK alright. Um",false],[3890,3890,"um about",false],[3988,3996,"yeah Ohh. Yeah",false],[4085,4088,"",false],[4095,4095,"OK. Alright. Um uh",false],[4350,4371,"OK. Alright. Um",false],[4633,4641,"gonna",false],[4740,4748,"gonna",false],[4794,4794,"OK yeah. Thank you.",false],[4841,4845,"OK OK. OK no.",false],[4855,4855,"what uh",false],[5064,5064,"Do you does it",false],[5108,5109,"an allergic",false],[5158,5165,"swell up um",true],[5201,5201,"Um I've",false],[5235,5235,"it's a it's",false],[5259,5264,"OK all right.",false],[5341,5347,"you",false],[5409,5430,"allergy OK OK. Ohh OK. Um alright um",true],[5521,5526,"into",false],[5635,5640,"OK Uh huh. Um",false],[5815,5837,"alright OK. OK. OK OK",false],[5888,5895,"after",false],[5916,5927,"that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset ~2 hours ago while gardening; diffuse mid-chest pressure\"."],["The note captures: Chest discomfort remains present during the consultation.","no","Does not state symptoms are still present during the consultation."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, sweating and SOB listed, but absence of vomiting not recorded."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","no","Faster heartbeat/palpitations not documented."],["The note captures: This is the first similar episode.","yes","\"No prior similar episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","yes","\"Smokes ~10 cigarettes/day for 15 years\"."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Hypertension and overweight listed; low physical activity omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","partial","Father MI ~60 captured; maternal heart problems omitted."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","partial","\"Communicate aspirin allergy to receiving hospital team\" but nature of reaction (swelling/mild) not recorded."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","no","Patient being alone and front-door access advice not documented."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible acute coronary syndrome (ACS) - priority to exclude myocardial infarction\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"EMS dispatched for on-scene assessment\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","ECG by EMS mentioned but hospital/destination decision based on findings not explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"Clinician to remain on line until EMS arrival and hand over details\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nChest discomfort with pressure, nausea, sweating and shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset ~2 hours ago while gardening; diffuse mid‑chest pressure, radiates to left arm and shoulder.\n\nNo prior similar episodes.\n\nSmokes ~10 cigarettes/day for 15 years; hypertension; family history of myocardial infarction (father ~60 y); overweight; consumes ~7‑8 beers/week.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute coronary syndrome (ACS) – priority to exclude myocardial infarction.\n\nPlan\n\nEMS dispatched for on‑scene assessment (ECG, treatment as indicated).\n\nCommunicate aspirin allergy to receiving hospital team.\n\nClinician to remain on line until EMS arrival and hand over details.","review":166.1578947368421,"saved":169.8421052631579,"clean":false,"effort":36.666666666666664,"sig":[["missing","Chest discomfort remains present during the consultation.","Ongoing chest pain at the time of the consultation drives urgency and reperfusion decisions, and the note does not record it."],["partial","Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","The clinician stressed that the mild swelling reaction matters for deciding whether to give aspirin despite the allergy, and that detail is missing."]],"mb":23.366045,"latency":27.165,"signable":193.3228947368421},{"label":"Run 2","wer":23.467862481315397,"text":"Hi there. Good\nmorning.\nHi. Good morning. I'm Dr. Dean Mezer from GP at Hand. Nice to see you. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\nThat's great. Thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old. 51. 51 years old, is that\ncorrect? Yeah, yeah. Around that. Yeah. That. 60. Yeah.\nAll right. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am.\nYeah.\nOkay, fantastic. So how can I help you today?\nYeah, I was. I was having a bit of chest discomfort, so I was doing some gardening a couple of hours ago.\nAnd I felt not exactly a pain but like a pressure on my chest. Feels like someone's sitting on my chest. And I've noticed a bit of nausea, no vomiting, but pretty sweaty, short of breath and it kind of feels like someone's sitting on my chest.\nRight. Okay. Now do you have these symptoms right now or have they gone off now? No, they're still present.\nOkay,\nso you've still got the chest discomfort right now?\nYes.\nOkay, we're probably gonna have to call an ambulance for you. Okay. Okay. So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. A bit more information to the ambulance team when they, when they arrive. Okay? Sure. So just to double check, where exactly in the chest is the pain.\nPain? It's in the middle of my chest over my pec. So. Yeah, but not necessarily to one side and it's quite a diffuse pain.\nIs it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that?\nYeah, it's mainly my left arm. It's feeling a little bit painful and. And in my shoulder as well.\nRight, okay. Do you remember what you were doing at the time?\nYeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and. Yeah, wasn't running or anything. It was during any physical exercise. Okay.\nAnd how much activity do you do normally? Do you walk a lot or do you run or do you go to do anything?\nNo, I don't. I generally don't do much activity at all. Yeah. Have you had this before? No, this is the first time, actually.\nRight. Okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nYeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today,\nso I know you're stressed. We've got an ambulance coming on the way. Okay? Yeah, we'll take care of everything, so don't worry. In the house with you at the\nMemantine, no one's in the house at the moment.\nOkay. And is your front door open?\nYes, it's open.\nOkay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can access you. All\nright.\nSo are you a smoker at all?\nYeah, I smoke a fair bit, so I smoke about 10 cigarettes a day. Yeah. How\nlong have you been smoking for?\nFor the past 15 years. Okay. Yeah.\nDo you have high blood pressure or high cholesterol? Diabetes?\nYeah, I have high blood pressure but not diabetes.\nOkay. Have you ever had your cholesterol checked?\nNo.\nOkay. All right. Now anyone in your wider family. In your family? Sorry? In your parents? Yes. Did either of them have any heart problems or heart attacks or anything like\nthat? Yes. So my father died of a heart attack and my mother had some heart problems. Okay.\nI'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\nHe was about my age. Right.\nSo just under six,\naround 60? Around 60, yes. Okay. All right.\nDo you drink much alcohol?\nYeah, I drink per week, probably about seven or eight pints a week.\nOkay. Is\nthat\na beer\nyou talk.\nYes. Okay. I can't tell from the video. Are you overweight?\nYes, I'm overweight, yeah.\nNow, do you normally live alone?\nYeah, I live alone at the moment. Yeah. It's just me in the house. Sure.\nOkay. And are you working at the moment?\nYeah, yeah, I work, yeah.\nWhat do you work as?\nI work as a restaurant owner. So I own a sushi shop.\nRight. Okay.\nYeah.\nAll right, so the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay. Ambulance team will be with you very shortly. I'm going to stay on the line with you until they come, okay? Okay. Yeah. Thank you. When they come.\nCome. What they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that. Okay. Can I just double check? Do you have any allergies to any medication?\nYes, actually, I have an allergy to Aspirin.\nRight, okay. Yeah. And no\nother allergies?\nSure. What's the nature of that allergy to Aspirin? Does it it cause you heartburn or is it like an allergic reaction?\nYeah, it's an allergic reaction. So I swell up a bit, but nothing life threatening. I sometimes even have it and it's a mild reaction to it.\nOkay. All right. It's very important that you communicate that to the hospital detail you've just told me because we may need to consider Aspirin despite. All right. Now, in terms of what happens from here.\nAssess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. Okay. What I'm going to do is we'll stay on the line for the time being, okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay. Sure. Okay. Thank you. Now, we'll end the conversation now for the purposes. Yeah. Okay. Thank you very much. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,60,"Resor",false],[66,77,".",false],[95,99,"That's the same thing. OK",false],[227,230,"Jim",true],[256,260,"nineteen fifty eight uh",false],[268,271,"eighth",false],[351,351,"um Yeah. Does that",false],[433,433,"or",false],[466,475,"about sixty",false],[481,481,"Six OK perfect.",false],[503,503,"see",false],[559,570,"you are OK",false],[586,586,"Yep.",false],[831,840,"someone",false],[894,894,"not",false],[912,912,"um I'm",false],[1029,1029,"those",false],[1385,1389,"OK OK. 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OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset while gardening ~2 hours ago; pressure central chest\"."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"symptoms ongoing\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiating to left arm/shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, sweating and SOB listed but absence of vomiting not documented."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","no","Faster heartbeat/palpitations not mentioned."],["The note captures: This is the first similar episode.","yes","\"no prior similar episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","partial","Only \"low baseline activity\" captured; hypertension and overweight omitted."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","partial","Allergy to be conveyed to emergency team, but nature of reaction (swelling, mild) omitted and allergy itself not recorded separately."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","no","Patient being alone and front-door advice not documented."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible acute myocardial infarction (ACS) – priority to exclude\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance dispatched for emergency ECG and management\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","ECG mentioned but the hospital/destination decision based on ECG findings is not explained."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","yes","\"clinician to remain on line\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nChest discomfort with pressure, nausea, sweating, shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset while gardening ~2 hours ago; pressure central chest radiating to left arm/shoulder; symptoms ongoing; no prior similar episodes; low baseline activity.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute myocardial infarction (ACS) – priority to exclude.\n\nPlan\n\nAmbulance dispatched for emergency ECG and management; clinician to remain on line and convey aspirin allergy to emergency team.","review":168.80263157894737,"saved":167.19736842105263,"clean":false,"effort":40.0,"sig":[["missing","Smoking approximately ten cigarettes daily for fifteen years.","Smoking history, a major cardiac risk factor, is absent from a suspected-ACS note."],["partial","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension, the patient's only known medical condition, is omitted."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Premature family history of MI is omitted from a suspected-ACS note."]],"mb":22.615993,"latency":25.571,"signable":194.37363157894737},{"label":"Run 3","wer":22.720478325859492,"text":"Hi there. Good morning.\nHi. Good morning. I'm Dr. Dean Moser from GP at Hand. Nice to see you. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure.\nMy name is Tim Gowers and I was born in 1958 on the 8th of August.\nThat's great. Thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old. 51. 51 years old, is that correct?\nYeah, yeah, around that. Yeah, that 60. Yeah.\nAll right. So nice to see you this morning. Are you in a private place where you're okay to speak freely? Yes, I am.\nYeah.\nOkay, fantastic. So how can I help you today?\nYeah, I was. I was having a bit of chest discomfort, so I was doing some gardening a couple.\nOf hours ago and I felt not exactly a pain but like a pressure on my chest. Feels like someone sitting on my chest. And I've noticed a bit of nausea, not no vomiting, but I'm pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\nRight. Okay. Now do you have these symptoms right now or have they gone off now? No, they're still present.\nOkay,\nso you've still got the chest discomfort right now?\nYes.\nOkay, we're probably gonna have to call an ambulance for you. Okay. Okay. So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. A little bit more information to the the ambulance team when they arrive. Okay? Sure. So just to double check.\nWhere exactly in the chest is the pain?\nIt's in the middle of my chest over my pec. So. Yeah, but not necessarily to one side. It's quite a diffuse pain.\nIs it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that?\nYeah, it's mainly my left arm. It's feeling a little bit painful and in my shoulder as well.\nRight, okay. Do you remember what you were doing at the time?\nYeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and. Yeah, wasn't running or anything. It was during any physical exercise. Okay,\nand how much activity do you do normally? Do you walk a lot or do you run or do you go to.\nNo, I generally don't do much activity at all.\nHave you had this before.\nNo, this is the first time actually.\nRight. Okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nYeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation but I haven't noticed it beating faster than usual today\nso I know you're stressed. We've got an ambulance coming on the way. Okay. So we'll take care of everything, so don't\nworry.\nIn the house with you at the\nMemantine, no one's in the house at the moment.\nOkay. And is your front door open?\nYes, it's open.\nOkay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access they can access you. Yeah. All right. So are you a smoker at all?\nYeah, I smoke a fair bit, so I smoke about 10 cigarettes a.\nDay. Yeah.\nHow long we've been smoking for.\nFor the past 15 years. 15 years, okay. Yeah.\nDo you have high blood pressure or high cholesterol or diabetes?\nYeah, I have high blood blood pressure but not diabetes.\nOkay. Have you ever had your cholesterol checked?\nNo.\nOkay. All right. Now, anyone in your wider family. In your family, sorry, in your parents, did. Yes. Either of them have any heart problems or heart attacks or anything like\nthat? Yes. So my father died of a heart attack and my mother had some heart problems. Okay.\nI'm sorry to hear about your father. Can you remember what age roughly he was when he had the heart attack?\nHe was about my age.\nRight. So just under six, around\n60? Around 60, yes.\nOkay. All right. Do you drink much alcohol?\nYeah, I drink per week.\nProbably about seven or eight pints a week.\nOkay. Is that\na beer you're talking about? Of beer? Yes.\nOkay. I can't tell from the video. Are you overweight?\nYes, I'm overweight, yeah. All right.\nNow, do you normally live alone?\nYeah, I live alone at the moment. Yeah. It's just me in the house. Sure.\nOkay. And are you working at the moment?\nYeah, yeah, I work, yeah. What do you work as? I work as a restaurant owner, so I own a sushi shop.\nRight. Okay. Yeah. All right, so the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay.\nAmbulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay? Okay. When they come what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that. Okay? And what can I just double check? Do you have any allergies to any medication?\nYes, actually I have an allergy to Aspirin.\nRight, okay. Yeah. And no\nother\nallergies? Sure. What's the nature of that allergy to Aspirin? Does it cause you heartburn or is it like an allergic reaction?\nYeah, it's an allergic reaction. So I swell up a bit but nothing life threatening. I sometimes even have it and it's a mild reaction to it.\nOkay, all right. It's very important that you communicate that to the hospital. Okay. Detail you've just told me because we may need to consider Aspirin despite the.\nOkay. All right. Now, in terms of what happens from here, the team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. All right? Okay. Okay. Sure. Okay. Thank you. We'll end the conversation now for the purposes. Yeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,60,"Resor",false],[66,77,".",false],[95,99,"That's the same thing. OK",false],[227,230,"Jim",true],[256,260,"nineteen fifty eight uh",false],[268,271,"eighth",false],[351,351,"um Yeah. 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Um",false],[3116,3121,"have you",false],[3248,3248,"or anything Yeah.",false],[3404,3411,"in",false],[3716,3716,"he had",false],[3777,3780,"sixty",false],[3789,3802,"sixty.",false],[3809,3825,"around sixty yes. Yeah OK alright. Um",false],[3866,3866,"um about",false],[3964,3971,"yeah Ohh. Yeah",false],[4060,4063,"",false],[4070,4070,"OK. Alright. Um uh",false],[4325,4346,"OK. Alright. Um",false],[4608,4616,"gonna",false],[4714,4722,"gonna",false],[4768,4768,"OK yeah. Thank you.",false],[4815,4819,"OK OK. OK no.",false],[4829,4829,"what uh",false],[5037,5037,"Do you does it",false],[5185,5185,"Um I've",false],[5219,5219,"it's a it's",false],[5336,5342,"you",false],[5404,5425,"allergy OK OK. Ohh OK. Um alright um",true],[5520,5525,"into",false],[5634,5645,"OK Uh huh. Um",false],[5820,5842,"alright OK. OK. OK OK",false],[5893,5900,"after",false],[5921,5932,"that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset ~2 hours ago while gardening; central chest pressure.\""],["The note captures: Chest discomfort remains present during the consultation.","no","Does not state that chest discomfort is still present during the consultation."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiating to left arm/shoulder.\""],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, sweating and dyspnoea captured, but absence of vomiting is not stated."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","no","Faster heartbeat/palpitations not documented."],["The note captures: This is the first similar episode.","yes","\"first episode.\""],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","no","Hypertension, overweight and low activity not documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Aspirin allergy causing mild swelling\" and \"Communicate aspirin allergy to receiving facility.\""],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","no","Living alone and front-door access not documented."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"possible acute coronary syndrome (heart attack) to be excluded.\""],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance dispatched.\""],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","yes","\"pre-hospital ECG and transport to appropriate hospital.\""],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","no","Clinician remaining on the line until arrival is not documented."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nChest discomfort with pressure, nausea, sweating, shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset ~2 hours ago while gardening; central chest pressure radiating to left arm/shoulder; associated nausea, sweating, dyspnoea; first episode; no relieving factors reported.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: possible acute coronary syndrome (heart attack) to be excluded.\n\nPlan\n\nMedications::\n\nAspirin allergy causing mild swelling (non‑life‑threatening).\n\nAmbulance dispatched for pre‑hospital ECG and transport to appropriate hospital.\n\nCommunicate aspirin allergy to receiving facility.","review":198.96052631578948,"saved":137.03947368421052,"clean":false,"effort":50.0,"sig":[["missing","Chest discomfort remains present during the consultation.","Does not record that chest pain is ongoing, which defines the emergency."],["missing","Smoking approximately ten cigarettes daily for fifteen years.","Smoking history, a major ACS risk factor, omitted."],["missing","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension and other risk factors omitted from a suspected-ACS note."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Premature family history of MI omitted."],["missing","Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","Lone patient and open-door safety advice given are not documented."]],"mb":22.276058,"latency":22.239,"signable":221.19952631578948},{"label":"Run 4","wer":23.318385650224215,"text":"Hi there. Good morning.\nHi, Good morning. I'm Dr. Dean Meza from GP at Hand. Nice to see you. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth?\nYeah, sure. My name is Tim Gowers and I was born in 1958 on the 8th of August.\nThat's great. Thank you so much for that. You look a lot younger, so that would make you roughly about 50 years old. 51. 51 years old, is that correct?\nYeah, yeah, around that. Yeah. That's 60. Yeah.\nAll right. So nice to see you. See this morning. Are you in a private place where you're okay to speak freely? Yes, I am.\nYeah.\nOkay, fantastic. So how can I help you today?\nYeah, I was. I was having a bit of chest discomfort, so I was doing some gardening a couple.\nOf hours ago, and I felt not exactly a pain, but like a pressure on my chest. Feels like someone sitting on my chest. And I've noticed a bit of nausea, not no vomiting, but pretty sweaty, short of breath, and it kind of feels like someone's sitting on my chest.\nRight. Okay. Now do you have these symptoms right now, or have they gone off now? No, they're still present.\nOkay,\nso you've still got the chest discomfort right now?\nYes.\nOkay, we're probably gonna have to call an ambulance for you. Okay. Okay. So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions, okay? Give a bit more information to the ambulance team when they arrive. Okay, sure. So just to double check.\nWhere exactly in the chest is the pain?\nIt's in the middle of my chest over my pec. So. Yeah, but not necessarily to one side. It's quite a diffuse pain.\nIs it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that?\nYeah, it's mainly in my left arm. It's feeling a little bit painful and in my shoulder as well.\nRight, okay. Do you remember what you were doing at the time?\nYeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and. Yeah, wasn't running or anything. It wasn't during any physical exercise. Okay,\nand how much activity do you do normally? Do you walk a lot or do you run or do you go to.\nNo, I generally don't do much activity at all.\nHave you had this before.\nNo, this is the first time, actually.\nRight. Okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nYeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today,\nso I know you're stressed. We've got an ambulance coming on the way. Okay. Yeah. So we'll take care of everything, so don't\nworry.\nIn the house with you at the\nMemantine, no one's in the house at the moment.\nOkay. And is your front door open?\nYes, it's open.\nOkay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can access you. Yeah.\nAll right.\nSo are you a smoker at all?\nYeah, I smoke a fair bit, so I smoke about 10 cigarettes.\nDay. Yeah.\nHow long we've been smoking for.\nFor the past 15 years. 15 years, okay. Yeah.\nDo you have high blood pressure or high cholesterol or diabetes?\nYeah, I have high blood blood pressure but not diabetes.\nOkay. Have you ever had your cholesterol checked?\nNo.\nOkay. All right. Now, anyone in your wider family. In your family. Sorry, in your parents, did. Yes. Did either of them have any heart problems or heart attacks or anything like\nthat? Yes. So my father died of a heart attack and my mother had some heart problems. Okay.\nI'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\nHe was about my age.\nRight. So just under six? Around\n60? Around 60, yes. Okay.\nAll right. Do you drink much alcohol?\nYeah, I drink per week.\nProbably about seven or eight pints a week.\nOkay. Is that\nbeer you're talking about? Oh, yeah. Yes.\nOkay. I can't tell from the video. Are you overweight?\nYes, I'm overweight, yeah. All right.\nNow, do you normally live alone?\nYeah, I live alone at the moment. Yeah. It's just me in the house. Sure.\nOkay. And are you working at the moment?\nYeah, yeah, I work, yeah. What do you work as? I work as a restaurant owner, so I own a sushi shop.\nRight. Okay.\nYeah.\nAll right, so the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay.\nAmbulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay? Okay. When they come what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that. Okay? And what can I just double check? Do you have any allergies to any medication?\nYes, actually I have an allergy to Aspirin.\nRight, okay. Yeah. And no other allergies? Sure. What's the nature of that allergy to Aspirin? Does it cause you heartburn or is it like a reaction?\nYeah, it's an allergic reaction. So I swallow a bit but nothing life threatening. I sometimes even have it and it's a mild reaction to it.\nOkay, all right. It's very important that you communicate that to the hospital. Okay. Detail you've just told me because we may need to consider Aspirin despite the.\nOkay. All right. Now, in terms of what happens from here, the team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. All\nright? Okay. Okay. Sure. Okay. Yeah. Thank you.\nWe'll end the conversation now for the purposes.\nYeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,59,"Resor",false],[65,76,".",false],[94,98,"That's the same thing. OK",false],[226,229,"Jim",true],[255,259,"nineteen fifty eight uh",false],[267,270,"eighth",false],[350,350,"um Yeah. Does that",false],[432,432,"or",false],[465,475,"about sixty",false],[481,481,"Six OK perfect.",false],[564,575,"you are OK",false],[591,591,"Yep.",false],[921,921,"um I'm",false],[1039,1039,"those",false],[1396,1406,"OK OK. Mmm sure. We're gonna",false],[1436,1436,"to help the",false],[1461,1461,"when they",false],[1586,1590,"my pecs",false],[1604,1604,"not",false],[1702,1704,"into",false],[1729,1736,"in your",false],[1773,1773,"it's um",false],[2107,2111,"Sure OK. And",false],[2197,2203,"do anything",false],[2206,2206,"I don't I",false],[2250,2250,"um you know.",false],[2322,2327,"OK. Can",false],[2431,2431,"Um yeah. It's",false],[2479,2486,"'cause",false],[2584,2584,"um and I did",false],[2715,2715,"don't",false],[2722,2722,"Who's",false],[2752,2761,"moment Yeah. OK thank you. Uh no",true],[2865,2865,"we'll",false],[2984,2987,"could",false],[3006,3016,"yeah . Alright. Um",false],[3123,3128,"have you",false],[3255,3255,"or anything Yeah.",false],[3411,3418,"in",false],[3459,3468,"",false],[3728,3732,"he had the",false],[3789,3792,"sixty",false],[3801,3814,"sixty.",false],[3821,3837,"around sixty yes. Yeah OK alright. Um",false],[3878,3878,"um about",false],[3974,3976,"yeah Ohh.",false],[4071,4074,"",false],[4081,4081,"OK. Alright. Um uh",false],[4336,4357,"OK. Alright. Um",false],[4619,4627,"gonna",false],[4725,4733,"gonna",false],[4779,4779,"OK yeah. Thank you.",false],[4826,4830,"OK OK. OK no.",false],[4840,4840,"what uh",false],[5048,5048,"Do you does it",false],[5092,5093,"an allergic",false],[5142,5149,"swell up um",true],[5185,5185,"Um I've",false],[5219,5219,"it's a it's",false],[5336,5342,"you",false],[5404,5425,"allergy OK OK. Ohh OK. Um alright um",true],[5520,5525,"into",false],[5634,5639,"OK Uh huh. Um",false],[5814,5836,"alright OK. OK. OK OK",false],[5893,5900,"after",false],[5921,5932,"that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset: a few hours ago while gardening, kneeling\"; \"pressure, diffuse middle chest\"."],["The note captures: Chest discomfort remains present during the consultation.","no","The note does not state the discomfort is still present."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiates to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, sweating and shortness of breath captured; absence of vomiting omitted."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","no","Faster heartbeat is not mentioned."],["The note captures: This is the first similar episode.","yes","\"First occurrence\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history is not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","no","Risk factors are not documented."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history is not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Aspirin: mild allergic reaction\" and \"Advise EMS of aspirin allergy\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","no","Living alone and front-door advice are not captured."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible acute coronary syndrome (heart attack)\" framed as possible, not confirmed."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance dispatched\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","ECG and transport to hospital noted, but not that the destination depends on the ECG findings."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","no","Clinician staying on the line is not mentioned."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nChest discomfort described as pressure, feeling of something sitting on chest, with nausea, sweating and shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset: a few hours ago while gardening, kneeling;\n\nQuality: pressure, diffuse middle chest, radiates to left arm and shoulder;\n\nAssociated symptoms: nausea, sweating, shortness of breath;\n\nNo relieving factors identified;\n\nFirst occurrence.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute coronary syndrome (heart attack) as primary diagnosis.\n\nPlan\n\nMedications::\n\nAspirin: mild allergic reaction (non‑life‑threatening) when taken.\n\nAmbulance dispatched; on‑scene assessment, ECG and transport to hospital;\n\nAdvise EMS of aspirin allergy.","review":218.44736842105263,"saved":117.55263157894737,"clean":false,"effort":53.333333333333336,"sig":[["missing","Chest discomfort remains present during the consultation.","Ongoing chest pain during the call is a key triage fact and is not stated."],["missing","Smoking approximately ten cigarettes daily for fifteen years.","10/day x 15y smoking, a major cardiac risk factor, is absent."],["missing","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension, overweight and inactivity risk factors are absent."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Premature paternal MI and maternal heart disease absent."]],"mb":23.580691,"latency":69.221,"signable":287.6683684210526},{"label":"Run 5","wer":23.393124065769804,"text":"Hi there. Good morning.\nHi, Good morning. I'm Dr. Dean Moser from GP at HAN. Nice to see you. Nice to see you. Okay, great. So before we start your appointment, could you please confirm your full name and date of birth? Yeah, sure.\nMy name is Tim Gowers and I was born in 1958 on the 8th of August.\nThat's great. Thank you so much for that. You look a lot younger, so. That would make you roughly about 50 years old. 51. 51 years old, is that correct?\nYeah, yeah, around that. Yeah. That's 60. Yeah.\nAll right. So nice to see you. See this morning. Are you in a private place where you're okay to speak freely? Yes, I am.\nYeah.\nOkay, fantastic. So how can I help you today?\nYeah, I was having a bit of chest discomfort, so I was doing some gardening a couple.\nOf hours ago and I felt not exactly a pain but like a pressure on my chest. Feels like someone's sitting on my chest and I've noticed a bit of nausea, not no vomiting, but I'm pretty sweaty, short of breath and it kind of feels like someone's sitting on my chest.\nRight. Okay. Now do you have these symptoms right now or have they gone off now? No, they're still present.\nOkay,\nso you've still got the chest discomfort right now? Yes. Okay, we're probably gonna have to call an ambulance for you. Okay. Okay. So what I'm gonna do is I'm gonna task my colleague next to me to sort that out. While we do that, I'm gonna ask you a few more questions. Okay? Sure. Give a bit more information to the the ambulance team when they arrive. Okay, sure. So just to double check.\nWhere exactly in the chest is the pain?\nIt's in the middle of my chest over my pec. So. Yeah, but not necessarily to one side. It's quite a diffuse pain.\nIs it spreading anywhere else, like down to your arm, up to the jaw and the neck, anything like that?\nYeah, it's mainly in my left arm. It's feeling a little bit painful and in my shoulder as well.\nRight, okay. Do you remember what you were doing at the time?\nYeah, so it started just when I was gardening, so nothing that was too strenuous. I was just kneeling down and. Yeah, wasn't running or anything. It was during any physical exercise. Okay,\nand how much activity do you do normally? Do you walk a lot or do you run or do you go to.\nNo, I generally don't do much activity at all.\nHave you had this before.\nNo, this is\nthe first time, actually. Right. Okay. Are you aware of any palpitations, like your heart beating faster or more prominently than normal?\nYeah, it's beating a bit faster now. I think that's because I'm a little bit stressed about the situation, but I haven't noticed it beating faster than usual today,\nso I know you're stressed. We've got an ambulance coming on the way. Okay. So we'll take care of everything, so don't worry. In the house with you at the\nMemantine, no one's in the house at the moment.\nOkay. And is your front door open?\nYes, it's open.\nOkay, so maybe we'll speak maybe in the hallway to the front door. Have the front door open so that in case people need access, they can access you. Yeah.\nAll right.\nSo are you a smoker at all?\nYeah, I smoke a fair bit, so I smoke about 10 cigarettes.\nA day? Yeah.\nHow long have we been smoking for?\nFor the past 15 years. 15 years, okay. Yeah.\nDo you have high blood pressure or high cholesterol? Diabetes?\nYeah, I have high blood blood pressure, but not diabetes.\nOkay. Have you ever had your cholesterol checked?\nNo.\nOkay. All right. Now, anyone in your wider family. In your family. Sorry, in your parents, did. Yes. Either of them have any heart problems or heart attacks or anything like\nthat? Yes. So my father died of a heart attack and my mother had some heart problems. Okay.\nI'm sorry to hear about your father. Can you remember what age roughly he was when he had that heart attack?\nHe was about my age.\nRight. So just under six?\nAround 60? Around 60, yes. Okay. All right.\nDo you drink much alcohol?\nYeah, I drink per week.\nProbably about seven or eight pints a week.\nOkay. Is that\na beer you're talking about? Oh, beer, yes.\nOkay. I can't tell from the video. Are you overweight?\nYes, I'm overweight, yeah. All right.\nNow, do you normally live alone?\nYeah, I live alone at the moment. Yeah. It's just me in the house. Sure. Okay.\nAnd are you working at the moment?\nYeah, yeah, I work, yeah. What do you work as? I work as a restaurant owner, so I own a sushi shop.\nRight. Okay.\nYeah.\nAll right, so the symptoms that you've described to me, they indicate the possibility of a heart attack. Okay. So I'm not saying you definitely have a heart attack, but it's our number one priority to exclude that. Okay.\nAmbulance team will be with you very shortly. I'm going to stay on the line with you until they come. Okay? Okay. When they come, what they'll do is they're going to put some stickers on your chest and do an ECG and then decide where to take you after that. Okay? And what? Can I just double check? Do you have any allergies to any medication?\nYes, actually I have an allergy to Aspirin.\nRight, okay. Yeah. And no other allergies? Sure. What's the nature of that allergy to Aspirin? Does it cause you heartburn or is it like a reaction?\nYeah, it's an allergic reaction. So I swallow a bit but nothing life threatening. I sometimes even have it and it's a mild reaction to it.\nOkay. It's very important that you communicate that to the hospital. Okay. Detail you've just told me because we may need to consider Aspirin despite the.\nOkay. All right. Now, in terms of what happens from here, team will assess you, and then they may take you in to one hospital or another based on how bad what the ECG looks like and what kind of treatment you might need. Okay. What I'm going to do is we'll stay on the line for the time being. Okay. Until they come. And then once they come, then I'll hand over to them. I'll explain what's going on. All right?\nOkay. Okay. Sure. Okay. Thank you.\nWe'll end the conversation now for the purposes.\nYeah. Okay. Okay. Thank you very much. Okay. Thanks. Bye. Thank you. Bye.","marks":[[0,0,"Hi",false],[55,60,"Resor",false],[66,76,".",false],[94,115,"That's the same thing. OK",false],[243,246,"Jim",true],[272,276,"nineteen fifty eight uh",false],[284,287,"eighth",false],[368,368,"um Yeah. Does that",false],[450,450,"or",false],[483,493,"about sixty",false],[499,499,"Six OK perfect.",false],[582,593,"you are OK",false],[609,609,"Yep.",false],[847,856,"someone",false],[1052,1052,"those",false],[1408,1412,"OK OK. Mmm",false],[1420,1424,"We're gonna",false],[1454,1454,"to help",false],[1483,1483,"when they",false],[1608,1612,"my pecs",false],[1626,1626,"not",false],[1724,1726,"into",false],[1751,1758,"in your",false],[1795,1795,"it's um",false],[2092,2095,"wasn't",true],[2126,2130,"Sure OK. And",false],[2216,2222,"do anything",false],[2225,2225,"I don't I",false],[2269,2269,"um you know.",false],[2341,2346,"OK. Can",false],[2450,2450,"Um yeah. It's",false],[2498,2505,"'cause",false],[2603,2603,"um and I did",false],[2728,2728,"don't",false],[2735,2735,"Who's",false],[2765,2774,"moment Yeah. OK thank you. Uh no",true],[2878,2878,"we'll",false],[2997,3000,"could",false],[3019,3029,"yeah . Alright. Um",false],[3260,3260,"or",false],[3270,3270,"or anything Yeah.",false],[3427,3434,"in",false],[3740,3744,"he had the",false],[3801,3804,"sixty",false],[3813,3826,"sixty.",false],[3833,3849,"around sixty yes. Yeah OK alright. Um",false],[3890,3890,"um about",false],[3988,3996,"yeah Ohh. Yeah",false],[4085,4088,"",false],[4095,4095,"OK. Alright. Um uh",false],[4350,4371,"OK. Alright. Um",false],[4633,4641,"gonna",false],[4740,4748,"gonna",false],[4794,4794,"OK yeah. Thank you.",false],[4841,4845,"OK OK. OK no.",false],[4855,4855,"what uh",false],[5064,5064,"Do you does it",false],[5108,5109,"an allergic",false],[5158,5165,"swell up um",true],[5201,5201,"Um I've",false],[5235,5235,"it's a it's",false],[5259,5264,"OK all right.",false],[5341,5347,"you",false],[5409,5430,"allergy OK OK. Ohh OK. Um alright um",true],[5521,5526,"into",false],[5635,5640,"OK Uh huh. Um",false],[5815,5837,"alright OK. OK. OK OK",false],[5888,5895,"after",false],[5916,5927,"that's OK. OK",false]],"facts":[["The note captures: Central chest pressure/heaviness began a few hours earlier during gardening or mild activity.","yes","\"Onset ~2 h ago while gardening\" with \"Central diffuse chest pressure\"."],["The note captures: Chest discomfort remains present during the consultation.","yes","\"Ongoing, not relieved\"."],["The note captures: Pain radiates to the left arm and shoulder.","yes","\"radiating to left arm and shoulder\"."],["The note captures: Associated nausea without vomiting, sweating and breathlessness.","partial","Nausea, sweating and shortness of breath are captured but not the absence of vomiting."],["The note captures: Faster heartbeat/palpitations are reported during the current episode.","no","Faster heartbeat/palpitations are not mentioned."],["The note captures: This is the first similar episode.","yes","\"No prior similar episodes\"."],["The note captures: Smoking approximately ten cigarettes daily for fifteen years.","no","Smoking history is not documented."],["The note captures: Hypertension, overweight and low baseline physical activity are relevant risk factors.","no","Hypertension, overweight and low activity are not mentioned."],["The note captures: Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","no","Family history is not documented."],["The note captures: Aspirin allergy causes swelling/a mild allergic reaction; the allergy must be communicated to the hospital.","yes","\"Aspirin - mild allergic reaction\" and \"Advise EMS and receiving hospital of aspirin allergy\"."],["The note captures: Patient is alone; keeping the front door open or accessible for ambulance staff is advised.","no","Patient being alone and the front-door advice are not captured."],["The note captures: Possible heart attack/acute coronary syndrome is suspected and must urgently be excluded, not presented as already confirmed.","yes","\"Possible acute coronary syndrome (ACS) - urgent exclusion required\"."],["The note captures: Ambulance/emergency assessment is being arranged urgently.","yes","\"Ambulance dispatched\"."],["The note captures: Ambulance ECG and subsequent hospital/destination decision based on its findings are explained.","partial","\"pre-hospital ECG and transport\" is noted but not that the destination decision depends on the ECG."],["The note captures: Clinician plans to remain on the line until ambulance arrival and hand over; do not require an already-completed handover.","partial","\"Continue monitoring symptoms until EMS arrival\" loosely implies staying with the patient; handover not mentioned."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nChest discomfort described as pressure, feeling of weight on chest, with nausea, sweating, shortness of breath.\n\nHistory of Presenting Complaint::\n\nOnset ~2 h ago while gardening (low‑intensity activity).\n\nCentral diffuse chest pressure radiating to left arm and shoulder.\n\nNo prior similar episodes.\n\nOngoing, not relieved.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible acute coronary syndrome (ACS) – urgent exclusion required.\n\nPlan\n\nMedications::\n\nAspirin – mild allergic reaction (non‑life‑threatening).\n\nAmbulance dispatched for pre‑hospital ECG and transport.\n\nAdvise EMS and receiving hospital of aspirin allergy.\n\nContinue monitoring symptoms until EMS arrival.","review":186.68421052631578,"saved":149.31578947368422,"clean":false,"effort":43.333333333333336,"sig":[["missing","Smoking approximately ten cigarettes daily for fifteen years.","10/day x 15y smoking, a major cardiac risk factor, is absent."],["missing","Hypertension, overweight and low baseline physical activity are relevant risk factors.","Hypertension, overweight and inactivity risk factors are absent."],["missing","Family history includes father dying of myocardial infarction around age sixty and maternal heart problems.","Premature paternal MI and maternal heart disease absent."]],"mb":23.590208,"latency":25.112,"signable":211.79621052631578}]}}