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Please have a seat. I understand you have had abdominal pain for at least four days. : Yes, Doctor. It started on Sunday evening. : Okay. Can you tell me where the pain began exactly? : It was right here in my upper belly. But now it's mostly down on the right side. : Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that? : Oui docteur, effectivement. : okay? Okay. Was the pain sudden or gradual? : It was gradual. Just a dull ache at first. But now, It's sharp about eight out of ten. : okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos où alors vos épaules? : No, doctor, it stays in the lower right. : Okay. Anything makes him better or worse? : Doctor nothing really helps. Moving around makes it a bit worse. : Et avez-vous de la fièvre aussi ? : Oui docteur, j’ai fait de la fièvre la nuit dernière et lorsque j’ai vérifié ma température, j’étais à 38 degrés. : Et quand est-il des nausées où alors les vomissements ? : I've vomited three times, especially after eating. I have no appetite at all. : Okay. Any diarrhea où alors de la constipation? : No, Doctor. Bowel movements are normal. : Any burning when you pass urine or going more often? : Non docteur, tout est bon de ce côté. : Okay. Okey je comprends. I'm going to press gently. You tell me when it's tender. Okay. : Ow. That hurts right there. : Okay. Okay. How about when I let go? : Worse Doctor, that really hurts. : Okay, je vais aussi mettre de pression sur le côté gauche. Let me know. Okay? : feel pain on the right side when you do that. : Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also a positive rough things sign. They are very suggestive of acute appendices. : Dr. but, is it serious? : It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP and likely an abdominal ultrasound or CT to confirm that. : Doctor, do I need surgery? : Plus au moins, plus au moins, Laparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you, okay? : Okay. Doctor, should I call my family? : Oui Oui allez-y, allez-y , c’est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l’opération, d’accord? : D’accord docteur, merci beaucoup. : Okay, You're welcome. You're welcome. We take good care of you and rest assured. Ici avec nous, c’est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D’accord madame? : D’accord 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1","wer":7.739307535641547,"text":"Bonjour madame. Je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. Understand your fat abdominal pain for at least 4 days?\n\n  Yes, doctor. It started on Sunday evening.\n\n  Okay. Can you tell me where the pain began exactly?\n\n  It was right here, in my upper belly. But now it's mostly down on the right side.\n\n  Je comprends. So it started in the upper abdomen, and moved to the right lower side. Is that—\n\n  Oui, docteur, effectivement.\n\n  Okay, okay. Was the pain sudden or gradual?\n\n  It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n\n  Okay, okay. Et est-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\n\n  No, doctor, it stays in the lower right.\n\n  Okay. Anything makes it better or worse?\n\n  Um, doctor, nothing really helps. Moving around makes it a bit worse.\n\n  Et avez-vous de la fièvre aussi?\n\n  Oui, docteur, j'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés.\n\n  Et qu'en est-il des nausées, ou alors du vomissement?\n\n  I vomited 3 times, especially after eating. I have no appetite at all.\n\n  Okay. Any diarrhea, or de la constipation?\n\n  No, doctor. Bowel movements are normal.\n\n  Any burning when you pass urine? Or going more often?\n\n  Um, no, doctor. Tout est bon de ce côté.\n\n  Okay, okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay?\n\n  Ow! That hurts right there.\n\n  Okay, okay. How about when I let go?\n\n  Worse, doctor. That really hurts.\n\n  Okay. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, okay?\n\n  Um, I feel pain on the right side when you do that.\n\n  Okay. You have tenderness. Gathering and rebound tenderness in your right lower abdomen. Also, a positive rough things sign. There are very suggestive of acute appendicitis.\n\n  Doctor, burnt? Is it serious?\n\n  It can be, if not treated. The appendix may be inflamed. And cold rupture. We need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\n\n  Doctor, um, do I need surgery?\n\n  Euh, plus ou moins, plus ou moins. Laparoscopique, but we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics. You should eat or drink anything now. In case we're going to operate you. Okay?\n\n  Okay, doctor. Should I call my family?\n\n  Euh, oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team. To see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération.\n\n  D'accord, docteur. Merci beaucoup.\n\n  Okay. You're welcome, you're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame?\n\n  D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":117,"said":"you have had","significant":false},{"start":686,"end":688,"said":"où","significant":false},{"start":776,"end":778,"said":"him","significant":false},{"start":922,"end":926,"said":"j ai","significant":false},{"start":974,"end":978,"said":"j ai","significant":false},{"start":1003,"end":1010,"said":"j étais","significant":false},{"start":1030,"end":1035,"said":"quand","significant":false},{"start":1056,"end":1058,"said":"où","significant":false},{"start":1065,"end":1085,"said":"les vomissements I've","significant":false},{"start":1178,"end":1180,"said":"où alors","significant":false},{"start":1304,"end":1319,"said":"Non docteur","significant":false},{"start":1354,"end":1359,"said":"Okey","significant":false},{"start":1575,"end":1581,"said":"","significant":false},{"start":1816,"end":1821,"said":"They","significant":false},{"start":1851,"end":1881,"said":"appendices. 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Initially upper abdomen; migrated to RLQ.\""],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Gradual onset, initially dull → sharp; severity 8/10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","\"No radiation to back or shoulders. Worse with movement; no relieving factors.\""],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever overnight; self-measured T 38°C\"; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomiting x3, especially after eating; anorexia\"."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"Denies diarrhea, constipation, dysuria, urinary frequency; bowel movements normal\"."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, RLQ rebound and \"Right-sided pain elicited with left-sided abdominal pressure\"."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"Suspected acute appendicitis\" and \"Discussed risk of appendix rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Blood tests: CBC, CRP. Abdominal US or CT for confirmation.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Possible laparoscopic surgery pending confirmation, \"Admit to hospital\", \"Surgical team review within hours\"."],["Plans IV fluids, analgesia and antibiotics.","yes","\"Start IV fluids, analgesia, and antibiotics\"."],["Encourages contacting family and provides reassurance.","partial","\"Wishes to contact family; agreed\" recorded, but clinician reassurance is not documented."]],"claims":[],"note":"Subjective\nAbdominal pain x4 days, onset Sunday evening.\nInitially upper abdomen; migrated to RLQ.\nGradual onset, initially dull → sharp; severity 8/10.\nNo radiation to back or shoulders.\nWorse with movement; no relieving factors.\nFever overnight; self-measured T 38°C.\nVomiting x3, especially after eating; anorexia.\nDenies diarrhea, constipation, dysuria, urinary frequency; bowel movements normal.\nAsked whether surgery will be required; advised possible laparoscopic surgery pending confirmation.\nWishes to contact family; agreed.\nObjective\nRLQ tenderness on palpation.\nRLQ rebound tenderness.\nRight-sided pain elicited with left-sided abdominal pressure; documented positive Rovsing sign.\nAssessment\nSuspected acute appendicitis: migratory abdominal pain to RLQ with fever, vomiting/anorexia, RLQ tenderness/rebound, and positive Rovsing sign.\nDiscussed risk of appendix rupture if untreated.\nPlan\nAdmit to hospital.\nNPO.\nStart IV fluids, analgesia, and antibiotics.\nBlood tests: CBC, CRP.\nAbdominal US or CT for confirmation.\nSurgical team review within hours; operative timing to be determined.","review":57.5,"saved":221.5,"clean":false,"effort":4.166666666666666,"sig":[]},{"label":"Run 2","wer":6.924643584521386,"text":"Bonjour madame. Je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. Understand you have had abdominal pain for at least 4 days?\n\n  Yes, doctor. It started on Sunday evening.\n\n  Okay. Can you tell me where the pain began exactly?\n\n  It was right here, in my upper belly. But now it's mostly down on the right side.\n\n  Je comprends. So it started in the upper abdomen, and moved to the right lower side. Is that—\n\n  Oui, docteur, effectivement.\n\n  Okay, okay. Was the pain sudden or gradual?\n\n  It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n\n  Okay, okay. Et est-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\n\n  No, doctor, it stays in the lower right.\n\n  Okay. Anything makes it better or worse?\n\n  Um, doctor, nothing really helps. Moving around makes it a bit worse.\n\n  Et avez-vous de la fièvre aussi?\n\n  Oui, docteur, j'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés.\n\n  Et qu'en est-il des nausées ou alors du vomissement?\n\n  I vomited 3 times. Especially after eating. I have no appetite at all.\n\n  Okay. Any diarrhea ou alors de la constipation?\n\n  No, doctor. Bowel movements are normal.\n\n  Any burning when you pass urine? Or going more often?\n\n  Um, no, doctor. Tout est bon de ce côté.\n\n  Okay, okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay?\n\n  Ow! That hurts right there.\n\n  Okay, okay. How about when I let go?\n\n  Worse, doctor. That really hurts.\n\n  Okay. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, okay?\n\n  Um, I feel pain on the right side when you do that.\n\n  Okay. You have tenderness. Gathering and rebound tenderness in your right lower abdomen. Also, a positive rough things sign. There are very suggestive of acute appendicite.\n\n  Doctor, but is it serious?\n\n  It can be, if not treated. The appendix may be inflamed. And cold rupture. We need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\n\n  Doctor, um, do I need surgery?\n\n  Euh, plus ou moins, plus ou moins. La paroscopique, but we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics. You should eat or drink anything now. In case we're going to operate you. Okay?\n\n  Okay, doctor. Should I call my family?\n\n  Euh, oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team. To see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération.\n\n  D'accord, docteur. Merci beaucoup.\n\n  Okay. You're welcome, you're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame?\n\n  D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":690,"end":692,"said":"où","significant":false},{"start":780,"end":782,"said":"him","significant":false},{"start":926,"end":930,"said":"j ai","significant":false},{"start":978,"end":982,"said":"j ai","significant":false},{"start":1007,"end":1014,"said":"j étais","significant":false},{"start":1034,"end":1039,"said":"quand","significant":false},{"start":1059,"end":1061,"said":"où","significant":false},{"start":1068,"end":1088,"said":"les vomissements I've","significant":false},{"start":1180,"end":1182,"said":"où","significant":false},{"start":1312,"end":1327,"said":"Non docteur","significant":false},{"start":1362,"end":1367,"said":"Okey","significant":false},{"start":1583,"end":1589,"said":"","significant":false},{"start":1824,"end":1829,"said":"They","significant":false},{"start":1859,"end":1881,"said":"appendices. Dr.","significant":false},{"start":1966,"end":1970,"said":"could","significant":false},{"start":2112,"end":2115,"said":"","significant":false},{"start":2122,"end":2124,"said":"au","significant":false},{"start":2137,"end":2139,"said":"au","significant":false},{"start":2147,"end":2162,"said":"Laparoscopic.","significant":false},{"start":2295,"end":2300,"said":"we are","significant":false},{"start":2374,"end":2382,"said":"","significant":false},{"start":2412,"end":2417,"said":"c est","significant":false},{"start":2587,"end":2611,"said":"l opération d accord D accord","significant":false},{"start":2679,"end":2684,"said":"We","significant":false},{"start":2740,"end":2745,"said":"c est","significant":false},{"start":2835,"end":2843,"said":"D accord","significant":false},{"start":2856,"end":2864,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","\"Abdominal pain x 4 days; onset Sunday evening\", upper abdominal migrated to RLQ."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","\"Initially dull...now sharp, 8/10\" but gradual onset not stated."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","\"Pain non-radiating; worsened by movement; no relieving factors.\""],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Reported fever overnight; self-measured T 38°C\" with no other vitals."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"vomited 3 times, particularly after eating; anorexia\"."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"Denies diarrhoea or constipation; BMs normal. Denies dysuria or urinary frequency.\""],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound, and \"RLQ pain elicited with left-sided abdominal pressure\"."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"Suspected acute appendicitis\" and \"risk of appendiceal rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Blood tests: CBC and CRP. Abdominal US and/or CT to confirm diagnosis.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","\"Admit for surgical assessment within hours\" and possible laparoscopic surgery pending confirmation."],["Plans IV fluids, analgesia and antibiotics.","yes","\"Start IV fluids, analgesia, and antibiotics.\""],["Encourages contacting family and provides reassurance.","partial","\"Patient advised to contact family\" but reassurance not recorded."]],"claims":[],"note":"Subjective\nAbdominal pain x 4 days; onset Sunday evening.\nInitially dull upper abdominal pain; migrated to RLQ and now sharp, 8/10.\nPain non-radiating; worsened by movement; no relieving factors.\nReported fever overnight; self-measured T 38°C.\nN/V: vomited 3 times, particularly after eating; anorexia.\nDenies diarrhoea or constipation; BMs normal.\nDenies dysuria or urinary frequency.\nObjective\nRLQ tenderness on palpation.\nRebound tenderness in RLQ.\nRLQ pain elicited with left-sided abdominal pressure; positive Rovsing sign.\nAssessment\nSuspected acute appendicitis.\nMigratory abdominal pain to RLQ, fever, vomiting/anorexia, RLQ tenderness with rebound, and positive Rovsing sign are suggestive.\nDiscussed risk of appendiceal rupture if untreated.\nPlan\nAdmit for surgical assessment within hours.\nBlood tests: CBC and CRP.\nAbdominal US and/or CT to confirm diagnosis.\nStart IV fluids, analgesia, and antibiotics.\nNPO pending possible surgery.\nDiscussed possible laparoscopic surgery pending diagnostic confirmation.\nPatient advised to contact family.","review":69.36842105263159,"saved":209.6315789473684,"clean":false,"effort":8.333333333333332,"sig":[],"mb":6.481635,"latency":14.951,"signable":84.31942105263158},{"label":"Run 3","wer":7.942973523421588,"text":"Bonjour madame. Je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. Understand you've had abdominal pain for at least 4 days?\n\n  Yes, doctor. It started on Sunday evening.\n\n  Okay. Can you tell me where the pain began exactly?\n\n  It was right here, in my upper belly. But now it's mostly down on the right side.\n\n  Je comprends. So it started in the upper abdomen, and moved to the right lower side. Is that—\n\n  Oui, docteur, effectivement.\n\n  Okay, okay. Was the pain sudden or gradual?\n\n  It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n\n  Okay, okay. Et est-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\n\n  No, doctor, it stays in the lower right.\n\n  Okay. Anything makes it better, or worse?\n\n  Um, doctor, nothing really helps. Moving around makes it a bit worse.\n\n  Et avez-vous de la fièvre aussi?\n\n  Oui, docteur, j'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés.\n\n  Et qu'en est-il des nausées, ou alors du vomissement?\n\n  I've vomited 3 times, especially after eating. I have no appetite at all.\n\n  Okay. Any diarrhea, or de la constipation?\n\n  No, doctor. Bon mouvement anormal.\n\n  Any burning when you pass urine? Or going more often?\n\n  Um, no, doctor. Tout est bon de ce côté.\n\n  Okay, okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay?\n\n  Ow! That hurts right there.\n\n  Okay, okay. How about when I let go?\n\n  Worse, doctor. That really hurts.\n\n  Okay. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, okay?\n\n  Um, I feel pain on the right side when you do that.\n\n  Okay. You have tenderness gathering and rebound tenderness in your right lower abdomen. Also, a positive rough things sign. There are very suggestive of acute appendicite.\n\n  Doctor, but is it serious?\n\n  It can be, if not treated. The appendix may be inflamed. And cold rupture. We need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT.\n\n  Doctor, do I need surgery?\n\n  Euh, plus ou moins, plus ou moins. Laparoscopique? But we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics. You should eat or drink anything now. In case we're going to operate you. Okay?\n\n  Okay, doctor. Should I call my family?\n\n  Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord?\n\n  D'accord, docteur. Merci beaucoup.\n\n  Okay. You're welcome, you're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame?\n\n  D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":688,"end":690,"said":"où","significant":false},{"start":778,"end":780,"said":"him","significant":false},{"start":925,"end":929,"said":"j ai","significant":false},{"start":977,"end":981,"said":"j ai","significant":false},{"start":1006,"end":1013,"said":"j étais","significant":false},{"start":1033,"end":1038,"said":"quand","significant":false},{"start":1059,"end":1061,"said":"où","significant":false},{"start":1068,"end":1082,"said":"les vomissements","significant":false},{"start":1184,"end":1186,"said":"où alors","significant":false},{"start":1222,"end":1244,"said":"Bowel movements are normal.","significant":true},{"start":1305,"end":1320,"said":"Non docteur","significant":false},{"start":1355,"end":1360,"said":"Okey","significant":false},{"start":1576,"end":1582,"said":"","significant":false},{"start":1816,"end":1821,"said":"They","significant":false},{"start":1851,"end":1873,"said":"appendices. Dr.","significant":false},{"start":1958,"end":1962,"said":"could","significant":false},{"start":2049,"end":2049,"said":"to confirm that.","significant":false},{"start":2083,"end":2086,"said":"","significant":false},{"start":2093,"end":2095,"said":"au","significant":false},{"start":2108,"end":2110,"said":"au","significant":false},{"start":2118,"end":2132,"said":"Laparoscopic.","significant":false},{"start":2265,"end":2270,"said":"we are","significant":false},{"start":2354,"end":2358,"said":"","significant":false},{"start":2377,"end":2382,"said":"c est","significant":false},{"start":2551,"end":2585,"said":"l opération d accord D accord","significant":false},{"start":2653,"end":2658,"said":"We","significant":false},{"start":2714,"end":2719,"said":"c est","significant":false},{"start":2809,"end":2817,"said":"D accord","significant":false},{"start":2830,"end":2838,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","\"Abdominal pain x ≥4 days, onset Sunday evening. Initially upper abdominal; migrated to RLQ.\""],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Gradual onset; initially dull, now sharp, 8/10.\""],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","\"Worse with movement; no relieving factors reported\" and \"no radiation to back or shoulders\"."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever overnight; reported temperature 38°C\" with no invented vitals."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomiting x3, especially after eating; anorexia.\""],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Denies diarrhea/constipation (normal bowels) and \"Denies dysuria or urinary frequency\"."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness with rebound, and \"Pain elicited in RLQ with pressure applied to left side\"."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"Suspected acute appendicitis\" and \"risk of appendiceal rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Order CBC and CRP. Obtain abdominal US and/or CT for diagnostic confirmation.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admit, surgical review within hours, laparoscopic surgery to be determined after further assessment."],["Plans IV fluids, analgesia and antibiotics.","yes","\"Start IV fluids, analgesia, and antibiotics.\""],["Encourages contacting family and provides reassurance.","no","No mention of advising the patient to contact family or of reassurance."]],"claims":[],"note":"Subjective\nAbdominal pain x ≥4 days, onset Sunday evening.\nInitially upper abdominal; migrated to RLQ.\nGradual onset; initially dull, now sharp, 8/10.\nPain localized to RLQ; no radiation to back or shoulders.\nWorse with movement; no relieving factors reported.\nFever overnight; reported temperature 38°C.\nVomiting x3, especially after eating; anorexia.\nDenies diarrhea and constipation.\nDenies dysuria or urinary frequency.\nObjective\nAbdominal examination: RLQ tenderness with rebound tenderness.\nPain elicited in RLQ with pressure applied to left side of abdomen; positive Rovsing sign.\nAssessment\nSuspected acute appendicitis.\nMigratory abdominal pain now localized to RLQ, fever, vomiting/anorexia, RLQ tenderness, rebound tenderness, and positive Rovsing sign are suggestive.\nDiscussed potential risk of appendiceal rupture if untreated.\nPlan\nAdmit to hospital.\nSurgical team review within hours; operative timing/need for laparoscopic surgery to be determined after further assessment.\nKeep NPO pending possible surgery.\nStart IV fluids, analgesia, and antibiotics.\nOrder CBC and CRP.\nObtain abdominal US and/or CT for diagnostic confirmation.","review":64.84210526315789,"saved":214.1578947368421,"clean":false,"effort":8.333333333333332,"sig":[],"mb":6.467213,"latency":12.248,"signable":77.0901052631579},{"label":"Run 4","wer":7.3319755600814664,"text":"Bonjour madame. Je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. Understand you've had abdominal pain for at least 4 days?\n\n  Yes, doctor. It started on Sunday evening.\n\n  Okay. Can you tell me where the pain began exactly?\n\n  It was right here, in my upper belly. But now it's mostly down on the right side.\n\n  Je comprends. So it started in the upper abdomen, and moved to the right lower side. Is that—\n\n  Oui, docteur, effectivement.\n\n  Okay, okay. Was the pain sudden or gradual?\n\n  It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n\n  Okay, okay. Et est-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\n\n  No, doctor, it stays in the lower right.\n\n  Okay. Anything makes it better or worse?\n\n  Um, doctor, nothing really helps. Moving around makes it a bit worse.\n\n  Et avez-vous de la fièvre aussi?\n\n  Oui, docteur, j'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés.\n\n  Et qu'en est-il des nausées, ou alors du vomissement?\n\n  I vomited 3 times, especially after eating. I have no appetite at all.\n\n  Okay. Any diarrhea, or de la constipation?\n\n  No, doctor. Bowel movements are normal.\n\n  Any burning when you pass urine? Or going more often?\n\n  Um, no, doctor. Tout est bon de ce côté.\n\n  Okay, okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay?\n\n  Ow! That hurts right there.\n\n  Okay, okay. How about when I let go?\n\n  Worse, doctor. That really hurts.\n\n  Okay. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, okay?\n\n  Um, I feel pain on the right side when you do that.\n\n  Okay. You have tenderness. Gathering and rebound tenderness in your right lower abdomen. Also, a positive rough things sign. There are very suggestive of acute appendicite.\n\n  Doctor, but is it serious?\n\n  It can be, if not treated. The appendix may be inflamed. And cold rupture. We need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\n\n  Doctor, um, do I need surgery?\n\n  Euh, plus ou moins, plus ou moins. La paroscopique— But we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics. You should eat or drink anything now. In case we're going to operate you. Okay?\n\n  Okay, doctor. Should I call my family?\n\n  Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team. To see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération.\n\n  D'accord, docteur. Merci beaucoup.\n\n  Okay. You're welcome, you're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame?\n\n  D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":688,"end":690,"said":"où","significant":false},{"start":778,"end":780,"said":"him","significant":false},{"start":924,"end":928,"said":"j ai","significant":false},{"start":976,"end":980,"said":"j ai","significant":false},{"start":1005,"end":1012,"said":"j étais","significant":false},{"start":1032,"end":1037,"said":"quand","significant":false},{"start":1058,"end":1060,"said":"où","significant":false},{"start":1067,"end":1087,"said":"les vomissements I've","significant":false},{"start":1180,"end":1182,"said":"où alors","significant":false},{"start":1306,"end":1321,"said":"Non docteur","significant":false},{"start":1356,"end":1361,"said":"Okey","significant":false},{"start":1577,"end":1583,"said":"","significant":false},{"start":1818,"end":1823,"said":"They","significant":false},{"start":1853,"end":1875,"said":"appendices. Dr.","significant":false},{"start":1960,"end":1964,"said":"could","significant":false},{"start":2106,"end":2109,"said":"","significant":false},{"start":2116,"end":2118,"said":"au","significant":false},{"start":2131,"end":2133,"said":"au","significant":false},{"start":2141,"end":2156,"said":"Laparoscopic.","significant":false},{"start":2289,"end":2294,"said":"we are","significant":false},{"start":2378,"end":2382,"said":"","significant":false},{"start":2401,"end":2406,"said":"c est","significant":false},{"start":2576,"end":2600,"said":"l opération d accord D accord","significant":false},{"start":2668,"end":2673,"said":"We","significant":false},{"start":2729,"end":2734,"said":"c est","significant":false},{"start":2824,"end":2832,"said":"D accord","significant":false},{"start":2845,"end":2853,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records '≥4 days, onset Sunday evening', initially upper abdomen now RLQ."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","'Gradual onset; initially dull, now sharp, 8/10.'"],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","'Worse with movement; no relieving factors' and no radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","'Reported fever overnight; measured temperature 38°C' with no invented vitals."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","'Vomiting x3, particularly after eating; anorexia.'"],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","'bowel motions normal' and 'Denies dysuria or urinary frequency.'"],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and RLQ pain with left-sided pressure documented."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Suspected acute appendicitis documented, but risk of rupture if untreated is not mentioned."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","'Arrange CBC, CRP, and abdominal US and/or CT to confirm diagnosis.'"],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission for surgical assessment within hours and possible laparoscopic surgery pending confirmation documented."],["Plans IV fluids, analgesia and antibiotics.","yes","'Start IV fluids, analgesia, and antibiotics.'"],["Encourages contacting family and provides reassurance.","partial","'Patient may contact family' recorded but reassurance given is not documented."]],"claims":[],"note":"Subjective\nAbdominal pain x ≥4 days, onset Sunday evening.\nPain initially upper abdomen; now localized to RLQ.\nGradual onset; initially dull, now sharp, 8/10.\nWorse with movement; no relieving factors reported.\nNo radiation to back or shoulders.\nReported fever overnight; measured temperature 38°C.\nVomiting x3, particularly after eating; anorexia.\nDenies diarrhoea or constipation; bowel motions normal.\nDenies dysuria or urinary frequency.\nObjective\nRLQ tenderness on palpation.\nRebound tenderness in RLQ.\nPain in RLQ with left-sided abdominal pressure; positive Rovsing’s sign.\nAssessment\nSuspected acute appendicitis.\nMigratory abdominal pain now localized to RLQ, fever, vomiting/anorexia, RLQ tenderness with rebound, and positive Rovsing’s sign are highly suggestive.\nPlan\nAdmit for urgent surgical assessment within hours.\nArrange CBC, CRP, and abdominal US and/or CT to confirm diagnosis.\nStart IV fluids, analgesia, and antibiotics.\nKeep NPO pending possible operative management.\nDiscussed possible laparoscopic surgery, pending confirmation and surgical team decision.\nPatient may contact family.","review":71.26315789473685,"saved":207.73684210526315,"clean":false,"effort":8.333333333333332,"sig":[],"mb":6.533421,"latency":13.206,"signable":84.46915789473685},{"label":"Run 5","wer":6.313645621181263,"text":"Bonjour madame. Je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. Understand you have had abdominal pain for at least 4 days?\n\n  Yes, doctor. It started on Sunday evening.\n\n  Okay. Can you tell me where the pain began exactly?\n\n  It was right here, in my upper belly. But now it's mostly down on the right side.\n\n  Je comprends. So it started in the upper abdomen, and moved to the right lower side. Is that—\n\n  Oui, docteur, effectivement.\n\n  Okay, okay. Was the pain sudden or gradual?\n\n  It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n\n  Okay, okay. Et est-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\n\n  No, doctor, it stays in the lower right.\n\n  Okay. Anything makes it better or worse?\n\n  Um, doctor, nothing really helps. Moving around makes it a bit worse.\n\n  Et avez-vous de la fièvre aussi?\n\n  Oui, docteur, j'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés.\n\n  Et qu'en est-il des nausées, ou alors du vomissement?\n\n  I've vomited 3 times, especially after eating. I have no appetite at all.\n\n  Okay. Any diarrhea, or de la constipation?\n\n  No, doctor. Bowel movements are normal.\n\n  Any burning when you pass urine? Or going more often?\n\n  Um, no, doctor. Tout est bon de ce côté.\n\n  Okay, okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay?\n\n  Ow! That hurts right there.\n\n  Okay, okay. How about when I let go?\n\n  Worse, doctor. That really hurts.\n\n  Okay. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, okay?\n\n  Um, I feel pain on the right side when you do that.\n\n  Okay. You have tenderness. Gathering and rebound tenderness in your right lower abdomen. Also, a positive rough things sign. There are very suggestive of acute appendicite.\n\n  Doctor, but is it serious?\n\n  It can be, if not treated. The appendix may be inflamed. And cold rupture. We need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\n\n  Doctor, um, do I need surgery?\n\n  Euh, plus ou moins, plus ou moins. Laparoscopique. But we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics. You should eat or drink anything now. In case we're going to operate you. Okay?\n\n  Okay, doctor. Should I call my family?\n\n  Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team. To see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord?\n\n  D'accord, docteur. Merci beaucoup.\n\n  Okay. You're welcome, you're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame?\n\n  D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":690,"end":692,"said":"où","significant":false},{"start":780,"end":782,"said":"him","significant":false},{"start":926,"end":930,"said":"j ai","significant":false},{"start":978,"end":982,"said":"j ai","significant":false},{"start":1007,"end":1014,"said":"j étais","significant":false},{"start":1034,"end":1039,"said":"quand","significant":false},{"start":1060,"end":1062,"said":"où","significant":false},{"start":1069,"end":1083,"said":"les vomissements","significant":false},{"start":1185,"end":1187,"said":"où alors","significant":false},{"start":1311,"end":1326,"said":"Non docteur","significant":false},{"start":1361,"end":1366,"said":"Okey","significant":false},{"start":1582,"end":1588,"said":"","significant":false},{"start":1823,"end":1828,"said":"They","significant":false},{"start":1858,"end":1880,"said":"appendices. Dr.","significant":false},{"start":1965,"end":1969,"said":"could","significant":false},{"start":2111,"end":2114,"said":"","significant":false},{"start":2121,"end":2123,"said":"au","significant":false},{"start":2136,"end":2138,"said":"au","significant":false},{"start":2146,"end":2161,"said":"Laparoscopic.","significant":false},{"start":2293,"end":2298,"said":"we are","significant":false},{"start":2382,"end":2386,"said":"","significant":false},{"start":2405,"end":2410,"said":"c est","significant":false},{"start":2580,"end":2614,"said":"l opération d accord D accord","significant":false},{"start":2682,"end":2687,"said":"We","significant":false},{"start":2743,"end":2748,"said":"c est","significant":false},{"start":2838,"end":2846,"said":"D accord","significant":false},{"start":2859,"end":2867,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","'≥4 days; onset Sunday evening. Initially upper abdominal, migrated to RLQ.'"],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","'Gradual onset; initially dull, now sharp, 8/10.'"],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","'Worse with movement; no relieving factors. No radiation.'"],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","'Reports fever overnight; home temperature 38°C' with no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","'N/V x3, particularly after eating; anorexia.'"],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Denies diarrhoea, constipation, dysuria and frequency, capturing normal bowels and no urinary symptoms."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound, and 'left-sided pressure elicited right-sided pain' documented."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Suspected acute appendicitis and 'risk of appendiceal rupture if untreated' documented."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","'CBC and CRP; abdominal US and/or CT to confirm diagnosis.'"],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission for surgical review within hours and possible laparoscopic surgery documented."],["Plans IV fluids, analgesia and antibiotics.","yes","'Start IV fluids, analgesia, and antibiotics.'"],["Encourages contacting family and provides reassurance.","no","Neither encouragement to contact family nor reassurance is documented."]],"claims":[],"note":"Subjective\nAbdominal pain x ≥4 days; onset Sunday evening.\nInitially upper abdominal, migrated to RLQ.\nGradual onset; initially dull, now sharp, 8/10.\nWorse with movement; no relieving factors. No radiation.\nReports fever overnight; home temperature 38°C.\nN/V x3, particularly after eating; anorexia.\nDenies diarrhoea, constipation, dysuria, and urinary frequency.\nObjective\nRLQ tenderness on palpation.\nRebound tenderness in RLQ.\nPositive Rovsing’s sign: left-sided pressure elicited right-sided pain.\nAssessment\nSuspected acute appendicitis.\nMigratory abdominal pain to RLQ with fever, vomiting/anorexia, RLQ tenderness, rebound tenderness, and positive Rovsing’s sign are suggestive of acute appendicitis.\nDiscussed potential risk of appendiceal rupture if untreated.\nPlan\nAdmit for urgent surgical review within hours.\nCBC and CRP; abdominal US and/or CT to confirm diagnosis.\nStart IV fluids, analgesia, and antibiotics.\nKeep NPO pending possible laparoscopic surgery.\nSurgical team to determine operative need and timing.","review":60.10526315789473,"saved":218.89473684210526,"clean":false,"effort":8.333333333333332,"sig":[],"mb":6.489308,"latency":15.498,"signable":75.60326315789473}],"heidi":[{"label":"Run 1","wer":12.219959266802444,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd'hui. So please have a seat. I understand you have had abdominal pain for at least four days ?\n\nYes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now it's mostly down on the right side. So it started in the upper abdomen and moved to the right\n\nLower side. Is that- Right doctor, effectively now. Okay, okay. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp, about eight out of ten. Okay, okay. Et est-ce que la douleur se propage autre part ? Par exemple, votre dos ou alors, euh, vos épaules ? No, doctor. It stays in the lower right. Okay. Anything makes it better or worse? Mm, doctor, nothing really helps.\n\nMoving around makes it a bit worse. Et avez-vous de la fièvre aussi ? Oui docteur, j'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à trente-huit degrés. Et qu'en est-il des nausées ou alors du vomissement ? I vomited three times, especially after eating. I have no appetite at all. OK. Any diarrhea ou alors euh, de la constipation ? No doctor. Bowel movements are normal.\n\nAny burning when you pass urine or going more often? Euh, none doctor. Tout est bon de ce côté. OK, OK. Je comprends. I'm going to press gently. You tell me when it's tender, OK ? Aouch ! That hurts right there. Mh. OK, OK. How about when I let go? Worse, doctor. That really hurts. OK. Je vais aussi, euh, mettre un peu de pression sur le côté gauche.\n\nLet me know, okay? Mm, I feel pain on the right side when you do that. Okay. You have tenderness, guarding, and rebound tenderness in your right lower abdomen. Also, a positive Rovsing's sign. They are very suggestive of acute appendicitis. Dr. Bert, is it serious? It can be if not treated.\n\nThe appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, mm, do I need surgery? Eh, presumably, presumably laparoscopic. But we will confirm first. I'm going to start IV fluid.\n\nPain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. OK? OK, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est, c'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ?\n\nD'accord docteur. Merci beaucoup. OK. You're welcome. You're welcome. We'll take, euh, good care of you and, euh, rest assured ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":80,"said":"aujourd hui.","significant":false},{"start":343,"end":343,"said":"Je comprends.","significant":false},{"start":418,"end":454,"said":"that Oui docteur effectivement.","significant":false},{"start":670,"end":672,"said":"où","significant":false},{"start":680,"end":683,"said":"","significant":false},{"start":761,"end":763,"said":"him","significant":false},{"start":899,"end":903,"said":"j ai","significant":false},{"start":950,"end":954,"said":"j ai","significant":false},{"start":979,"end":986,"said":"j étais","significant":false},{"start":989,"end":1000,"said":"38","significant":false},{"start":1012,"end":1017,"said":"quand","significant":false},{"start":1037,"end":1039,"said":"où","significant":false},{"start":1046,"end":1064,"said":"les vomissements I've","significant":false},{"start":1155,"end":1157,"said":"où","significant":false},{"start":1164,"end":1167,"said":"","significant":false},{"start":1283,"end":1300,"said":"Non docteur","significant":false},{"start":1326,"end":1333,"said":"Okay. Okey","significant":false},{"start":1405,"end":1415,"said":"Okay. Ow.","significant":false},{"start":1442,"end":1453,"said":"Okay. Okay.","significant":false},{"start":1532,"end":1535,"said":"","significant":false},{"start":1544,"end":1550,"said":"","significant":false},{"start":1682,"end":1690,"said":"gathering","significant":false},{"start":1761,"end":1770,"said":"rough things","significant":false},{"start":1811,"end":1824,"said":"appendices.","significant":false},{"start":1829,"end":1833,"said":"but","significant":false},{"start":2050,"end":2076,"said":"Plus au moins plus au moins","significant":false},{"start":2302,"end":2306,"said":"","significant":false},{"start":2325,"end":2337,"said":"c est","significant":false},{"start":2506,"end":2539,"said":"l opération d accord D accord","significant":false},{"start":2601,"end":2606,"said":"We","significant":false},{"start":2613,"end":2616,"said":"","significant":false},{"start":2640,"end":2643,"said":"","significant":false},{"start":2673,"end":2678,"said":"c est","significant":false},{"start":2741,"end":2749,"said":"","significant":false},{"start":2777,"end":2785,"said":"D accord","significant":false},{"start":2796,"end":2804,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","partial","Four days and upper abdomen to RLQ migration recorded, but Sunday evening onset omitted."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","\"Gradual onset\" and \"Now sharp, 8/10\" recorded, but the initial dull character is omitted."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","\"Movement exacerbates pain; no relieving factors\"; \"No radiation to back or shoulders\"."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever last night, temp 38°C\"; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomiting x3, particularly after eating; complete loss of appetite.\""],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"Bowel movements normal\"; \"No dysuria or increased urinary frequency.\""],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","Tenderness and rebound tenderness in RLQ plus \"Positive Rovsing's sign\"."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"highly suggestive of acute appendicitis\"; \"at risk of rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Bloods: FBC, CRP\" (FBC = CBC) and \"Abdominal ultrasound or CT to confirm diagnosis\"."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Laparoscopic surgery to confirm after investigations, admission, surgical review within hours."],["Plans IV fluids, analgesia and antibiotics.","yes","\"Commence IV fluids, analgesia and antibiotics.\""],["Encourages contacting family and provides reassurance.","partial","\"Encouraged to contact family\" recorded, but reassurance is not."]],"claims":[],"note":"Subjective\n\n- Gradual onset abdominal pain x4 days, beginning in upper abdomen and migrating to RLQ\n\n- Now sharp, 8/10\n\n- Movement exacerbates pain; no relieving factors\n\n- No radiation to back or shoulders\n\n- Fever last night, temp 38°C\n\n- Vomiting x3, particularly after eating; complete loss of appetite\n\n- Bowel movements normal; no diarrhoea or constipation\n\n- No dysuria or increased urinary frequency\n\n\n\n\nObjective\n\n- Abdominal exam: tenderness, guarding and rebound tenderness in RLQ\n\n- Positive Rovsing's sign\n\n\n\n\nAssessment\n\n- Findings highly suggestive of acute appendicitis\n\n- Appendix may be inflamed and at risk of rupture if untreated\n\n\n\n\nPlan\n\n- Bloods: FBC, CRP\n\n- Abdominal ultrasound or CT to confirm diagnosis\n\n- Presumed laparoscopic surgery; to confirm after investigations\n\n- Commence IV fluids, analgesia and antibiotics\n\n- NBM in preparation for potential surgery\n\n- Admission to hospital\n\n- Surgical team review within hours to schedule surgery and provide timeframe\n\n- Encouraged to contact family","review":85.14473684210526,"saved":193.85526315789474,"clean":false,"effort":12.5,"sig":[],"mb":33.655297,"latency":23.486,"signable":108.63073684210526},{"label":"Run 2","wer":12.627291242362526,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. I understand you have had abdominal pain\n\nFor at least four days? Yes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now it's mostly down on the right side.\n\nJe comprends. So it started in the upper abdomen and moved to the right lower side. Is that? Right, Doctor. Effectivement. OK, OK. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp, about eight out of ten. OK, OK. Et est-ce que la douleur se propage autre part ? Par exemple, votre dos ou alors, euh, vos épaules ? No, Doctor. It stays in the lower right. OK. Anything makes it better or worse?\n\nEuh, docteur, nothing really helps. Moving around makes it a bit worse. Et avez-vous de la fièvre aussi ? Oui docteur, j'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à trente-huit degrés. Et qu'en est-il des nausées ou alors du vomissement ? I vomited three times, especially after eating. I have no appetite at all. OK. Any diarrhea ou alors, euh, de la constipation ? No, doctor.\n\nBowel movements are normal. Any burning when you pass urine or going more often? Mm, none, doctor. Tutto è buon, tutto è buon. Okay. Okay. Je comprends. I'm going to press gently. You tell me when it's tender, okay? Ow! That hurts right there. Mm. Okay. Okay. How about when I let go? Worse, doctor. That really hurts. Okay. Je vais aussi, euh...\n\nmettre un peu de pression sur le côté gauche. Let me know, okay? Euh, I feel pain on the right side when you do that. Ok. You have tenderness, gathering and rebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis. Doctor Bert, is it serious?\n\nIt can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, um, do I need surgery? Uh, plus or minus, plus or minus laparoscopic. But we will confirm first. I'm going to start IV fluid.\n\nPain relief and antibiotics. You should eat or drink anything now in case we're going to operate you. OK? OK, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est, c'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ?\n\nD'accord docteur. Merci beaucoup. OK. You're welcome. You're welcome. We'll take, euh, good care of you and, euh, rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":434,"end":448,"said":"Oui docteur","significant":false},{"start":671,"end":673,"said":"où","significant":false},{"start":681,"end":684,"said":"","significant":false},{"start":760,"end":762,"said":"him","significant":false},{"start":781,"end":793,"said":"Doctor","significant":false},{"start":900,"end":904,"said":"j ai","significant":false},{"start":951,"end":955,"said":"j ai","significant":false},{"start":980,"end":987,"said":"j étais","significant":false},{"start":990,"end":1001,"said":"38","significant":false},{"start":1013,"end":1018,"said":"quand","significant":false},{"start":1038,"end":1040,"said":"où","significant":false},{"start":1047,"end":1065,"said":"les vomissements I've","significant":false},{"start":1156,"end":1158,"said":"où","significant":false},{"start":1166,"end":1169,"said":"","significant":false},{"start":1286,"end":1331,"said":"Non docteur tout est bon de ce côté.","significant":false},{"start":1338,"end":1343,"said":"Okey","significant":false},{"start":1545,"end":1551,"said":"","significant":false},{"start":1560,"end":1566,"said":"","significant":false},{"start":1618,"end":1624,"said":"","significant":false},{"start":1774,"end":1783,"said":"rough things","significant":false},{"start":1824,"end":1849,"said":"appendices. Dr. but","significant":false},{"start":2075,"end":2083,"said":"au moins","significant":false},{"start":2090,"end":2098,"said":"au moins","significant":false},{"start":2244,"end":2249,"said":"we are","significant":false},{"start":2323,"end":2327,"said":"","significant":false},{"start":2346,"end":2358,"said":"c est","significant":false},{"start":2527,"end":2560,"said":"l opération d accord D accord","significant":false},{"start":2622,"end":2627,"said":"We","significant":false},{"start":2634,"end":2637,"said":"","significant":false},{"start":2661,"end":2664,"said":"","significant":false},{"start":2695,"end":2700,"said":"c est","significant":false},{"start":2763,"end":2771,"said":"","significant":false},{"start":2799,"end":2807,"said":"D accord","significant":false},{"start":2818,"end":2826,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","partial","Records onset \"since Sunday evening\" and upper abdomen moving to RLQ, but does not state the four-day duration."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Gradual onset\", \"Initially dull ache... now sharp, 8/10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","\"Exacerbated by movement\" and \"No radiation\" recorded, but nothing relieving it is omitted."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever 38°C last night\" with no other invented vitals."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomiting x3, particularly post-prandial\" and \"Loss of appetite\"."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"Normal bowel movements\" and \"No dysuria or increased urinary frequency\"."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","\"Tenderness RLQ\", \"Rebound tenderness RLQ\", \"Positive Rovsing's sign\"."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","\"highly suggestive of acute appendicitis\" but no mention of rupture risk if untreated."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"FBC, CRP; abdominal ultrasound or CT to confirm diagnosis\" (FBC equivalent to CBC)."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","\"Admit\" and \"Surgical team review within hours... (laparoscopic appendectomy +/-)\" after confirmatory imaging."],["Plans IV fluids, analgesia and antibiotics.","yes","\"IV fluids\", \"Analgesia\", \"Antibiotics\"."],["Encourages contacting family and provides reassurance.","partial","\"Advised to contact family\" captured; reassurance not recorded."]],"claims":[],"note":"Subjective\n\n- Gradual onset abdominal pain since Sunday evening.\n\n- Initially dull ache in upper abdomen, now sharp, 8/10, localised to RLQ.\n\n- Exacerbated by movement.\n\n- No radiation.\n\n- Fever 38°C last night.\n\n- Vomiting x3, particularly post-prandial.\n\n- Loss of appetite.\n\n- Normal bowel movements.\n\n- No dysuria or increased urinary frequency.\n\n\n\n\nObjective\n\n- Abdominal exam:\n\n  - Tenderness RLQ.\n\n  - Guarding RLQ.\n\n  - Rebound tenderness RLQ.\n\n  - Positive Rovsing's sign.\n\n\n\n\nAssessment\n\n- Clinical presentation highly suggestive of acute appendicitis.\n\n\n\n\nPlan\n\n- Admit for further management.\n\n- IV fluids.\n\n- Analgesia.\n\n- Antibiotics.\n\n- NBM in preparation for potential surgery.\n\n- Investigations: FBC, CRP; abdominal ultrasound or CT to confirm diagnosis.\n\n- Surgical team review within hours for assessment and surgical planning (laparoscopic appendectomy +/-).\n\n- Advised to contact family.","review":92.55263157894737,"saved":186.44736842105263,"clean":false,"effort":16.666666666666664,"sig":[],"mb":29.963303,"latency":28.073,"signable":120.62563157894738},{"label":"Run 3","wer":11.405295315682281,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd'hui. Please have a seat. I understand\n\nYou have had abdominal pain for at least four days? Yes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now\n\nIt's mostly down on the right side Je comprends. So it started in the upper abdomen and moved to the right lower side. Is that- Right doctor. Effectivement Okay. Okay. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp. About eight out of 10. Okay. Okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos ou alors, euh, vos épaules? No, doctor. It stays in the lower right\n\nOkay. Anything makes it better or worse? Hmm, doctor, nothing really helps. Moving around makes it a bit worse. Et avez-vous de la fièvre aussi? Oui, docteur. J'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à trente-huit degrés. Et qu'en est-il des nausées ou alors du vomissement? I vomited three times, especially after eating. I have no appetite at all. Okay. Any diarrhea?\n\nOu alors, euh, de la constipation? No, doctor. Bowel movements are normal. Any burning when you pass urine or going more often? Mmh. Non, docteur. Tout est bon de ce côté. Ok, ok. Je comprends. I'm going to press gently. You tell me when it's tender, OK? Aww, that hurts right there. Mmh. Ok, ok. How about when I let go?\n\nWorse, doctor. That really hurts. Okay. Je vais aussi, euh, mettre un peu de pression sur le côté gauche. Let me know, okay? Hmm, I feel pain on the right side when you do that. Okay. You have tenderness, gathering and rebound tenderness in your right lower abdomen. Also, a positive Rovsing's sign. They are very suggestive of acute appendicitis\n\nDr. Bert, is it serious? It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, um, do I need surgery? Eh, please hold on, please hold on.\n\nLaparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You shouldn't eat or drink anything now in case we're going to operate you. Okay? Okay, doctor. Should I call my family? Uh, oui, oui, oui. フランス語 We will admit you and have the surgical team to see\n\nWithin the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ? D'accord, docteur. Merci beaucoup. Ok. You're welcome. You're welcome. We take uh, good care of you and uh, rest assured. Ici, avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":427,"end":446,"said":"that Oui docteur","significant":false},{"start":674,"end":676,"said":"où","significant":false},{"start":684,"end":687,"said":"","significant":false},{"start":764,"end":766,"said":"him","significant":false},{"start":902,"end":906,"said":"j ai","significant":false},{"start":953,"end":957,"said":"j ai","significant":false},{"start":982,"end":989,"said":"j étais","significant":false},{"start":992,"end":1003,"said":"38","significant":false},{"start":1015,"end":1020,"said":"quand","significant":false},{"start":1040,"end":1042,"said":"où","significant":false},{"start":1049,"end":1066,"said":"les vomissements I've","significant":false},{"start":1161,"end":1163,"said":"où","significant":false},{"start":1171,"end":1174,"said":"","significant":false},{"start":1289,"end":1293,"said":"","significant":false},{"start":1333,"end":1340,"said":"Okay. Okey","significant":false},{"start":1412,"end":1419,"said":"Okay. Ow.","significant":false},{"start":1445,"end":1457,"said":"Okay. Okay.","significant":false},{"start":1539,"end":1542,"said":"","significant":false},{"start":1551,"end":1557,"said":"","significant":false},{"start":1768,"end":1777,"said":"rough things","significant":false},{"start":1818,"end":1830,"said":"appendices.","significant":false},{"start":1836,"end":1840,"said":"but","significant":false},{"start":2056,"end":2091,"said":"Plus au moins plus au moins","significant":false},{"start":2196,"end":2205,"said":"should","significant":false},{"start":2240,"end":2245,"said":"we are","significant":false},{"start":2327,"end":2337,"said":"allez-y allez-y c est important.","significant":false},{"start":2496,"end":2528,"said":"l opération d accord D accord","significant":false},{"start":2658,"end":2663,"said":"c est","significant":false},{"start":2726,"end":2734,"said":"","significant":false},{"start":2762,"end":2770,"said":"D accord","significant":false},{"start":2781,"end":2789,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","\"Abdominal pain x4 days, commenced Sunday evening\"; began upper abdomen, now right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Gradual onset, initially dull ache, now sharp, rated 8/10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","\"Movement exacerbates pain; nothing relieves\" and \"No radiation to back or shoulders\"."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever last night, temp 38°C\" with no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomited x3, particularly after eating; no appetite\"."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"Bowels normal\" and \"Denies dysuria or increased urinary frequency\"."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","Right lower tenderness with rebound and positive Rovsing's sign."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"highly suggestive of acute appendicitis\" and \"at risk of rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Bloods: FBC, CRP\" and \"abdominal ultrasound or CT to confirm diagnosis\"."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical review for potential laparoscopic appendicectomy, but 'within hours' is omitted."],["Plans IV fluids, analgesia and antibiotics.","yes","\"Commence IV fluids\", \"Administer analgesia\", \"Commence antibiotics\"."],["Encourages contacting family and provides reassurance.","partial","States \"Family notified\" rather than patient encouraged to call family; no reassurance recorded."]],"claims":[["Family notified of admission and potential surgery","Transcript only has the doctor telling the patient to go ahead and call her family; no notification is recorded as having occurred."]],"note":"Subjective\n\n- Abdominal pain x4 days, commenced Sunday evening\n\n- Pain began in upper abdomen, now localised to right lower side\n\n- Gradual onset, initially dull ache, now sharp, rated 8/10\n\n- No radiation to back or shoulders\n\n- Movement exacerbates pain; nothing relieves\n\n- Fever last night, temp 38°C\n\n- Vomited x3, particularly after eating; no appetite\n\n- Bowels normal\n\n- Denies dysuria or increased urinary frequency\n\n\n\n\nObjective\n\n- Tenderness, guarding and rebound tenderness in right lower abdomen\n\n- Positive Rovsing's sign\n\n\n\n\nAssessment\n\n- Findings highly suggestive of acute appendicitis\n\n- Appendix may be inflamed and at risk of rupture if untreated\n\n\n\n\nPlan\n\n- Admit for further management\n\n- Commence IV fluids\n\n- Administer analgesia\n\n- Commence antibiotics\n\n- NBM in anticipation of potential surgery\n\n- Bloods: FBC, CRP\n\n- Imaging: abdominal ultrasound or CT to confirm diagnosis\n\n- Surgical team review to determine timing for potential laparoscopic appendicectomy\n\n- Family notified of admission and potential surgery","review":80.89473684210526,"saved":198.10526315789474,"clean":false,"effort":16.666666666666664,"sig":[],"mb":29.104869,"latency":40.373,"signable":121.26773684210525},{"label":"Run 4","wer":14.25661914460285,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd'hui. So please have a seat. I understand you have had abdominal pain for at least four days\n\nYes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now it's mostly down on the right side. So it started in the upper abdomen and moved to the right\n\nLower side. Is that- Right doctor. Effective now. Okay. Okay. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp, about eight out of ten. Okay. Okay. No, doctor. It stays in the lower right. Okay. Anything makes it better or worse? Mm, doctor, nothing really helps.\n\nMoving around makes it a bit worse. Et avez-vous de la fièvre aussi ? Oui docteur, j'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement ? I vomited three times, especially after eating. I have no appetite at all. OK. Any diarrhea ou alors, euh, de la constipation ? No doctor. Bowel movements are normal.\n\nAny burning when you pass urine or going more often? Euh, non, docteur. Tout est bon de ce côté. OK, OK. Je comprends. I'm going to press gently. You tell me when it's tender, OK ? Aouch ! That hurts right there. Mh. OK, OK. How about when I let go ? Worse, docteur. That really hurts. OK. Je vais aussi, euh, mettre un peu de pression sur le côté gauche.\n\nLet me know, okay? Mm, I feel pain on the right side when you do that. Okay. You have tenderness, guarding, and rebound tenderness in your right lower abdomen. Also, a positive Rovsing's sign. They are very suggestive of acute appendicitis. Dr. Berg, is it serious? It can be if not treated.\n\nThe appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, mm, do I need surgery? Eh, plus or moins, plus or moins. Laparoscopic. But we will confirm first. I'm going to start IV fluid.\n\nPain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. OK? OK, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est, c'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ?\n\nD'accord docteur. Merci beaucoup. OK. You're welcome. You're welcome. We'll take, euh, good care of you and, euh, rest assured, ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":80,"said":"aujourd hui.","significant":false},{"start":341,"end":341,"said":"Je comprends.","significant":false},{"start":416,"end":450,"said":"that Oui docteur effectivement.","significant":false},{"start":593,"end":593,"said":"Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":656,"end":658,"said":"him","significant":false},{"start":794,"end":798,"said":"j ai","significant":false},{"start":845,"end":849,"said":"j ai","significant":false},{"start":874,"end":881,"said":"j étais","significant":false},{"start":898,"end":903,"said":"quand","significant":false},{"start":923,"end":925,"said":"où","significant":false},{"start":932,"end":950,"said":"les vomissements I've","significant":false},{"start":1041,"end":1043,"said":"où","significant":false},{"start":1051,"end":1054,"said":"","significant":false},{"start":1170,"end":1173,"said":"","significant":false},{"start":1214,"end":1221,"said":"Okay. 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Please have a seat. I understand\n\nYou have had abdominal pain for at least four days? Yes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now\n\nIt's mostly down on the right side. You comprend. So it started in the upper abdomen and moved to the right lower side. Is that- Right doctor. Effectivement Okay. Okay. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp, about eight out of ten. Okay. Okay. No, doctor. It stays in the lower right.\n\nOkay. Anything makes it better or worse? Hmm, doctor, nothing really helps. Moving around makes it a bit worse. Et avez-vous de la fièvre aussi ? Oui, docteur. J'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à trente-huit degrés. Et qu'en est-il des nausées ou alors du vomissement ? I vomited three times, especially after eating. I have no appetite at all. Okay. Any diarrhea?\n\nOu alors, euh, de la constipation? No, doctor. Bowel movements are normal. Any burning when you pass urine or going more often? Mmh. Non, docteur. Tout est bon de ce côté. Ok, ok. Je comprends. I'm going to press gently. You tell me when it's tender, OK? Aww, that hurts right there. Mmh. Ok, ok. How about when I let go?\n\nWorse, doctor. That really hurts. Okay. Je vais aussi, euh, mettre un peu de pression sur le côté gauche. Let me know, okay? Hmm. I feel pain on the right side when you do that. Hmm, okay. You have tenderness, gathering and rebound tenderness in your right lower abdomen. Also, a positive Rovsing's sign. They are very suggestive of acute appendicitis\n\nDr. Burke, is it serious? It can be if not treated. The appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, mm, do I need surgery? Eh, presume one, presume one.\n\nLaparoscopic. But we will confirm first. I'm going to start IV fluid, pain relief and antibiotics. You shouldn't eat or drink anything now in case we're going to operate you. Okay? Okay, doctor. Should I call my family? Uh, oui, oui, oui. We will admit you and have the surgical team to see\n\nWithin the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ? D'accord, docteur. Merci beaucoup. Ok. You're welcome. You're welcome. We take uh good care of you and uh rest assured. Ici, avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":341,"end":354,"said":"Je comprends.","significant":false},{"start":428,"end":447,"said":"that Oui docteur","significant":false},{"start":604,"end":604,"said":"Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":668,"end":670,"said":"him","significant":false},{"start":807,"end":811,"said":"j ai","significant":false},{"start":858,"end":862,"said":"j ai","significant":false},{"start":887,"end":894,"said":"j étais","significant":false},{"start":897,"end":908,"said":"38","significant":false},{"start":920,"end":925,"said":"quand","significant":false},{"start":945,"end":947,"said":"où","significant":false},{"start":954,"end":972,"said":"les vomissements I've","significant":false},{"start":1067,"end":1069,"said":"où","significant":false},{"start":1077,"end":1080,"said":"","significant":false},{"start":1195,"end":1199,"said":"","significant":false},{"start":1239,"end":1246,"said":"Okay. 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So please have a seat. I understand you have had abdominal pain for at least four days\n\nYes, doctor. It started on Sunday evening. Okay. Can you tell me where the pain began exactly? It was right here in my upper belly, but now it's mostly down on the right side. You confirm. So it started in the upper abdomen and moved to the right\n\nLower side. Is that- Right Doctor, if that you remember Okay, okay. Was the pain sudden or gradual? It was gradual. Just a dull ache at first, but now it's sharp, about eight out of ten. Okay, okay. Et est-ce que la douleur se propage autre part? Par exemple, votre dos ou alors, euh, vos épaules? No, doctor. It stays in the lower right. Okay. Anything makes it better or worse? Mm, doctor, nothing really helps\n\nMoving around makes it a bit worse. Et avez-vous de la fièvre aussi ? Oui, docteur. J'ai fait de la fièvre la nuit dernière et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement ? I vomited three times, especially after eating. I have no appetite at all. OK. Any diarrhea ou alors, euh, de la constipation ? No, doctor. Bowel movements are normal.\n\nAny burning when you pass urine or going more often? Mh, non, docteur. Tout est bon de ce côté. OK, OK. Je comprends. I'm going to press gently. You tell me when it's tender, OK ? Aouch! That hurts right there. Mh, OK, OK. How about when I let go? Worse, doctor. That really hurts. OK. Je vais aussi, euh, mettre un peu de pression sur le côté gauche.\n\nLet me know, okay? Mm, I feel pain on the right side when you do that. Mm, okay. You have tenderness, gathering and rebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis. Dr. Bert, is it serious? It can be if not treated.\n\nThe appendix may be inflamed and could rupture. We need to do blood work, CBC, CRP, and likely an abdominal ultrasound or CT to confirm that. Doctor, um, do I need surgery? Uh, plus or minus, plus or minus. Laparoscopic. But we will confirm first. I'm going to start IV fluid.\n\nPain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. OK? OK, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est, c'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord ?\n\nD'accord docteur. Merci beaucoup. OK. You're welcome. You're welcome. We take, euh, good care of you and, euh, rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et pro-- et solution à votre problème. D'accord, madame ? D'accord, docteur.","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":65,"end":80,"said":"aujourd hui.","significant":false},{"start":342,"end":354,"said":"Je comprends.","significant":false},{"start":429,"end":451,"said":"","significant":false},{"start":457,"end":469,"said":"Oui docteur effectivement.","significant":false},{"start":684,"end":686,"said":"où","significant":false},{"start":694,"end":697,"said":"","significant":false},{"start":774,"end":776,"said":"him","significant":false},{"start":912,"end":916,"said":"j ai","significant":false},{"start":963,"end":967,"said":"j ai","significant":false},{"start":992,"end":999,"said":"j étais","significant":false},{"start":1016,"end":1021,"said":"quand","significant":false},{"start":1041,"end":1043,"said":"où","significant":false},{"start":1050,"end":1068,"said":"les vomissements I've","significant":false},{"start":1159,"end":1161,"said":"où","significant":false},{"start":1169,"end":1172,"said":"","significant":false},{"start":1289,"end":1291,"said":"","significant":false},{"start":1332,"end":1339,"said":"Okay. 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Okay.","significant":false},{"start":1537,"end":1540,"said":"","significant":false},{"start":1549,"end":1555,"said":"","significant":false},{"start":1769,"end":1778,"said":"rough things","significant":false},{"start":1819,"end":1832,"said":"appendices.","significant":false},{"start":1837,"end":1841,"said":"but","significant":false},{"start":2067,"end":2075,"said":"au moins","significant":false},{"start":2082,"end":2091,"said":"au moins","significant":false},{"start":2317,"end":2321,"said":"","significant":false},{"start":2340,"end":2352,"said":"c est","significant":false},{"start":2521,"end":2554,"said":"l opération d accord D accord","significant":false},{"start":2625,"end":2628,"said":"","significant":false},{"start":2652,"end":2655,"said":"","significant":false},{"start":2686,"end":2691,"said":"c est","significant":false},{"start":2754,"end":2762,"said":"","significant":false},{"start":2790,"end":2798,"said":"D accord","significant":false},{"start":2809,"end":2817,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","x4 days from Sunday evening, upper abdomen now RIF."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","Dull then sharp, 8/10 recorded but gradual onset not stated."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","No radiation and worse with movement recorded; lack of relieving factors omitted."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","\"Fever last night, temp 38°C\"."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Vomiting x3 after eating; no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Bowels normal; no dysuria or frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RIF tenderness, rebound tenderness, positive Rovsing sign."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Acute appendicitis identified but rupture risk not recorded."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Ix: FBC, CRP, abdominal US or CT\"."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission, surgical review within hours, likely laparoscopic appendicectomy if confirmed."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief, antibiotics."],["Encourages contacting family and provides reassurance.","partial","\"Family to be informed\" recorded; no reassurance documented."]],"claims":[],"note":"Subjective\n\n- Abdominal pain x4 days, commenced Sunday evening\n\n- Initially dull ache in upper abdomen, now sharp and localised to RIF, severity 8/10\n\n- No radiation to back or shoulders\n\n- Worsened by movement\n\n- Fever last night, temp 38°C\n\n- Vomiting x3, particularly after eating; no appetite\n\n- Bowels normal, no diarrhoea or constipation\n\n- No dysuria or increased urinary frequency\n\n\n\n\nObjective\n\n- Abdominal exam: tenderness, guarding and rebound tenderness in RIF\n\n- Positive Rovsing's sign\n\n\n\n\nAssessment\n\n- Clinical findings highly suggestive of acute appendicitis\n\n\n\n\nPlan\n\n- IV fluids commenced\n\n- Pain relief administered\n\n- Antibiotics commenced\n\n- NBM in preparation for potential surgery\n\n- Ix: FBC, CRP, abdominal US or CT\n\n- Admission to hospital\n\n- Surgical team review within hours for assessment and surgical planning (likely laparoscopic appendicectomy if confirmed)\n\n- Family to be informed","review":89.59210526315789,"saved":189.4078947368421,"clean":false,"effort":16.666666666666664,"sig":[],"mb":34.012023,"latency":25.762,"signable":115.35410526315789}],"freed":[{"label":"Run 1","wer":26.476578411405292,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd 'hui. Please have a seat. I understand you have had abdominal pain for at least 4 days?\n  Yes doctor, it started on Sunday evening.\n  Okay, can you tell me where the pain began exactly?\n  It was right here in my upper belly. It's mostly down on the right side.\n  So it started in the upper abdomen and moved to the right lower side.\n  Was the pain sudden or gradual? It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n  Does the pain spread elsewhere? For example, your back or your shoulders?\n  No, doctor. It stays in the lower right.\n  Anything makes it better or worse?\n  Doctor, nothing really helps. Moving around makes it a bit worse.\n  Do you have a fever too?\n  Yes, Doctor. I had a fever last night, and when I checked my temperature, I was at 38 degrees.\n  And what about nausea, or vomiting?\n  I vomited 3 times, especially after eating. I have no appetite at all.\n  Okay. Any diarrhea, or constipation?\n  No, Doctor. Bowel movements are normal.\n  Any burning when you pass urine? Or going more often?\n  Non docteur, tout est bon de ce côté.\n  Okay, okay, je comprends. I'm going to press gently. You tell me when it's tender, okay?\n  Ow, that hurts right there.\n  OK, OK. How about when I let go?\n  Words, doctor, that really hurts.\n  OK. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, OK?\n  I feel pain on the right side when you do that.\n  OK. You have tenderness, gathering, and... Rebound tenderness in your right lower abdomen, also a positive roughness sign. They are very suggestive of acute appendicitis.\n  Is it serious?\n  It can be, if not treated. The appendix may be inflamed. and called rupture. We need to do blood work, CBC, CRB, and likely an abdominal ultrasound or CT to confirm that.\n  Doctor, do I need surgery?\n  But, we will confirm 1st, I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\n  Okay, Doctor. Should I call my family?\n  Oui, oui, oui. Allez-y, allez-y. C 'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmerer si on va vous opérer et ils vont donner la période exacte de l 'opération. D 'accord?\n  D 'accord, docteur. Merci beaucoup.\n  Okay. You're welcome. You're welcome. We'll take good care of you and rest assured, ici avec nous, c 'est la guérison. Don't worry, you're going to find a cure and solution to your problem. Okay, madam?","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":73,"end":78,"said":"hui.","significant":false},{"start":297,"end":297,"said":"But now","significant":false},{"start":333,"end":333,"said":"Je comprends.","significant":false},{"start":405,"end":405,"said":"Is that Oui docteur effectivement. okay Okay.","significant":false},{"start":524,"end":596,"said":"okay okay. Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":658,"end":660,"said":"him","significant":false},{"start":748,"end":857,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à","significant":false},{"start":861,"end":911,"said":"degrés. Et quand est-il des nausées où alors les vomissements I've","significant":false},{"start":1003,"end":1005,"said":"où alors de la","significant":false},{"start":1166,"end":1170,"said":"Okey","significant":false},{"start":1316,"end":1321,"said":"Worse","significant":false},{"start":1377,"end":1383,"said":"","significant":false},{"start":1592,"end":1601,"said":"rough things","significant":false},{"start":1642,"end":1655,"said":"appendices. Dr. but","significant":false},{"start":1736,"end":1742,"said":"could","significant":false},{"start":1783,"end":1786,"said":"CRP","significant":true},{"start":1873,"end":1873,"said":"Plus au moins plus au moins Laparoscopic.","significant":true},{"start":1898,"end":1901,"said":"first.","significant":false},{"start":2094,"end":2098,"said":"","significant":false},{"start":2119,"end":2123,"said":"est","significant":false},{"start":2220,"end":2232,"said":"programmer","significant":false},{"start":2296,"end":2307,"said":"opération","significant":false},{"start":2310,"end":2317,"said":"accord","significant":false},{"start":2323,"end":2330,"said":"accord","significant":false},{"start":2397,"end":2402,"said":"We","significant":false},{"start":2460,"end":2464,"said":"est","significant":false},{"start":2478,"end":2522,"said":"assurée. Vous allez forcément trouver guérison et","significant":false},{"start":2532,"end":2560,"said":"à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4-day pain from Sunday evening, upper abdomen migrating to right lower quadrant."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Records movement aggravates, nothing relieves, no radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever with 38 degrees Celsius last night recorded; no other measured vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Records vomiting three times particularly after eating and complete loss of appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Records normal bowel movements and denial of dysuria or urinary frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and positive Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Identifies acute appendicitis but omits the risk of rupture if untreated."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","Plans CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical team review within hours recorded, but laparoscopic approach not mentioned."],["Plans IV fluids, analgesia and antibiotics.","yes","Plans IV fluids, pain relief and antibiotics."],["Encourages contacting family and provides reassurance.","partial","Advises contacting family but omits the reassurance given to the patient."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 1b0084e8 presents with abdominal pain that began on Sunday evening, approximately 4 days ago. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10 in severity. The patient reports that nothing alleviates the pain, and movement tends to aggravate it. She denies radiation of the pain to the back or shoulders.\n\nShe reports an associated fever, measured at 38 degrees Celsius the previous night. She has vomited three times, particularly after eating, and reports complete loss of appetite. She denies diarrhea or constipation, stating that bowel movements have been normal. She denies dysuria or urinary frequency.\n\nReview of Systems  \n- General: Positive for fever and decreased appetite  \n- Gastrointestinal: Positive for vomiting, denies diarrhea, constipation  \n- Genitourinary: Denies dysuria, urinary frequency\n\nObjective\nPhysical Examination  \n- Abdomen: Tenderness in the right lower abdomen. Rebound tenderness present. Positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in the upper abdomen and migrated to the right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute appendicitis  \nAssessment: Patient presents with classic signs and symptoms of acute appendicitis. Pain began 4 days ago in the epigastrium and has migrated to the right lower quadrant, which is characteristic of appendiceal inflammation. Pain has progressed from a dull ache to sharp 8/10 intensity. Associated symptoms include fever of 38°C, nausea, vomiting particularly after eating, and anorexia. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen with a positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis requiring prompt surgical evaluation.  \nPlan:  \n- Obtain CBC and CRP blood work  \n- Order abdominal ultrasound or CT scan to confirm diagnosis  \n- Start IV fluids  \n- Administer pain relief medication  \n- Initiate antibiotic therapy  \n- Keep patient NPO in preparation for possible surgery  \n- Admit to hospital  \n- Consult surgical team for evaluation within hours  \n- Surgical team will determine timing of appendectomy if indicated  \n- Patient advised to contact family members regarding admission\n","review":146.76315789473685,"saved":132.23684210526315,"clean":false,"effort":12.5,"sig":[],"mb":11.685892,"latency":41.35,"signable":178.47515789473684},{"label":"Run 2","wer":26.476578411405292,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd 'hui. Please have a seat. I understand you have had abdominal pain for at least 4 days?\n  Yes doctor, it started on Sunday evening.\n  Okay, can you tell me where the pain began exactly?\n  It was right here in my upper belly. It's mostly down on the right side.\n  So it started in the upper abdomen and moved to the right lower side.\n  Was the pain sudden or gradual? It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n  Does the pain spread elsewhere? For example, your back or your shoulders?\n  No, doctor. It stays in the lower right.\n  Anything makes it better or worse?\n  Doctor, nothing really helps. Moving around makes it a bit worse.\n  Do you have a fever too?\n  Yes, Doctor. I had a fever last night, and when I checked my temperature, I was at 38 degrees.\n  And what about nausea, or vomiting?\n  I vomited 3 times, especially after eating. I have no appetite at all.\n  Okay. Any diarrhea, or constipation?\n  No, Doctor. Bowel movements are normal.\n  Any burning when you pass urine? Or going more often?\n  Non docteur, tout est bon de ce côté.\n  Okay, okay, je comprends. I'm going to press gently. You tell me when it's tender, okay?\n  Ow, that hurts right there.\n  OK, OK. How about when I let go?\n  Words, doctor, that really hurts.\n  OK. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, OK?\n  I feel pain on the right side when you do that.\n  OK. You have tenderness, gathering, and... Rebound tenderness in your right lower abdomen, also a positive roughness sign. They are very suggestive of acute appendicitis.\n  Is it serious?\n  It can be, if not treated. The appendix may be inflamed. and called rupture. We need to do blood work, CBC, CRB, and likely an abdominal ultrasound or CT to confirm that.\n  Doctor, do I need surgery?\n  But, we will confirm 1st, I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\n  Okay, Doctor. Should I call my family?\n  Oui, oui, oui. Allez-y, allez-y. C 'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmerer si on va vous opérer et ils vont donner la période exacte de l 'opération. D 'accord?\n  D 'accord, docteur. Merci beaucoup.\n  Okay. You're welcome. You're welcome. We'll take good care of you and rest assured, ici avec nous, c 'est la guérison. Don't worry, you're going to find a cure and solution to your problem. Okay, madam?","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":73,"end":78,"said":"hui.","significant":false},{"start":297,"end":297,"said":"But now","significant":false},{"start":333,"end":333,"said":"Je comprends.","significant":false},{"start":405,"end":405,"said":"Is that Oui docteur effectivement. okay Okay.","significant":false},{"start":524,"end":596,"said":"okay okay. Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":658,"end":660,"said":"him","significant":false},{"start":748,"end":857,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à","significant":false},{"start":861,"end":911,"said":"degrés. Et quand est-il des nausées où alors les vomissements I've","significant":false},{"start":1003,"end":1005,"said":"où alors de la","significant":false},{"start":1166,"end":1170,"said":"Okey","significant":false},{"start":1316,"end":1321,"said":"Worse","significant":false},{"start":1377,"end":1383,"said":"","significant":false},{"start":1592,"end":1601,"said":"rough things","significant":false},{"start":1642,"end":1655,"said":"appendices. Dr. but","significant":false},{"start":1736,"end":1742,"said":"could","significant":false},{"start":1783,"end":1786,"said":"CRP","significant":true},{"start":1873,"end":1873,"said":"Plus au moins plus au moins Laparoscopic.","significant":true},{"start":1898,"end":1901,"said":"first.","significant":false},{"start":2094,"end":2098,"said":"","significant":false},{"start":2119,"end":2123,"said":"est","significant":false},{"start":2220,"end":2232,"said":"programmer","significant":false},{"start":2296,"end":2307,"said":"opération","significant":false},{"start":2310,"end":2317,"said":"accord","significant":false},{"start":2323,"end":2330,"said":"accord","significant":false},{"start":2397,"end":2402,"said":"We","significant":false},{"start":2460,"end":2464,"said":"est","significant":false},{"start":2478,"end":2522,"said":"assurée. Vous allez forcément trouver guérison et","significant":false},{"start":2532,"end":2560,"said":"à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","Dull ache progressively worsened to sharp 8/10."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Movement aggravates, nothing relieves, denies radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Suspected appendicitis recorded but risk of rupture if untreated is not mentioned."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical review within hours recorded; laparoscopic surgery after confirmation not stated beyond \"possible surgery\"."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to contact family; reassurance not recorded."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 6af0f381 presents with a 4-day history of abdominal pain that began on Sunday evening. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache but has progressively worsened to a sharp character, rated 8 out of 10 in severity. The patient reports that movement aggravates the pain and that nothing provides relief. She denies radiation of the pain to the back or shoulders.\n\nShe reports an associated fever, measured at 38 degrees Celsius the previous night. She has vomited three times, particularly after eating, and reports complete loss of appetite. She denies diarrhea or constipation, stating that bowel movements have been normal. She denies dysuria or urinary frequency.\n\nReview of Systems  \n- General: Positive for fever and decreased appetite  \n- Gastrointestinal: Positive for vomiting, negative for diarrhea, constipation  \n- Genitourinary: Negative for dysuria, urinary frequency\n\nObjective\nPhysical Examination  \n- Abdomen: Right lower abdominal tenderness, rebound tenderness, and positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in upper abdomen and migrated to right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute Appendicitis  \nAssessment: Patient presents with classic signs of acute appendicitis including 4-day history of abdominal pain that began in the upper abdomen and migrated to the right lower quadrant. Pain has progressed from dull ache to sharp 8/10 intensity, worsened by movement. Associated symptoms include fever of 38°C, nausea, vomiting three times after eating, and anorexia. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen with positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis requiring urgent surgical evaluation.  \nPlan:  \n- Obtain blood work including CBC and CRP  \n- Order abdominal ultrasound or CT scan to confirm diagnosis  \n- Start IV fluids, pain relief, and antibiotics  \n- Keep patient NPO in preparation for possible surgery  \n- Admit patient to hospital  \n- Consult surgical team for evaluation within hours  \n- Patient advised to contact family members\n","review":141.71052631578948,"saved":137.28947368421052,"clean":false,"effort":12.5,"sig":[],"mb":9.516664,"latency":61.148,"signable":183.78252631578948},{"label":"Run 3","wer":26.476578411405292,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd 'hui. Please have a seat. I understand you have had abdominal pain for at least 4 days?\n  Yes doctor, it started on Sunday evening.\n  Okay, can you tell me where the pain began exactly?\n  It was right here in my upper belly. It's mostly down on the right side.\n  So it started in the upper abdomen and moved to the right lower side.\n  Was the pain sudden or gradual? It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n  Does the pain spread elsewhere? For example, your back or your shoulders?\n  No, doctor. It stays in the lower right.\n  Anything makes it better or worse?\n  Doctor, nothing really helps. Moving around makes it a bit worse.\n  Do you have a fever too?\n  Yes, Doctor. I had a fever last night, and when I checked my temperature, I was at 38 degrees.\n  And what about nausea, or vomiting?\n  I vomited 3 times, especially after eating. I have no appetite at all.\n  Okay. Any diarrhea, or constipation?\n  No, Doctor. Bowel movements are normal.\n  Any burning when you pass urine? Or going more often?\n  Non docteur, tout est bon de ce côté.\n  Okay, okay, je comprends. I'm going to press gently. You tell me when it's tender, okay?\n  Ow, that hurts right there.\n  OK, OK. How about when I let go?\n  Words, doctor, that really hurts.\n  OK. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, OK?\n  I feel pain on the right side when you do that.\n  OK. You have tenderness, gathering, and... Rebound tenderness in your right lower abdomen, also a positive roughness sign. They are very suggestive of acute appendicitis.\n  Is it serious?\n  It can be, if not treated. The appendix may be inflamed. and called rupture. We need to do blood work, CBC, CRB, and likely an abdominal ultrasound or CT to confirm that.\n  Doctor, do I need surgery?\n  But, we will confirm 1st, I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\n  Okay, Doctor. Should I call my family?\n  Oui, oui, oui. Allez-y, allez-y. C 'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmerer si on va vous opérer et ils vont donner la période exacte de l 'opération. D 'accord?\n  D 'accord, docteur. Merci beaucoup.\n  Okay. You're welcome. You're welcome. We'll take good care of you and rest assured, ici avec nous, c 'est la guérison. Don't worry, you're going to find a cure and solution to your problem. Okay, madam?","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":73,"end":78,"said":"hui.","significant":false},{"start":297,"end":297,"said":"But now","significant":false},{"start":333,"end":333,"said":"Je comprends.","significant":false},{"start":405,"end":405,"said":"Is that Oui docteur effectivement. okay Okay.","significant":false},{"start":524,"end":596,"said":"okay okay. Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":658,"end":660,"said":"him","significant":false},{"start":748,"end":857,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à","significant":false},{"start":861,"end":911,"said":"degrés. Et quand est-il des nausées où alors les vomissements I've","significant":false},{"start":1003,"end":1005,"said":"où alors de la","significant":false},{"start":1166,"end":1170,"said":"Okey","significant":false},{"start":1316,"end":1321,"said":"Worse","significant":false},{"start":1377,"end":1383,"said":"","significant":false},{"start":1592,"end":1601,"said":"rough things","significant":false},{"start":1642,"end":1655,"said":"appendices. Dr. but","significant":false},{"start":1736,"end":1742,"said":"could","significant":false},{"start":1783,"end":1786,"said":"CRP","significant":true},{"start":1873,"end":1873,"said":"Plus au moins plus au moins Laparoscopic.","significant":true},{"start":1898,"end":1901,"said":"first.","significant":false},{"start":2094,"end":2098,"said":"","significant":false},{"start":2119,"end":2123,"said":"est","significant":false},{"start":2220,"end":2232,"said":"programmer","significant":false},{"start":2296,"end":2307,"said":"opération","significant":false},{"start":2310,"end":2317,"said":"accord","significant":false},{"start":2323,"end":2330,"said":"accord","significant":false},{"start":2397,"end":2402,"said":"We","significant":false},{"start":2460,"end":2464,"said":"est","significant":false},{"start":2478,"end":2522,"said":"assurée. Vous allez forcément trouver guérison et","significant":false},{"start":2532,"end":2560,"said":"à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4-day pain from Sunday evening, upper abdomen migrating to right lower quadrant."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Records movement aggravates, nothing relieves, no radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever with 38 degrees Celsius last night recorded; no other measured vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Records vomiting three times particularly after eating and complete loss of appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Records normal bowel movements and denial of dysuria or urinary frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and positive Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"warrant urgent surgical evaluation given the risk of appendiceal rupture if left untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","Plans CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical team review within hours recorded, but laparoscopic approach not mentioned."],["Plans IV fluids, analgesia and antibiotics.","yes","Plans IV fluids, pain relief and antibiotics."],["Encourages contacting family and provides reassurance.","partial","Advises contacting family but omits the reassurance given to the patient."]],"claims":[],"note":"Subjective\nCliniTech Benchmark d756f8e9 presents with a 4-day history of abdominal pain that began on Sunday evening. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10 in severity. The pain does not radiate to the back or shoulders and remains localized to the right lower abdomen. Movement aggravates the pain, and nothing provides relief.\n\nThe patient reports associated fever, with a recorded temperature of 38 degrees Celsius last night, nausea, and vomiting on three occasions, particularly after eating. The patient reports complete loss of appetite. The patient denies diarrhea or constipation, stating bowel movements are normal. The patient also denies dysuria or urinary frequency.\n\nReview of Systems  \n- General: Positive for fever and decreased appetite  \n- Gastrointestinal: Positive for nausea and vomiting, denies diarrhea, constipation  \n- Genitourinary: Denies dysuria, urinary frequency\n\nObjective\nPhysical Examination  \n- Abdomen: Tenderness in the right lower abdomen. Rebound tenderness present. Positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in upper abdomen and migrated to right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute appendicitis  \nAssessment: Patient presents with classic signs and symptoms suggestive of acute appendicitis. Pain began 4 days ago in the epigastric region and has migrated to the right lower quadrant, which is characteristic of appendiceal inflammation. Pain has progressed from a dull ache to sharp, severe pain rated 8/10 in intensity. Associated symptoms include fever of 38°C, nausea, vomiting occurring 3 times particularly after eating, and anorexia. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen, along with a positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis and warrant urgent surgical evaluation given the risk of appendiceal rupture if left untreated.  \nPlan:  \n- Obtain blood work including CBC and CRP  \n- Obtain abdominal ultrasound or CT scan to confirm diagnosis  \n- Start IV fluids  \n- Administer pain relief medication  \n- Start antibiotics  \n- Keep patient NPO in preparation for possible surgery  \n- Admit patient to hospital  \n- Consult surgical team for evaluation within the next few hours  \n- Surgical team will determine need for appendectomy and provide specific timing for operation  \n- Patient advised to contact family members given potential need for surgery\n","review":146.26315789473685,"saved":132.73684210526315,"clean":false,"effort":8.333333333333332,"sig":[],"mb":11.917533,"latency":45.282,"signable":180.94815789473685},{"label":"Run 4","wer":26.476578411405292,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd 'hui. Please have a seat. I understand you have had abdominal pain for at least 4 days?\n  Yes doctor, it started on Sunday evening.\n  Okay, can you tell me where the pain began exactly?\n  It was right here in my upper belly. It's mostly down on the right side.\n  So it started in the upper abdomen and moved to the right lower side.\n  Was the pain sudden or gradual? It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n  Does the pain spread elsewhere? For example, your back or your shoulders?\n  No, doctor. It stays in the lower right.\n  Anything makes it better or worse?\n  Doctor, nothing really helps. Moving around makes it a bit worse.\n  Do you have a fever too?\n  Yes, Doctor. I had a fever last night, and when I checked my temperature, I was at 38 degrees.\n  And what about nausea, or vomiting?\n  I vomited 3 times, especially after eating. I have no appetite at all.\n  Okay. Any diarrhea, or constipation?\n  No, Doctor. Bowel movements are normal.\n  Any burning when you pass urine? Or going more often?\n  Non docteur, tout est bon de ce côté.\n  Okay, okay, je comprends. I'm going to press gently. You tell me when it's tender, okay?\n  Ow, that hurts right there.\n  OK, OK. How about when I let go?\n  Words, doctor, that really hurts.\n  OK. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, OK?\n  I feel pain on the right side when you do that.\n  OK. You have tenderness, gathering, and... Rebound tenderness in your right lower abdomen, also a positive roughness sign. They are very suggestive of acute appendicitis.\n  Is it serious?\n  It can be, if not treated. The appendix may be inflamed. and called rupture. We need to do blood work, CBC, CRB, and likely an abdominal ultrasound or CT to confirm that.\n  Doctor, do I need surgery?\n  But, we will confirm 1st, I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\n  Okay, Doctor. Should I call my family?\n  Oui, oui, oui. Allez-y, allez-y. C 'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmerer si on va vous opérer et ils vont donner la période exacte de l 'opération. D 'accord?\n  D 'accord, docteur. Merci beaucoup.\n  Okay. You're welcome. You're welcome. We'll take good care of you and rest assured, ici avec nous, c 'est la guérison. Don't worry, you're going to find a cure and solution to your problem. Okay, madam?","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":73,"end":78,"said":"hui.","significant":false},{"start":297,"end":297,"said":"But now","significant":false},{"start":333,"end":333,"said":"Je comprends.","significant":false},{"start":405,"end":405,"said":"Is that Oui docteur effectivement. okay Okay.","significant":false},{"start":524,"end":596,"said":"okay okay. Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":658,"end":660,"said":"him","significant":false},{"start":748,"end":857,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à","significant":false},{"start":861,"end":911,"said":"degrés. Et quand est-il des nausées où alors les vomissements I've","significant":false},{"start":1003,"end":1005,"said":"où alors de la","significant":false},{"start":1166,"end":1170,"said":"Okey","significant":false},{"start":1316,"end":1321,"said":"Worse","significant":false},{"start":1377,"end":1383,"said":"","significant":false},{"start":1592,"end":1601,"said":"rough things","significant":false},{"start":1642,"end":1655,"said":"appendices. Dr. but","significant":false},{"start":1736,"end":1742,"said":"could","significant":false},{"start":1783,"end":1786,"said":"CRP","significant":true},{"start":1873,"end":1873,"said":"Plus au moins plus au moins Laparoscopic.","significant":true},{"start":1898,"end":1901,"said":"first.","significant":false},{"start":2094,"end":2098,"said":"","significant":false},{"start":2119,"end":2123,"said":"est","significant":false},{"start":2220,"end":2232,"said":"programmer","significant":false},{"start":2296,"end":2307,"said":"opération","significant":false},{"start":2310,"end":2317,"said":"accord","significant":false},{"start":2323,"end":2330,"said":"accord","significant":false},{"start":2397,"end":2402,"said":"We","significant":false},{"start":2460,"end":2464,"said":"est","significant":false},{"start":2478,"end":2522,"said":"assurée. Vous allez forcément trouver guérison et","significant":false},{"start":2532,"end":2560,"said":"à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","Dull ache that \"progressively worsened\", now sharp 8/10."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Worse with movement, nothing relieves, no radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","\"highly suggestive of acute appendicitis with potential risk of rupture if untreated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical consult for \"potential appendectomy\" recorded, but not laparoscopic approach or review within hours."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to contact family; reassurance not recorded."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 7e66b8cc presents with abdominal pain that began on Sunday evening, approximately 4 days prior to presentation. The pain started in the upper abdomen and gradually migrated to the right lower quadrant. Initially described as a dull ache, it has progressively worsened and is now sharp in character, rated 8 out of 10 in severity. The patient reports the pain does not radiate to the back or shoulders and remains localized to the right lower abdomen. Movement aggravates the pain, and nothing provides relief.\n\nAssociated symptoms include fever, with a recorded temperature of 38 degrees Celsius the previous night, vomiting on 3 occasions, particularly after eating, and complete loss of appetite. The patient denies diarrhea or constipation, reporting normal bowel movements. She also denies dysuria or urinary frequency.\n\nReview of Systems  \n- General: Positive for fever and decreased appetite  \n- Gastrointestinal: Positive for vomiting, negative for diarrhea, constipation  \n- Genitourinary: Negative for dysuria, urinary frequency\n\nObjective\nPhysical Examination  \n- Abdomen: Tenderness in the right lower abdomen. Rebound tenderness present. Positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in upper abdomen and migrated to right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute Appendicitis  \nAssessment: Pain began 4 days ago on Sunday evening in the upper abdomen and has migrated to the right lower quadrant, becoming sharp and severe at 8/10 intensity. Associated symptoms include fever of 38°C, nausea, vomiting occurring 3 times particularly after eating, and complete loss of appetite. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen, along with a positive Rovsing sign. These clinical findings are highly suggestive of acute appendicitis with potential risk of rupture if untreated.  \nPlan:  \n- Order blood work including CBC and CRP  \n- Obtain abdominal ultrasound or CT scan to confirm diagnosis  \n- Start IV fluids  \n- Administer pain relief medication  \n- Start antibiotics  \n- Keep patient NPO in preparation for possible surgery  \n- Admit patient to hospital  \n- Consult surgical team for evaluation and potential appendectomy  \n- Patient advised to contact family members given potential surgical intervention\n","review":132.36842105263156,"saved":146.63157894736844,"clean":false,"effort":8.333333333333332,"sig":[],"mb":11.532693,"latency":41.452,"signable":163.09942105263156},{"label":"Run 5","wer":26.476578411405292,"text":"Bonjour madame, je suis le docteur qui va vous prendre en charge aujourd 'hui. Please have a seat. I understand you have had abdominal pain for at least 4 days?\n  Yes doctor, it started on Sunday evening.\n  Okay, can you tell me where the pain began exactly?\n  It was right here in my upper belly. It's mostly down on the right side.\n  So it started in the upper abdomen and moved to the right lower side.\n  Was the pain sudden or gradual? It was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10.\n  Does the pain spread elsewhere? For example, your back or your shoulders?\n  No, doctor. It stays in the lower right.\n  Anything makes it better or worse?\n  Doctor, nothing really helps. Moving around makes it a bit worse.\n  Do you have a fever too?\n  Yes, Doctor. I had a fever last night, and when I checked my temperature, I was at 38 degrees.\n  And what about nausea, or vomiting?\n  I vomited 3 times, especially after eating. I have no appetite at all.\n  Okay. Any diarrhea, or constipation?\n  No, Doctor. Bowel movements are normal.\n  Any burning when you pass urine? Or going more often?\n  Non docteur, tout est bon de ce côté.\n  Okay, okay, je comprends. I'm going to press gently. You tell me when it's tender, okay?\n  Ow, that hurts right there.\n  OK, OK. How about when I let go?\n  Words, doctor, that really hurts.\n  OK. Je vais aussi mettre un peu de pression sur le côté gauche. Let me know, OK?\n  I feel pain on the right side when you do that.\n  OK. You have tenderness, gathering, and... Rebound tenderness in your right lower abdomen, also a positive roughness sign. They are very suggestive of acute appendicitis.\n  Is it serious?\n  It can be, if not treated. The appendix may be inflamed. and called rupture. We need to do blood work, CBC, CRB, and likely an abdominal ultrasound or CT to confirm that.\n  Doctor, do I need surgery?\n  But, we will confirm 1st, I'm going to start IV fluid, pain relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\n  Okay, Doctor. Should I call my family?\n  Oui, oui, oui. Allez-y, allez-y. C 'est important. We will admit you and have the surgical team to see within the hours. Donc, ils vont programmerer si on va vous opérer et ils vont donner la période exacte de l 'opération. D 'accord?\n  D 'accord, docteur. Merci beaucoup.\n  Okay. You're welcome. You're welcome. We'll take good care of you and rest assured, ici avec nous, c 'est la guérison. Don't worry, you're going to find a cure and solution to your problem. Okay, madam?","marks":[{"start":8,"end":14,"said":"madam","significant":false},{"start":73,"end":78,"said":"hui.","significant":false},{"start":297,"end":297,"said":"But now","significant":false},{"start":333,"end":333,"said":"Je comprends.","significant":false},{"start":405,"end":405,"said":"Is that Oui docteur effectivement. okay Okay.","significant":false},{"start":524,"end":596,"said":"okay okay. Et est-ce que la douleur se propage autre part Par exemple votre dos où alors vos épaules","significant":false},{"start":658,"end":660,"said":"him","significant":false},{"start":748,"end":857,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à","significant":false},{"start":861,"end":911,"said":"degrés. Et quand est-il des nausées où alors les vomissements I've","significant":false},{"start":1003,"end":1005,"said":"où alors de la","significant":false},{"start":1166,"end":1170,"said":"Okey","significant":false},{"start":1316,"end":1321,"said":"Worse","significant":false},{"start":1377,"end":1383,"said":"","significant":false},{"start":1592,"end":1601,"said":"rough things","significant":false},{"start":1642,"end":1655,"said":"appendices. Dr. but","significant":false},{"start":1736,"end":1742,"said":"could","significant":false},{"start":1783,"end":1786,"said":"CRP","significant":true},{"start":1873,"end":1873,"said":"Plus au moins plus au moins Laparoscopic.","significant":true},{"start":1898,"end":1901,"said":"first.","significant":false},{"start":2094,"end":2098,"said":"","significant":false},{"start":2119,"end":2123,"said":"est","significant":false},{"start":2220,"end":2232,"said":"programmer","significant":false},{"start":2296,"end":2307,"said":"opération","significant":false},{"start":2310,"end":2317,"said":"accord","significant":false},{"start":2323,"end":2330,"said":"accord","significant":false},{"start":2397,"end":2402,"said":"We","significant":false},{"start":2460,"end":2464,"said":"est","significant":false},{"start":2478,"end":2522,"said":"assurée. Vous allez forcément trouver guérison et","significant":false},{"start":2532,"end":2560,"said":"à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4-day pain from Sunday evening, upper abdomen migrating to right lower quadrant."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Records movement aggravates, nothing relieves, no radiation to back or shoulders."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever with 38 degrees Celsius last night recorded; no other measured vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Records vomiting three times particularly after eating and complete loss of appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Records normal bowel movements and denial of dysuria or urinary frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and positive Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Identifies acute appendicitis but omits the risk of rupture if untreated."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","Plans CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical team review within hours recorded, but laparoscopic approach not mentioned."],["Plans IV fluids, analgesia and antibiotics.","yes","Plans IV fluids, pain relief and antibiotics."],["Encourages contacting family and provides reassurance.","partial","Advises contacting family but omits the reassurance given to the patient."]],"claims":[],"note":"Subjective\nCliniTech Benchmark e08661e3 presents with a 4-day history of abdominal pain that began on Sunday evening. The pain initially started in the upper abdomen and gradually migrated to the right lower quadrant. It began as a dull ache and has progressively worsened to a sharp character, rated 8 out of 10 in severity. The patient reports that nothing alleviates the pain, and movement aggravates it. The patient denies radiation of the pain to the back or shoulders.\n\nAssociated symptoms include fever, measured at 38 degrees Celsius the night prior, vomiting on 3 occasions, particularly after eating, and complete loss of appetite. The patient denies diarrhea or constipation, reporting normal bowel movements. The patient also denies dysuria or urinary frequency.\n\nReview of Systems  \n- Gastrointestinal: Denies diarrhea, constipation  \n- Genitourinary: Denies dysuria, urinary frequency\n\nObjective\nPhysical Examination  \n- Abdomen: Tenderness in the right lower abdomen. Rebound tenderness present. Positive Rovsing sign\n\nAssessment & Plan\nPatient presents with 4-day history of abdominal pain that started in upper abdomen and migrated to right lower quadrant, associated with fever, nausea, and vomiting.\n\nAcute appendicitis  \nAssessment: Patient presents with classic signs and symptoms of acute appendicitis. Pain began 4 days ago in the upper abdomen and has migrated to the right lower quadrant, which is characteristic of appendiceal inflammation. Pain has progressed from a dull ache to sharp, severe pain rated 8/10 in intensity. Associated symptoms include fever of 38°C, nausea, vomiting occurring 3 times particularly after eating, and complete loss of appetite. Physical examination reveals tenderness, guarding, and rebound tenderness in the right lower abdomen, along with a positive Rovsing's sign. These clinical findings are highly suggestive of acute appendicitis and warrant urgent surgical evaluation.  \nPlan:  \n- Order blood work including CBC and CRP  \n- Obtain abdominal ultrasound or CT scan to confirm diagnosis  \n- Start IV fluids  \n- Administer pain relief medication  \n- Start antibiotics  \n- Keep patient NPO in preparation for possible surgery  \n- Admit patient to hospital  \n- Consult surgical team for evaluation within the next few hours  \n- Surgical team will determine need for appendectomy and provide exact timing if surgery is indicated  \n- Patient advised to contact family members regarding hospitalization\n","review":149.28947368421052,"saved":129.71052631578948,"clean":false,"effort":12.5,"sig":[],"mb":11.893669,"latency":45.605,"signable":184.1744736842105}],"cliniscripts":[{"label":"Run 1","wer":7.942973523421588,"text":"Bonjour madame.\nJe suis le docteur qui va vous prendre en charge aujourd'hui.\nPlease have a seat.\nUnderstand you've had abdominal pain for at least 4 days? Yes, doctor.\nIt started on Sunday evening.\nOkay.\nCan you tell me where the pain began exactly?\nIt was right here, in my upper belly, but now it's mostly down on the right side. Je comprends. So it started in the upper abdomen, and moved to the right lower side.\nIs that— Wait, doctor, effectivement. Okay, okay. Was the pain sudden or gradual?\nIt was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10. Okay, okay.\nEst-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\nNo, doctor, it stays in the lower right. Okay. Anything makes it better, or worse? Um, doctor, nothing really helps. Moving around makes it a bit worse.\nEt avez-vous de la fièvre aussi?\nOui, docteur.\nJ'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement?\nI've vomited 3 times. Especially after eating. I have no appetite at all.\nOkay.\nAny diarrhea, ou alors de la constipation? No, doctor.\nBowel movements are normal.\nAny burning when you pass urine?\nOr going more often? Um, no, doctor. Tout est bon de ce côté. Okay, okay. Je comprends.\nI'm going to press gently. You tell me when it's tender, okay?\nOw! That hurts right there. Hmm, okay, okay. How about when I let go?\nWorse, doctor. That really hurts.\nOkay. Je vais aussi mettre un peu de pression sur le côté gauche.\nLet me know, okay?\nUm, I feel pain on the right side when you do that. Okay. You have tenderness.\nGathering and rebound tenderness in your right lower abdomen.\nAlso, a positive rough things sign.\nThere are very suggestive of acute appendicite.\nDoctor, but is it serious? It can be, if not treated.\nThe appendix may be inflamed. And cold rupture.\nWe need to do blood work. CBC, CRP, and likely an abdominal ultrasound or CT to confirm that.\nDoctor, um, do I need surgery? Euh, plus ou moins, plus ou moins.\nLaparoscopique, but we will confirm first. I'm going to start IV fluid.\nPain relief and antibiotics.\nYou should eat or drink anything now. In case we're going to operate you. Okay? Okay, doctor. Should I call my family? Euh, oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team to see within the hours.\nDonc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord? D'accord, docteur. Merci beaucoup. Okay. You're welcome. You're welcome. We'll take, uh, good care of you and, uh, rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame? D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":427,"end":439,"said":"Oui docteur","significant":false},{"start":593,"end":593,"said":"Et","significant":false},{"start":661,"end":663,"said":"où","significant":false},{"start":745,"end":747,"said":"him","significant":false},{"start":883,"end":887,"said":"j ai","significant":false},{"start":935,"end":939,"said":"j ai","significant":false},{"start":964,"end":971,"said":"j étais","significant":false},{"start":988,"end":993,"said":"quand","significant":false},{"start":1013,"end":1015,"said":"où","significant":false},{"start":1022,"end":1036,"said":"les vomissements","significant":false},{"start":1132,"end":1134,"said":"où","significant":false},{"start":1255,"end":1270,"said":"Non docteur","significant":false},{"start":1302,"end":1307,"said":"Okey","significant":false},{"start":1516,"end":1522,"said":"","significant":false},{"start":1751,"end":1756,"said":"They","significant":false},{"start":1786,"end":1805,"said":"appendices. Dr.","significant":false},{"start":1887,"end":1891,"said":"could","significant":false},{"start":2026,"end":2029,"said":"","significant":false},{"start":2036,"end":2038,"said":"au","significant":false},{"start":2051,"end":2053,"said":"au","significant":false},{"start":2061,"end":2075,"said":"Laparoscopic.","significant":false},{"start":2208,"end":2213,"said":"we are","significant":false},{"start":2281,"end":2289,"said":"","significant":false},{"start":2319,"end":2324,"said":"c est","significant":false},{"start":2493,"end":2524,"said":"l opération d accord D accord","significant":false},{"start":2589,"end":2594,"said":"We","significant":false},{"start":2660,"end":2665,"said":"c est","significant":false},{"start":2755,"end":2763,"said":"D accord","significant":false},{"start":2773,"end":2781,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","Gradual onset, dull ache progressing to sharp 8/10."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Does not radiate, nothing alleviates, moving worsens."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Appendicitis suspected; rupture if untreated noted."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Laparoscopic surgery and surgical consult recorded, but admission omitted and timing given as \"within the hour\"."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to contact family; reassurance not recorded."]],"claims":[],"note":"S (Subjective):\n- Patient presents with abdominal pain for 4 days, starting Sunday evening.\n- Pain initially localized to the upper abdomen, now predominantly in the right lower side.\n- Onset was gradual, described as a dull ache, progressing to a sharp pain rated 8/10.\n- Pain does not radiate; it remains in the lower right abdomen.\n- Nothing alleviates the pain; moving around slightly worsens it.\n- Patient reports fever of 38 degrees Celsius last night.\n- Patient experienced 3 episodes of vomiting, especially after eating, and has no appetite.\n- Bowel movements are normal; no diarrhea or constipation.\n- No dysuria or increased urinary frequency reported.\n\nO (Objective):\n- Abdominal palpation revealed tenderness in the right lower abdomen.\n- Rebound tenderness was noted in the right lower abdomen.\n- Positive Rovsing's sign observed (pain on the right side when pressure applied to the left).\n\nA (Assessment):\n- Findings are highly suggestive of acute appendicitis.\n- Potential complication of appendix inflammation and rupture if untreated.\n\nP (Plan):\n- Initiate IV fluids.\n- Administer pain relief medication.\n- Administer antibiotics.\n- NPO status (nothing by mouth) for the patient.\n- Order blood work: CBC, CRP.\n- Order imaging studies: abdominal ultrasound or CT scan to confirm diagnosis.\n- Consult with the surgical team for evaluation within the hour to schedule potential laparoscopic surgery.\n- Patient advised to contact family.\n","review":91.0,"saved":188.0,"clean":false,"effort":8.333333333333332,"sig":[["partial","Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","Decision to admit omitted and surgical review timing misstated as within the hour."]],"mb":16.550697,"latency":21.508,"signable":100.992},{"label":"Run 2","wer":5.906313645621181,"text":"Bonjour madame.\nJe suis le docteur qui va vous prendre en charge aujourd'hui.\nPlease have a seat.\nUnderstand you've had abdominal pain for at least 4 days, correct? Yes, doctor.\nIt started on Sunday evening.\nOkay.\nCan you tell me where the pain began exactly?\nIt was right here, in my upper belly, but now it's mostly down on the right side.\nJe comprends. So it started in the upper abdomen, and moved to the right lower side. Is that— Wait, doctor, effectivement. Okay, okay. Was the pain sudden or gradual?\nIt was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10. Okay, okay.\nEst-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\nNo, doctor, it stays in the lower right. Okay. Anything makes it better or worse? Doctor, nothing really helps. Moving around makes it a bit worse.\nEt avez-vous de la fièvre aussi?\nOui, docteur.\nJ'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement?\nI've vomited 3 times. Especially after eating. I have no appetite at all.\nOkay.\nAny diarrhea ou alors de la constipation? No, doctor.\nBowel movements are normal.\nAny burning when you pass urine or going more often?\nNon, docteur. Tout est bon de ce côté. Okay, okay. Je comprends.\nI'm going to press gently. You tell me when it's tender, okay?\nOw! That hurts right there.\nOkay, okay. How about when I let go? Worse, doctor. That really hurts.\nOkay. Je vais aussi mettre un peu de pression sur le côté gauche.\nLet me know, okay?\nI feel pain on the right side when you do that. Okay. You have tenderness.\nGathering and rebound tenderness in your right lower abdomen.\nAlso, a positive rough things sign.\nThere are very suggestive of acute appendicite.\nDoctor, is it serious? It can be, if not treated.\nThe appendix may be inflamed. And cold rupture.\nWe need to do blood work. CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\nDoctor, do I need surgery? Plus ou moins, plus ou moins.\nLaparoscopic, but we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics.\nYou should eat or drink anything now. In case we're going to operate you. Okay? Okay, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team. To see within the hours.\nDonc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord? D'accord, docteur. Merci beaucoup.\nOkay. You're welcome. You're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame? D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":156,"end":163,"said":"","significant":false},{"start":436,"end":448,"said":"Oui docteur","significant":false},{"start":602,"end":602,"said":"Et","significant":false},{"start":670,"end":672,"said":"où","significant":false},{"start":754,"end":756,"said":"him","significant":false},{"start":887,"end":891,"said":"j ai","significant":false},{"start":939,"end":943,"said":"j ai","significant":false},{"start":968,"end":975,"said":"j étais","significant":false},{"start":992,"end":997,"said":"quand","significant":false},{"start":1017,"end":1019,"said":"où","significant":false},{"start":1026,"end":1040,"said":"les vomissements","significant":false},{"start":1135,"end":1137,"said":"où","significant":false},{"start":1302,"end":1307,"said":"Okey","significant":false},{"start":1511,"end":1517,"said":"","significant":false},{"start":1742,"end":1747,"said":"They","significant":false},{"start":1777,"end":1796,"said":"appendices. Dr. but","significant":false},{"start":1874,"end":1878,"said":"could","significant":false},{"start":2015,"end":2017,"said":"au","significant":false},{"start":2030,"end":2032,"said":"au","significant":false},{"start":2185,"end":2190,"said":"we are","significant":false},{"start":2268,"end":2272,"said":"","significant":false},{"start":2291,"end":2296,"said":"c est","significant":false},{"start":2466,"end":2497,"said":"l opération d accord D accord","significant":false},{"start":2562,"end":2567,"said":"We","significant":false},{"start":2623,"end":2628,"said":"c est","significant":false},{"start":2718,"end":2726,"said":"D accord","significant":false},{"start":2736,"end":2744,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","Records now sharp 8/10 but omits gradual onset and initial dull ache."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","Movement worsens and nothing relieves recorded; absence of radiation to back/shoulder omitted."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Appendicitis suspected with \"rupture of the appendix if not promptly treated\"."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission, surgical team within hours, possible laparoscopic surgery recorded."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to contact family; reassurance not recorded."]],"claims":[],"note":"S (Subjective):\n- The patient reports abdominal pain for the past 4 days, which began on Sunday evening.\n- The pain initially started in the upper abdomen and subsequently localized to the right lower side, now described as sharp with a severity of 8/10.\n- They state that moving around exacerbates the pain, and no specific factors provide relief.\n- Associated symptoms include a fever of 38 degrees Celsius last night, 3 episodes of vomiting, especially after eating, and a complete loss of appetite.\n- The patient denies experiencing diarrhea, constipation, dysuria, or increased urinary frequency, noting normal bowel movements.\n\nO (Objective):\n- Physical examination revealed significant tenderness upon gentle palpation of the right lower abdomen.\n- Rebound tenderness was elicited in the right lower abdomen, reported as worse upon release of pressure.\n- A positive Rovsing's sign was observed, with the patient experiencing pain on the right side when pressure was applied to the left lower abdomen.\n\nA (Assessment):\n- The clinical presentation, including the migratory abdominal pain, fever, vomiting, and specific physical exam findings, is highly suggestive of acute appendicitis.\n- There is a concern for potential inflammation and rupture of the appendix if not promptly treated.\n\nP (Plan):\n- Initiate intravenous fluids, pain relief medication, and antibiotics.\n- Order blood work including a Complete Blood Count (CBC) and C-reactive Protein (CRP).\n- Schedule an abdominal ultrasound or CT scan to confirm the diagnosis.\n- The patient is to remain NPO (nil per os) in preparation for potential surgery.\n- The surgical team will be consulted to evaluate the patient within hours for possible laparoscopic surgery, and the patient will be admitted.\n- Advise the patient to contact their family.\n","review":123.19736842105263,"saved":155.80263157894737,"clean":false,"effort":12.5,"sig":[],"mb":16.527491,"latency":27.892,"signable":139.19336842105264},{"label":"Run 3","wer":5.906313645621181,"text":"Bonjour madame.\nJe suis le docteur qui va vous prendre en charge aujourd'hui.\nPlease have a seat.\nUnderstand you've had abdominal pain for at least 4 days, correct? Yes, doctor.\nIt started on Sunday evening.\nOkay.\nCan you tell me where the pain began exactly?\nIt was right here, in my upper belly, but now it's mostly down on the right side.\nJe comprends. So it started in the upper abdomen, and moved to the right lower side. Is that— Wait, doctor, effectivement. Okay, okay. Was the pain sudden or gradual?\nIt was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10. Okay, okay.\nEst-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\nNo, doctor, it stays in the lower right. Okay. Anything makes it better or worse? Doctor, nothing really helps. Moving around makes it a bit worse.\nEt avez-vous de la fièvre aussi?\nOui, docteur.\nJ'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement?\nI've vomited 3 times. Especially after eating. I have no appetite at all.\nOkay.\nAny diarrhea ou alors de la constipation? No, doctor.\nBowel movements are normal.\nAny burning when you pass urine or going more often?\nNon, docteur. Tout est bon de ce côté. Okay, okay. Je comprends.\nI'm going to press gently. You tell me when it's tender, okay?\nOw! That hurts right there.\nOkay, okay. How about when I let go? Worse, doctor. That really hurts.\nOkay. Je vais aussi mettre un peu de pression sur le côté gauche.\nLet me know, okay?\nI feel pain on the right side when you do that. Okay. You have tenderness.\nGathering and rebound tenderness in your right lower abdomen.\nAlso, a positive rough things sign.\nThere are very suggestive of acute appendicite.\nDoctor, is it serious? It can be, if not treated.\nThe appendix may be inflamed. And cold rupture.\nWe need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\nDoctor, do I need surgery? Plus ou moins, plus ou moins.\nLaparoscopic.\nBut we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics.\nYou should eat or drink anything now in case we're going to operate you. Okay? Okay, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team to see within the hours.\nDonc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord? D'accord, docteur. Merci beaucoup.\nOkay. You're welcome. You're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame? D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":156,"end":163,"said":"","significant":false},{"start":436,"end":448,"said":"Oui docteur","significant":false},{"start":602,"end":602,"said":"Et","significant":false},{"start":670,"end":672,"said":"où","significant":false},{"start":754,"end":756,"said":"him","significant":false},{"start":887,"end":891,"said":"j ai","significant":false},{"start":939,"end":943,"said":"j ai","significant":false},{"start":968,"end":975,"said":"j étais","significant":false},{"start":992,"end":997,"said":"quand","significant":false},{"start":1017,"end":1019,"said":"où","significant":false},{"start":1026,"end":1040,"said":"les vomissements","significant":false},{"start":1135,"end":1137,"said":"où","significant":false},{"start":1302,"end":1307,"said":"Okey","significant":false},{"start":1511,"end":1517,"said":"","significant":false},{"start":1742,"end":1747,"said":"They","significant":false},{"start":1777,"end":1796,"said":"appendices. Dr. but","significant":false},{"start":1874,"end":1878,"said":"could","significant":false},{"start":2015,"end":2017,"said":"au","significant":false},{"start":2030,"end":2032,"said":"au","significant":false},{"start":2184,"end":2189,"said":"we are","significant":false},{"start":2267,"end":2271,"said":"","significant":false},{"start":2290,"end":2295,"said":"c est","significant":false},{"start":2464,"end":2495,"said":"l opération d accord D accord","significant":false},{"start":2560,"end":2565,"said":"We","significant":false},{"start":2621,"end":2626,"said":"c est","significant":false},{"start":2716,"end":2724,"said":"D accord","significant":false},{"start":2734,"end":2742,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","Dull ache now sharp 8/10 recorded; gradual onset not stated."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Not radiating, movement exacerbates, nothing relieves."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Appendicitis highly suspected; rupture if not treated noted."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Surgical consult for potential laparoscopic appendectomy recorded, but admission and review within hours omitted."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to inform family; reassurance not recorded."]],"claims":[["Patient appeared cooperative during the examination.","No observation of the patient demeanour or cooperation appears anywhere in the transcript."]],"note":"S (Subjective):\n- Patient presents with abdominal pain for 4 days, starting Sunday evening.\n- Pain began in the upper abdomen and migrated to the right lower side.\n- Initially a dull ache, pain is now sharp, rated 8/10, and is not radiating.\n- Moving around exacerbates the pain; nothing provides relief.\n- Associated symptoms include fever (38°C last night), 3 episodes of vomiting (especially after eating), and no appetite. Patient denies diarrhea, constipation, dysuria, or increased urinary frequency.\n\nO (Objective):\n- Abdominal palpation revealed tenderness in the right lower abdomen.\n- Rebound tenderness was noted in the right lower abdomen.\n- Positive Rovsing's sign observed, with pain in the right side upon palpation of the left side.\n- Patient appeared cooperative during the examination.\n\nA (Assessment):\n- Acute appendicitis is highly suspected based on clinical findings.\n- Potential complication of appendix rupture if not treated.\n\nP (Plan):\n- Initiate IV fluids, pain relief, and antibiotics immediately.\n- NPO status ordered in preparation for potential surgery.\n- Order blood work: CBC and CRP.\n- Schedule abdominal ultrasound or CT scan to confirm diagnosis.\n- Consult surgical team for evaluation and potential laparoscopic appendectomy.\n- Patient advised to inform family about the situation.\n","review":108.86842105263158,"saved":170.13157894736844,"clean":false,"effort":25.0,"sig":[["partial","Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","Decision to admit and within-hours surgical review omitted from the plan."]],"mb":16.557091,"latency":19.313,"signable":117.86242105263157},{"label":"Run 4","wer":6.109979633401222,"text":"Bonjour madame.\nJe suis le docteur qui va vous prendre en charge aujourd'hui.\nPlease have a seat.\nUnderstand you've had abdominal pain for at least 4 days? Yes, doctor.\nIt started on Sunday evening.\nOkay.\nCan you tell me where the pain began exactly?\nIt was right here, in my upper belly, but now it's mostly down on the right side.\nJe comprends. So it started in the upper abdomen, and moved to the right lower side. Is that— Wait, doctor, effectivement. Okay, okay. Was the pain sudden or gradual?\nIt was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10. Okay, okay.\nEst-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\nNo, doctor, it stays in the lower right. Okay. Anything makes it better or worse? Doctor, nothing really helps. Moving around makes it a bit worse.\nEt avez-vous de la fièvre aussi?\nOui, docteur.\nJ'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement?\nI've vomited 3 times. Especially after eating. I have no appetite at all.\nOkay.\nAny diarrhea ou alors de la constipation? No, doctor.\nBowel movements are normal.\nAny burning when you pass urine or going more often?\nNo, doctor. Tout est bon de ce côté. Okay, okay. Je comprends.\nI'm going to press gently. You tell me when it's tender, okay?\nOw! That hurts right there.\nOkay, okay. How about when I let go? Worse, doctor. That really hurts.\nOkay. Je vais aussi mettre un peu de pression sur le côté gauche.\nLet me know, okay?\nI feel pain on the right side when you do that. Okay. You have tenderness.\nGathering and rebound tenderness in your right lower abdomen.\nAlso, a positive rough things sign.\nThere are very suggestive of acute appendicite.\nDoctor, is it serious? It can be, if not treated.\nThe appendix may be inflamed. And cold rupture.\nWe need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\nDoctor, do I need surgery? Plus ou moins, plus ou moins.\nLaparoscopic.\nBut we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics.\nYou should eat or drink anything now in case we're going to operate you. Okay? Okay, doctor. Should I call my family? Oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team to see within the hours.\nDonc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord? D'accord, docteur. Merci beaucoup.\nOkay. You're welcome. You're welcome. We'll take good care of you and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame? D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":427,"end":439,"said":"Oui docteur","significant":false},{"start":593,"end":593,"said":"Et","significant":false},{"start":661,"end":663,"said":"où","significant":false},{"start":745,"end":747,"said":"him","significant":false},{"start":878,"end":882,"said":"j ai","significant":false},{"start":930,"end":934,"said":"j ai","significant":false},{"start":959,"end":966,"said":"j étais","significant":false},{"start":983,"end":988,"said":"quand","significant":false},{"start":1008,"end":1010,"said":"où","significant":false},{"start":1017,"end":1031,"said":"les vomissements","significant":false},{"start":1126,"end":1128,"said":"où","significant":false},{"start":1248,"end":1259,"said":"Non docteur","significant":false},{"start":1291,"end":1296,"said":"Okey","significant":false},{"start":1500,"end":1506,"said":"","significant":false},{"start":1731,"end":1736,"said":"They","significant":false},{"start":1766,"end":1785,"said":"appendices. Dr. but","significant":false},{"start":1863,"end":1867,"said":"could","significant":false},{"start":2004,"end":2006,"said":"au","significant":false},{"start":2019,"end":2021,"said":"au","significant":false},{"start":2173,"end":2178,"said":"we are","significant":false},{"start":2256,"end":2260,"said":"","significant":false},{"start":2279,"end":2284,"said":"c est","significant":false},{"start":2453,"end":2484,"said":"l opération d accord D accord","significant":false},{"start":2549,"end":2554,"said":"We","significant":false},{"start":2610,"end":2615,"said":"c est","significant":false},{"start":2705,"end":2713,"said":"D accord","significant":false},{"start":2723,"end":2731,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Onset was gradual, described as a dull ache initially, now sharp and rated 8/10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","Does not radiate, nothing alleviates, moving worsens."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Appendicitis suspected; rupture if untreated noted."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission and surgical consultation within hours for potential laparoscopic surgery."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","no","Neither contacting family nor reassurance is recorded."]],"claims":[],"note":"S (Subjective):\n- Patient presents with abdominal pain for 4 days, starting Sunday evening.\n- Pain initially in the upper abdomen, migrating to the right lower side.\n- Onset was gradual, described as a dull ache initially, now sharp and rated 8/10.\n- Pain is localized to the lower right abdomen and does not radiate.\n- Patient reports nothing alleviates the pain; moving around slightly worsens it.\n- Patient experienced fever last night, with a documented temperature of 38 degrees Celsius.\n- Nausea and vomiting occurred 3 times, especially after eating, with associated loss of appetite.\n- Bowel movements are reported as normal; no diarrhea or constipation.\n- No dysuria or increased urinary frequency reported.\n\nO (Objective):\n- Right lower abdominal tenderness upon gentle palpation.\n- Rebound tenderness elicited in the right lower abdomen.\n- Positive Rovsing's sign observed (pain on the right side when pressure is applied to the left).\n\nA (Assessment):\n- Findings are highly suggestive of acute appendicitis.\n- Potential complication includes appendix inflammation and rupture if untreated.\n\nP (Plan):\n- Blood work ordered: CBC and CRP.\n- Imaging studies planned: abdominal ultrasound or CT scan to confirm diagnosis.\n- Initiation of IV fluids, pain relief, and antibiotics.\n- Patient instructed to refrain from eating or drinking in preparation for potential surgery.\n- Admission to the hospital for further management.\n- Surgical team consultation within hours to evaluate and schedule potential laparoscopic surgery.\n","review":82.84210526315789,"saved":196.1578947368421,"clean":false,"effort":8.333333333333332,"sig":[],"mb":16.551207,"latency":19.237,"signable":91.82010526315788},{"label":"Run 5","wer":7.535641547861507,"text":"Bonjour madame.\nJe suis le docteur qui va vous prendre en charge aujourd'hui.\nPlease have a seat.\nUnderstand you've had abdominal pain for at least 4 days, correct? Yes, doctor.\nIt started on Sunday evening.\nOkay.\nCan you tell me where the pain began exactly?\nIt was right here, in my upper belly, but now it's mostly down on the right side.\nJe comprends. So it started in the upper abdomen, and moved to the right lower side. Is that— Wait, doctor, effectivement. Okay, okay. Was the pain sudden or gradual?\nIt was gradual, just a dull ache at first, but now it's sharp, about 8 out of 10. Okay, okay.\nEst-ce que la douleur se propage autre part, par exemple votre dos ou alors vos épaules?\nNo, doctor, it stays in the lower right. Okay. Anything makes it better or worse? Doctor, nothing really helps. Moving around makes it a bit worse.\nEt avez-vous de la fièvre aussi?\nOui, docteur.\nJ'ai fait de la fièvre la nuit dernière, et lorsque j'ai vérifié ma température, j'étais à 38 degrés. Et qu'en est-il des nausées ou alors du vomissement?\nI've vomited 3 times. Especially after eating. I have no appetite at all.\nOkay.\nAny diarrhea ou alors de la constipation? No, doctor.\nBowel movements are normal.\nAny burning when you pass urine or going more often? Hmm, no, doctor. Tout est bon de ce côté. Okay, okay. Je comprends.\nI'm going to press gently. You tell me when it's tender, okay?\nOw! That hurts right there. Hmm, okay, okay. How about when I let go? Worse, doctor. That really hurts.\nOkay. Je vais aussi mettre un peu de pression sur le côté gauche.\nLet me know, okay?\nHmm, I feel pain on the right side when you do that. Okay. You have tenderness.\nGathering and rebound tenderness in your right lower abdomen.\nAlso, a positive rough things sign.\nThere are very suggestive of acute appendicite.\nDoctor, is it serious? It can be, if not treated.\nThe appendix may be inflamed. And cold rupture.\nWe need to do blood work: CBC, CRP, and likely an abdominal ultrasound or CT. To confirm that.\nDoctor, do I need surgery? Euh, plus ou moins, plus ou moins.\nLaparoscopique, but we will confirm first. I'm going to start IV fluid. Pain relief and antibiotics.\nYou should eat or drink anything now in case we're going to operate you. Okay? Okay, doctor. Should I call my family? Euh, oui, oui, oui. Allez-y, allez-y. C'est important. We will admit you and have the surgical team to see within the hours.\nDonc, ils vont programmer si on va vous opérer et ils vont donner la période exacte de l'opération. D'accord? D'accord, docteur. Merci beaucoup.\nOkay. You're welcome. You're welcome. We'll take good care of you, and rest assured. Ici avec nous, c'est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D'accord, madame? D'accord, docteur.","marks":[{"start":8,"end":15,"said":"madam","significant":false},{"start":65,"end":77,"said":"aujourd hui.","significant":false},{"start":109,"end":115,"said":"you have","significant":false},{"start":156,"end":163,"said":"","significant":false},{"start":436,"end":448,"said":"Oui docteur","significant":false},{"start":602,"end":602,"said":"Et","significant":false},{"start":670,"end":672,"said":"où","significant":false},{"start":754,"end":756,"said":"him","significant":false},{"start":887,"end":891,"said":"j ai","significant":false},{"start":939,"end":943,"said":"j ai","significant":false},{"start":968,"end":975,"said":"j étais","significant":false},{"start":992,"end":997,"said":"quand","significant":false},{"start":1017,"end":1019,"said":"où","significant":false},{"start":1026,"end":1040,"said":"les vomissements","significant":false},{"start":1135,"end":1137,"said":"où","significant":false},{"start":1257,"end":1273,"said":"Non docteur","significant":false},{"start":1305,"end":1310,"said":"Okey","significant":false},{"start":1519,"end":1525,"said":"","significant":false},{"start":1755,"end":1760,"said":"They","significant":false},{"start":1790,"end":1809,"said":"appendices. Dr. but","significant":false},{"start":1887,"end":1891,"said":"could","significant":false},{"start":2023,"end":2026,"said":"","significant":false},{"start":2033,"end":2035,"said":"au","significant":false},{"start":2048,"end":2050,"said":"au","significant":false},{"start":2058,"end":2072,"said":"Laparoscopic.","significant":false},{"start":2204,"end":2209,"said":"we are","significant":false},{"start":2277,"end":2285,"said":"","significant":false},{"start":2315,"end":2320,"said":"c est","significant":false},{"start":2489,"end":2520,"said":"l opération d accord D accord","significant":false},{"start":2585,"end":2590,"said":"We","significant":false},{"start":2647,"end":2652,"said":"c est","significant":false},{"start":2742,"end":2750,"said":"D accord","significant":false},{"start":2760,"end":2768,"said":"D accord","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Records 4 days from Sunday evening, upper abdomen then right lower side."],["Records gradual onset, initially dull then sharp, currently 8/10.","partial","Dull ache now sharp 8/10 recorded; gradual onset not stated."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","yes","No radiation to back/shoulders, nothing alleviates, movement worsens."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","yes","Fever last night measured at 38 degrees; no other vitals invented."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","Three vomiting episodes especially after eating, and no appetite."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","Normal bowel movements; denies dysuria and increased frequency."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and Rovsing sign (right pain on left pressure) recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","yes","Appendicitis suspected with rupture risk if untreated."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","yes","Admission, surgical consultation within hours, laparoscopic operation if indicated."],["Plans IV fluids, analgesia and antibiotics.","yes","IV fluids, pain relief and antibiotics planned."],["Encourages contacting family and provides reassurance.","partial","Advised to contact family; reassurance not recorded."]],"claims":[],"note":"S (Subjective):\n- The patient presented with abdominal pain for 4 days, starting Sunday evening.\n- Pain began in the upper abdomen and migrated to the right lower side, described initially as a dull ache, now sharp, 8/10 in severity.\n- They reported no radiation of pain to the back or shoulders, and nothing alleviates the pain, though moving around worsens it.\n- Associated symptoms include a fever of 38 degrees Celsius last night, 3 episodes of vomiting, especially after eating, and complete loss of appetite.\n- The patient reported normal bowel movements with no diarrhea or constipation, and no dysuria or increased urinary frequency.\n\nO (Objective):\n- Physical examination revealed tenderness in the right lower abdomen upon gentle palpation.\n- Rebound tenderness was elicited in the right lower abdomen.\n- A positive Rovsing's sign was noted, with pain in the right lower abdomen upon pressure to the left side.\n\nA (Assessment):\n- The patient's presentation and physical exam findings are highly suggestive of acute appendicitis.\n- Potential complications include inflammation and rupture of the appendix if left untreated.\n\nP (Plan):\n- Initiate IV fluids, pain relief, and antibiotics.\n- Order blood work including CBC and CRP.\n- Schedule an abdominal ultrasound or CT scan for confirmation of diagnosis.\n- Keep the patient NPO (nil per os) in anticipation of potential surgery.\n- Admit the patient and arrange for a surgical team consultation within hours.\n- Advise the patient to contact their family.\n- The surgical team will determine the need for and schedule a laparoscopic operation if indicated.\n","review":99.36842105263158,"saved":179.63157894736844,"clean":false,"effort":8.333333333333332,"sig":[],"mb":16.555454,"latency":26.65,"signable":114.36842105263158}],"patientnotes":[{"label":"Run 1","wer":32.79022403258656,"text":"Bonjour, madam. So, please have a seat. Understand you have had abdominal pain for at least four days?\nYes, Doctor. It started on Sunday evening.\nOkay. Can you tell me where the pain began exactly?\nIt was right here in my upper belly. But now it's mostly down on the right side.\nSo it started in the upper abdomen and moved to the right lower side. Is that okay? Okay. Was the pain sudden or gradual?\nIt was gradual. Just a tall ache at first. But now it's sharp, about 8 out of 10.\nOkay. Okay. Et CE la doulour se propage autre pas par exemple, votre d'. Eau. Voil?\nNo, Doctor. It stays in the lower right.\nOkay. Anything makes it better or worse,\nDoctor? Nothing really helps. Moving around makes it a bit worse. I've vomited three times, especially after eating. I have no appetite at all. Home.\nOkay. Any diarrhoea, constipation?\nNo, doctor.\nBowel movements\nare normal. Any burning when you pass urine or going more often. Okay. Okay. I'm going to press gently. You tell me when it's tender. Okay.\nOw. That hurts right there.\nOkay. Okay. How about when I let go?\nWorse. Doctor, that really hurts.\nOkay, Let me know. Okay.\nI feel pain on the right side when you do that.\nOkay. You have tenderness gathering and.\nRebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis.\nTotal birth. Is it serious?\nIt can be. If not treated, the appendix may be inflamed and could rupture. We need to do blood work, cbc, CRP and likely an abdominal ultrasound or CT to confirm that.\nDoctor, do I need surgery?\nLaparoscopic.\nBut we will confirm first. I'm going to start IV Felodipine relief and antibiotics. You should eat or drink anything now in case. We are going to operate you. Okay?\nOkay. Doctor, Should I call my family?\nWe will admit you and have the surgical team to see within the ass. Okay? You're welcome. You're welcome. We take good care of you and rest. Ass.\nShot.","marks":[{"start":16,"end":18,"said":"je suis le docteur qui va vous prendre en charge aujourd hui.","significant":false},{"start":278,"end":278,"said":"Je comprends.","significant":false},{"start":356,"end":356,"said":"Oui docteur effectivement.","significant":false},{"start":424,"end":428,"said":"dull","significant":true},{"start":498,"end":500,"said":"est-ce que","significant":false},{"start":504,"end":511,"said":"douleur","significant":false},{"start":529,"end":532,"said":"part","significant":false},{"start":552,"end":565,"said":"dos où alors vos épaules","significant":false},{"start":629,"end":631,"said":"him","significant":false},{"start":714,"end":714,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à 38 degrés. Et quand est-il des nausées où alors les vomissements","significant":true},{"start":793,"end":798,"said":"","significant":false},{"start":809,"end":818,"said":"diarrhea où alors de la","significant":false},{"start":926,"end":926,"said":"Non docteur tout est bon de ce côté.","significant":true},{"start":933,"end":938,"said":"Okey je comprends.","significant":false},{"start":1105,"end":1105,"said":"je vais aussi mettre de pression sur le côté gauche.","significant":false},{"start":1279,"end":1288,"said":"rough things","significant":false},{"start":1329,"end":1355,"said":"appendices. Dr. but","significant":false},{"start":1564,"end":1564,"said":"Plus au moins plus au moins","significant":false},{"start":1629,"end":1639,"said":"fluid pain","significant":true},{"start":1782,"end":1782,"said":"Oui Oui allez-y allez-y c est important.","significant":false},{"start":1847,"end":1851,"said":"hours. Donc ils vont programmer si on va vous opérer et ils vont donner la période exacte de l opération d accord D accord docteur merci beaucoup.","significant":true},{"start":1925,"end":1935,"said":"assured. Ici avec nous c est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Began Sunday evening in upper abdomen, now right lower abdomen, at least four days."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","Gradual, dull ache then sharp, severity 8/10 recorded, though phrasing is slightly muddled."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","\"worsened by movement, no relieving measures\" recorded, but absence of radiation to back/shoulder is omitted."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","no","Fever and the measured 38 degree temperature are not recorded anywhere."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"Vomited three times after eating, loss of appetite.\""],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"bowel movements normal\" and \"no ... urinary symptoms\"."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","Right lower tenderness, rebound tenderness and \"Positive Rovsing's sign\" recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","\"Clinical impression: acute appendicitis\" given, but rupture risk if untreated is not mentioned."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Obtain blood work including CBC and CRP. Arrange abdominal ultrasound or CT to confirm diagnosis.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission and surgical evaluation for laparoscopic appendectomy noted, but \"within hours\" timing is missing."],["Plans IV fluids, analgesia and antibiotics.","no","\"IV Felodipine for pain relief\" is a wrong drug; IV fluids omitted; only antibiotics correct."],["Encourages contacting family and provides reassurance.","no","No family contact advice or reassurance recorded."]],"claims":[["IV Felodipine for pain relief discussed.","Transcript says only \"pain relief\"; no felodipine (an antihypertensive) is mentioned anywhere."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with abdominal pain lasting at least four days.\n\nHistory of Presenting Complaint::\n\nPain began Sunday evening in the upper abdomen, gradually became a dull ache then sharp, now localised to the right lower abdomen, severity 8/10.\n\nDuration four days, worsened by movement, no relieving measures.\n\nVomited three times after eating, loss of appetite, no diarrhoea, constipation, or urinary symptoms; bowel movements normal.\n\nObjective\n\nTenderness noted in the right lower abdomen.\n\nRebound tenderness present in the right lower abdomen.\n\nPositive Rovsing's sign observed.\n\nNot discussed\n\nAssessment\n\nClinical impression: acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for pain relief discussed.\n\nAntibiotics discussed.\n\nObtain blood work including CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit patient and have surgical team evaluate for possible laparoscopic appendectomy.\n\nAdvise nil by mouth until further assessment.","review":154.14473684210526,"saved":124.85526315789474,"clean":false,"effort":45.83333333333333,"sig":[["missing","Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","Fever of 38C is a key history item supporting appendicitis and is entirely absent."],["missing","Plans IV fluids, analgesia and antibiotics.","Analgesia recorded as IV felodipine (an antihypertensive) and IV fluids omitted."]],"mb":16.47986,"latency":24.191,"signable":178.33573684210526},{"label":"Run 2","wer":34.0122199592668,"text":"Bonjour, madam. So, please have a seat. Understand you have had abdominal pain for at least four days?\nYes, Doctor. It started on Sunday evening.\nOkay. Can you tell me where the pain began exactly?\nIt was right here in my upper belly. But now it's mostly down on the right side.\nSo it started in the upper abdomen and moved to the right lower side. Is that okay? Okay. Was the pain sudden or gradual?\nIt was gradual. Just a tall ache at first, but now it's sharp. About eight out of ten.\nOkay.\nEsque. La douleur se propage autre pas. Par exemple. Votre d'. Eau. Voil? Vaux?\nNo, Doctor. It stays in the lower right.\nOkay. Anything makes it better or worse,\nDoctor? Nothing really helps. Moving around makes it a bit worse. I vomited three times, especially after eating. I have no appetite at all.\nOkay. Any diarrhoea, constipation?\nNo, doctor. BOA movement.\nAnimal. Any burning when you pass urine or going more often? Okay. Okay. I'm going to press gently. You tell me when it's tender. Okay.\nOw. That hurts right there.\nOkay. Okay. How about when I let go?\nWorse. Doctor, that really hurts.\nOkay, Let me know. Okay.\nI feel pain on the right side when you do that.\nOkay. You have tenderness gathering and rebound tenderness in your right.\nAbdomen. Also a positive rough things sign. They are very suggestive of acute appendicitis.\nDoctor, Birth. Is it serious?\nIt can be if not treated. The appendix may be inflamed. Cold rupture. We need to do blood work, cbc, CRP and likely an abdominal ultrasound or CT to confirm that.\nDoctor, do I need surgery?\nPRISMA. PRISMA laparoscopic, but we will confirm.\nConfirmed. First I'm going to start IV Felodipine relief and antibiotics. You should eat or drink anything now in case we are going to operate you. Okay?\nOkay. Doctor, Should I call my family?\nWe will admit you and have the surgical team to see within the ass. Okay? You're welcome. You're welcome. We take good care of you and rest assured. Isia VEGNU for sale.\nVato problem.","marks":[{"start":16,"end":18,"said":"je suis le docteur qui va vous prendre en charge aujourd hui.","significant":false},{"start":278,"end":278,"said":"Je comprends.","significant":false},{"start":356,"end":356,"said":"Oui docteur effectivement.","significant":false},{"start":424,"end":428,"said":"dull","significant":true},{"start":494,"end":500,"said":"okay. Et est-ce que","significant":false},{"start":529,"end":533,"said":"part","significant":false},{"start":553,"end":572,"said":"dos où alors vos épaules","significant":false},{"start":636,"end":638,"said":"him","significant":false},{"start":722,"end":723,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à 38 degrés. Et quand est-il des nausées où alors les vomissements I've","significant":true},{"start":807,"end":816,"said":"diarrhea où alors de la","significant":false},{"start":844,"end":865,"said":"Bowel movements are normal.","significant":false},{"start":917,"end":917,"said":"Non docteur tout est bon de ce côté.","significant":true},{"start":925,"end":930,"said":"Okey je comprends.","significant":false},{"start":1097,"end":1097,"said":"je vais aussi mettre de pression sur le côté gauche.","significant":false},{"start":1239,"end":1239,"said":"lower","significant":true},{"start":1318,"end":1346,"said":"appendices. Dr. but","significant":false},{"start":1418,"end":1422,"said":"and could","significant":false},{"start":1552,"end":1566,"said":"Plus au moins plus au moins","significant":false},{"start":1602,"end":1612,"said":"","significant":false},{"start":1641,"end":1651,"said":"fluid pain","significant":true},{"start":1793,"end":1793,"said":"Oui Oui allez-y allez-y c est important.","significant":false},{"start":1858,"end":1862,"said":"hours. Donc ils vont programmer si on va vous opérer et ils vont donner la période exacte de l opération d accord D accord docteur merci beaucoup.","significant":true},{"start":1944,"end":1978,"said":"Ici avec nous c est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","\"Abdominal pain ≥4 days\" and \"Onset Sunday evening in upper abdomen, migrated to right lower quadrant.\""],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"Gradual dull ache progressing to sharp pain, 8/10 intensity.\""],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","Records \"Movement worsens pain\" but omits that nothing relieves it and the absence of radiation to back/shoulder."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","no","Fever last night with measured 38 degrees is not recorded anywhere in the note."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","\"three episodes of vomiting after meals; loss of appetite.\""],["Records normal bowel movements and denial of urinary burning or increased frequency.","partial","\"No diarrhoea or constipation\" covers bowels, but denial of urinary burning/frequency is omitted."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","partial","\"Tenderness and rebound tenderness in right abdomen\" does not localise to lower abdomen, and the left-pressure/right-pain finding is only given as the source-ambiguous \"rough things sign\" without description."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Identifies \"highly suggestive of acute appendicitis\" but omits risk of rupture if untreated."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Order CBC and CRP. Arrange abdominal ultrasound or CT to confirm diagnosis.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","\"Admit patient... surgical team to assess for laparoscopic appendectomy\" but omits review within hours."],["Plans IV fluids, analgesia and antibiotics.","no","IV fluids omitted and analgesia recorded as \"IV Felodipine for analgesia\", a wrong medication; only antibiotics correct."],["Encourages contacting family and provides reassurance.","partial","\"Advise patient to inform family\" captured; reassurance not recorded."]],"claims":[["IV Felodipine for analgesia initiated.","Transcript only says \"pain relief\"; no felodipine (an antihypertensive) or any named drug was mentioned."]],"note":"Subjective\n\nChief Complaint::\n\nAbdominal pain ≥4 days.\n\nHistory of Presenting Complaint::\n\nOnset Sunday evening in upper abdomen, migrated to right lower quadrant.\n\nGradual dull ache progressing to sharp pain, 8/10 intensity.\n\nMovement worsens pain; three episodes of vomiting after meals; loss of appetite.\n\nNo diarrhoea or constipation.\n\nObjective\n\nTenderness and rebound tenderness in right abdomen.\n\nPositive rough things sign suggestive of acute appendicitis.\n\nNot discussed\n\nAssessment\n\nClinical picture highly suggestive of acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for analgesia initiated.\n\nEmpiric antibiotics started.\n\nOrder CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit patient, keep NPO, surgical team to assess for laparoscopic appendectomy.\n\nAdvise patient to inform family of situation.","review":173.5,"saved":105.5,"clean":false,"effort":50.0,"sig":[["missing","Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","Measured fever of 38 degrees is absent, a key supporting feature for appendicitis severity."],["missing","Plans IV fluids, analgesia and antibiotics.","IV fluids omitted and analgesia recorded as felodipine, a wrong drug."]],"mb":16.808886,"latency":23.184,"signable":196.684},{"label":"Run 3","wer":32.9938900203666,"text":"Bonjour, madam. So, please have a seat. Understand you have had abdominal pain for at least four days?\nYes, Doctor. It started on Sunday evening.\nOkay. Can you tell me where the pain began exactly?\nIt was right here in my upper belly. But now it's mostly down on the right side.\nSo it started in the upper abdomen and moved to the right lower side. Is that okay? Okay. Was the pain sudden or gradual?\nIt was gradual. Just a dull ache at first. But now it's sharp, about 8 out of 10.\nOkay. Okay. Esque la doulour se propage autre pas. Par exemple, votre d'. Eau?\nNo, Doctor. It stays in the lower. Right.\nOkay. Anything makes it better or worse,\nDoctor? Nothing really helps. Moving around makes it a bit worse. I've vomited three times, especially after eating. I have no appetite at all. Home.\nOkay. Any diarrhoea, constipation?\nNo, doctor.\nBowel movements\nare normal. Any burning when you pass urine or going more often. Okay. Okay. I'm going to press gently. You tell me when it's tender. Okay.\nOw. That hurts right there.\nOkay. Okay. How about when I let go?\nWorse. Doctor, that really hurts.\nOkay, Let me know. Okay.\nI feel pain on the right side when you do that.\nOkay. You have tenderness gathering and.\nRebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis.\nTotal birth. Is it serious?\nIt can be. If not treated, the appendix may be inflamed and could rupture. We need to do blood work, cbc, CRP and likely an abdominal ultrasound or CT to confirm that.\nDoctor, do I need surgery?\nPrismo. Prismo Laparoscopic.\nBut we will confirm first. I'm going to start IV Felodipine relief and antibiotics. You should eat or drink anything now in case. We are going to operate you. Okay?\nOkay. Doctor, Should I call my family?\nWe will admit you and have the surgical team to see within the ass. Okay? You're welcome. You're welcome. We take good care of you and rest. Ass.\nShot.","marks":[{"start":16,"end":18,"said":"je suis le docteur qui va vous prendre en charge aujourd hui.","significant":false},{"start":278,"end":278,"said":"Je comprends.","significant":false},{"start":356,"end":356,"said":"Oui docteur effectivement.","significant":false},{"start":495,"end":500,"said":"Et est-ce que","significant":false},{"start":504,"end":511,"said":"douleur","significant":false},{"start":529,"end":533,"said":"part","significant":false},{"start":553,"end":560,"said":"dos où alors vos épaules","significant":false},{"start":625,"end":627,"said":"him","significant":false},{"start":710,"end":710,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à 38 degrés. Et quand est-il des nausées où alors les vomissements","significant":true},{"start":789,"end":794,"said":"","significant":false},{"start":805,"end":814,"said":"diarrhea où alors de la","significant":false},{"start":922,"end":922,"said":"Non docteur tout est bon de ce côté.","significant":true},{"start":929,"end":934,"said":"Okey je comprends.","significant":false},{"start":1101,"end":1101,"said":"je vais aussi mettre de pression sur le côté gauche.","significant":false},{"start":1275,"end":1284,"said":"rough things","significant":false},{"start":1325,"end":1351,"said":"appendices. Dr. but","significant":false},{"start":1562,"end":1576,"said":"Plus au moins plus au moins","significant":false},{"start":1640,"end":1650,"said":"fluid pain","significant":true},{"start":1793,"end":1793,"said":"Oui Oui allez-y allez-y c est important.","significant":false},{"start":1858,"end":1862,"said":"hours. Donc ils vont programmer si on va vous opérer et ils vont donner la période exacte de l opération d accord D accord docteur merci beaucoup.","significant":true},{"start":1936,"end":1946,"said":"assured. Ici avec nous c est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","\"Abdominal pain ≥4 days\", onset Sunday evening, upper abdomen migrated to right lower quadrant."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","\"gradual dull ache\" now \"sharp, 8/10\"."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","\"worsened by movement\" recorded but no mention that nothing relieves it or absence of radiation."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","no","Fever and the 38 degree temperature are not recorded."],["Records three vomiting episodes especially after eating, and absent appetite.","partial","\"vomiting ×3, loss of appetite\" recorded, but 'after eating' is attached to pain worsening rather than vomiting."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","\"No diarrhoea, constipation, urinary symptoms; normal bowel movements.\""],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and positive Rovsing's sign (right pain on left pressure)."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","\"highly suggestive of acute appendicitis\" but rupture risk if untreated is omitted."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","\"Order CBC and CRP. Arrange abdominal ultrasound or CT for confirmation.\""],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission, surgical team and possible laparoscopic appendectomy noted, but not the review within hours."],["Plans IV fluids, analgesia and antibiotics.","partial","IV fluids, analgesia and antibiotics listed, but analgesia wrongly specified as \"IV Felodipine\"."],["Encourages contacting family and provides reassurance.","no","No family contact advice or reassurance recorded."]],"claims":[["IV Felodipine for analgesia.","Transcript only says 'pain relief'; no drug named, and felodipine is an antihypertensive, not an analgesic."]],"note":"Subjective\n\nChief Complaint::\n\nAbdominal pain ≥4 days.\n\nHistory of Presenting Complaint::\n\nOnset Sunday evening, gradual dull ache in upper abdomen → migrated to right lower quadrant.\n\nNow sharp, 8/10, worsened by movement and after eating, vomiting ×3, loss of appetite.\n\nNo diarrhoea, constipation, urinary symptoms; normal bowel movements.\n\nObjective\n\nTenderness in RLQ with rebound tenderness and positive Rovsing's sign.\n\nPain increases on release of pressure.\n\nPain intensity 8/10.\n\nAssessment\n\nFindings highly suggestive of acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for analgesia.\n\nAntibiotics started.\n\nOrder CBC and CRP.\n\nArrange abdominal ultrasound or CT for confirmation.\n\nAdmit patient, involve surgical team for possible laparoscopic appendectomy.\n\nProvide IV fluids and analgesia.","review":152.98684210526315,"saved":126.01315789473685,"clean":false,"effort":45.83333333333333,"sig":[["missing","Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","Fever of 38C is a key supporting finding for appendicitis and is absent."],["partial","Plans IV fluids, analgesia and antibiotics.","Analgesia recorded as IV felodipine, an antihypertensive never mentioned."]],"mb":19.814239,"latency":21.165,"signable":174.15184210526314},{"label":"Run 4","wer":33.19755600814664,"text":"Bonjour, madam. So, please have a seat. Understand you have had abdominal pain for at least four days?\nYes, Doctor. It started on Sunday evening.\nOkay. Can you tell me where the pain began exactly?\nIt was right here in my upper belly. But now it's mostly down on the right side.\nSo it started in the upper abdomen and moved to the right lower side. Is that okay? Okay. Was the pain sudden or gradual?\nIt was gradual. Just a tall ache at first. But now it's sharp, about 8 out of 10.\nOkay. Okay. Et CE la doulour se propage autopart par exemple votre d'. Eau. Voil?\nNo, Doctor. It stays in the lower right.\nOkay. Anything makes it better or worse,\nDoctor? Nothing really helps. Moving around makes it a bit worse. I've vomited three times, especially after eating. I have no appetite at all.\nOkay. Any diarrhoea, constipation?\nNo, Doctor.\nBowel movements\nare normal. Any burning when you pass urine or going more often. Okay. Okay. I'm going to press gently. You tell me when it's tender. Okay.\nOw. That hurts right there.\nOkay. Okay. How about when I let go?\nWorse. Doctor, that really hurts.\nOkay, Let me know. Okay.\nI feel pain on the right side when you do that.\nOkay. You have tenderness gathering and.\nRebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis.\nTotal birth. Is it serious?\nIt can be. If not treated, the appendix may be inflamed and could rupture. We need to do blood work, cbc, CRP and likely an abdominal ultrasound or CT to confirm that.\nDoctor need surgery.\nPrismo. Prismo Laparoscopic.\nBut we will confirm first. I'm going to start IV Felodipine relief and antibiotics. You should eat or drink anything now in case. We are going to operate you. Okay?\nOkay. Doctor, Should I call my family?\nWe will admit you and have the surgical team to see within the ass. Okay? You're welcome. You're welcome. We take good care of you and rest. Ass.\nShot.","marks":[{"start":16,"end":18,"said":"je suis le docteur qui va vous prendre en charge aujourd hui.","significant":false},{"start":278,"end":278,"said":"Je comprends.","significant":false},{"start":356,"end":356,"said":"Oui docteur effectivement.","significant":false},{"start":424,"end":428,"said":"dull","significant":true},{"start":498,"end":500,"said":"est-ce que","significant":false},{"start":504,"end":511,"said":"douleur","significant":false},{"start":523,"end":531,"said":"autre part","significant":false},{"start":550,"end":563,"said":"dos où alors vos épaules","significant":false},{"start":627,"end":629,"said":"him","significant":false},{"start":712,"end":712,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à 38 degrés. Et quand est-il des nausées où alors les vomissements","significant":true},{"start":801,"end":810,"said":"diarrhea où alors de la","significant":false},{"start":918,"end":918,"said":"Non docteur tout est bon de ce côté.","significant":true},{"start":925,"end":930,"said":"Okey je comprends.","significant":false},{"start":1097,"end":1097,"said":"je vais aussi mettre de pression sur le côté gauche.","significant":false},{"start":1271,"end":1280,"said":"rough things","significant":false},{"start":1321,"end":1347,"said":"appendices. Dr. but","significant":false},{"start":1537,"end":1537,"said":"do I","significant":false},{"start":1552,"end":1566,"said":"Plus au moins plus au moins","significant":false},{"start":1630,"end":1640,"said":"fluid pain","significant":true},{"start":1783,"end":1783,"said":"Oui Oui allez-y allez-y c est important.","significant":false},{"start":1848,"end":1852,"said":"hours. Donc ils vont programmer si on va vous opérer et ils vont donner la période exacte de l opération d accord D accord docteur merci beaucoup.","significant":true},{"start":1926,"end":1936,"said":"assured. Ici avec nous c est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Onset Sunday evening in upper abdomen, migrated to right lower abdomen, at least four days."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","'gradual dull ache' then 'Current pain sharp, 8/10'."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","Worse with movement recorded; nothing relieving and no radiation to back/shoulder omitted."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","no","Fever with 38 degrees temperature not recorded."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","'three episodes of vomiting, loss of appetite' with relation to eating."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","'No diarrhoea, constipation, urinary symptoms; bowel movements normal'."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness, positive Rovsing's sign."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","Acute appendicitis identified but rupture risk not mentioned."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","CBC and CRP plus abdominal ultrasound or CT to confirm."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission, surgical team and likely laparoscopic appendectomy, but no review within hours."],["Plans IV fluids, analgesia and antibiotics.","no","IV fluids missing and analgesia given as 'IV Felodipine for relief'; only antibiotics correct."],["Encourages contacting family and provides reassurance.","partial","'Discuss family notification with patient' but no reassurance recorded."]],"claims":[["IV Felodipine for relief","Transcript plans 'IV fluid, pain relief and antibiotics'; felodipine (an antihypertensive) is never mentioned, a wrong-medication assertion."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with abdominal pain lasting at least four days.\n\nHistory of Presenting Complaint::\n\nPain onset Sunday evening, gradual dull ache in upper abdomen, migrated to right lower abdomen.\n\nCurrent pain sharp, 8/10, worsened by movement and after eating, three episodes of vomiting, loss of appetite.\n\nNo diarrhoea, constipation, urinary symptoms; bowel movements normal.\n\nObjective\n\nTenderness in right lower abdomen.\n\nRebound tenderness present.\n\nPositive Rovsing's sign.\n\nPain increases on release of pressure during palpation.\n\nPain intensity reported as 8/10.\n\nAssessment\n\nFindings highly suggestive of acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for relief\n\nAntibiotics\n\nOrder blood work: CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit patient and involve surgical team for likely laparoscopic appendectomy.\n\nDiscuss family notification with patient.","review":146.17105263157896,"saved":132.82894736842104,"clean":false,"effort":41.66666666666667,"sig":[["missing","Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","Measured fever of 38C is omitted."],["missing","Plans IV fluids, analgesia and antibiotics.","IV fluids omitted and analgesia given as a wrong drug."]],"mb":17.34287,"latency":23.136,"signable":169.30705263157896},{"label":"Run 5","wer":33.19755600814664,"text":"Bonjour, madam. So, please have a seat. Understand you have had abdominal pain for at least four days?\nYes, Doctor. It started on Sunday evening.\nOkay. Can you tell me where the pain began exactly?\nIt was right here in my upper belly. But now it's mostly down on the right side.\nSo it started in the upper abdomen and moved to the right lower side. Is that okay? Okay. Was the pain sudden or gradual?\nIt was gradual. Just a tall ache at first. But now it's sharp, about 8 out of 10.\nOkay. Okay. Et CE la doulour se propage autopart par exemple votre d'. Eau. Voil?\nNo, Doctor. It stays in the lower right.\nOkay. Anything makes it better or worse,\nDoctor? Nothing really helps. Moving around makes it a bit worse. I've vomited three times, especially after eating. I have no appetite at all.\nOkay. Any diarrhoea, constipation?\nNo, Doctor.\nBowel movements\nare normal. Any burning when you pass urine or going more often. Okay. Okay. I'm going to press gently. You tell me when it's tender. Okay.\nOw. That hurts right there.\nOkay. Okay. How about when I let go?\nWorse. Doctor, that really hurts.\nOkay, Let me know. Okay.\nI feel pain on the right side when you do that.\nOkay. You have tenderness gathering and.\nRebound tenderness in your right lower abdomen. Also a positive Rovsing's sign. They are very suggestive of acute appendicitis.\nTotal birth. Is it serious?\nIt can be. If not treated, the appendix may be inflamed and could rupture. We need to do blood work, cbc, CRP and likely an abdominal ultrasound or CT to confirm that.\nDoctor need surgery.\nPrismo. Prismo Laparoscopic.\nBut we will confirm first. I'm going to start IV Felodipine relief and antibiotics. You should eat or drink anything now in case. We are going to operate you. Okay?\nOkay. Doctor, Should I call my family?\nWe will admit you and have the surgical team to see within the ass. Okay? You're welcome. You're welcome. We take good care of you and rest. Ass.\nShot.","marks":[{"start":16,"end":18,"said":"je suis le docteur qui va vous prendre en charge aujourd hui.","significant":false},{"start":278,"end":278,"said":"Je comprends.","significant":false},{"start":356,"end":356,"said":"Oui docteur effectivement.","significant":false},{"start":424,"end":428,"said":"dull","significant":true},{"start":498,"end":500,"said":"est-ce que","significant":false},{"start":504,"end":511,"said":"douleur","significant":false},{"start":523,"end":531,"said":"autre part","significant":false},{"start":550,"end":563,"said":"dos où alors vos épaules","significant":false},{"start":627,"end":629,"said":"him","significant":false},{"start":712,"end":712,"said":"Et avez-vous de la fièvre aussi Oui docteur j ai fait de la fièvre la nuit dernière et lorsque j ai vérifié ma température j étais à 38 degrés. Et quand est-il des nausées où alors les vomissements","significant":true},{"start":801,"end":810,"said":"diarrhea où alors de la","significant":false},{"start":918,"end":918,"said":"Non docteur tout est bon de ce côté.","significant":true},{"start":925,"end":930,"said":"Okey je comprends.","significant":false},{"start":1097,"end":1097,"said":"je vais aussi mettre de pression sur le côté gauche.","significant":false},{"start":1271,"end":1280,"said":"rough things","significant":false},{"start":1321,"end":1347,"said":"appendices. Dr. but","significant":false},{"start":1537,"end":1537,"said":"do I","significant":false},{"start":1552,"end":1566,"said":"Plus au moins plus au moins","significant":false},{"start":1630,"end":1640,"said":"fluid pain","significant":true},{"start":1783,"end":1783,"said":"Oui Oui allez-y allez-y c est important.","significant":false},{"start":1848,"end":1852,"said":"hours. Donc ils vont programmer si on va vous opérer et ils vont donner la période exacte de l opération d accord D accord docteur merci beaucoup.","significant":true},{"start":1926,"end":1936,"said":"assured. Ici avec nous c est la guérison assurée. Vous allez forcément trouver guérison et solution à votre problème. D accord madame D accord docteur.","significant":false}],"facts":[["Records four days of abdominal pain beginning Sunday evening, initially upper abdominal then migrating to the right lower abdomen.","yes","Four days, started Sunday evening in upper abdomen, migrated to right lower abdomen."],["Records gradual onset, initially dull then sharp, currently 8/10.","yes","'began gradually as a dull ache and is now described as sharp, rating 8/10'."],["Records pain worsened by movement, nothing relieving it, and no radiation to back or shoulder.","partial","Records 'Moving worsens the pain' but omits nothing relieving it and no radiation to back/shoulder."],["Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","no","Fever last night with temperature 38 degrees is not recorded."],["Records three vomiting episodes especially after eating, and absent appetite.","yes","'vomited three times, especially after eating, with loss of appetite'."],["Records normal bowel movements and denial of urinary burning or increased frequency.","yes","'no diarrhoea, constipation, or urinary symptoms and bowel movements are normal'."],["Records right lower abdominal tenderness and rebound tenderness, and right-sided pain elicited by left abdominal pressure.","yes","RLQ tenderness, rebound tenderness and positive Rovsing's sign recorded."],["Identifies suspected acute appendicitis and risk of rupture if untreated.","partial","'highly suggestive of acute appendicitis' but risk of rupture if untreated is not mentioned."],["Plans CBC and CRP blood tests, with abdominal ultrasound or CT to confirm.","yes","'Order blood work including CBC and CRP' and 'abdominal ultrasound or CT to confirm'."],["Discusses likely laparoscopic surgery after confirmation and admission with surgical team review within hours.","partial","Admission, surgical team and likely laparoscopic appendectomy recorded, but review within hours is missing."],["Plans IV fluids, analgesia and antibiotics.","no","IV fluids omitted and analgesia replaced by 'IV Felodipine for relief'; only antibiotics correct."],["Encourages contacting family and provides reassurance.","partial","'Advise the patient to call family' recorded; reassurance only vaguely as 'supportive care'."]],"claims":[["IV Felodipine for relief","Transcript plans 'IV fluid, pain relief and antibiotics'; felodipine (an antihypertensive) is never mentioned, a wrong-medication assertion."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with abdominal pain of at least four days duration.\n\nHistory of Presenting Complaint::\n\nThe pain started on Sunday evening in the upper abdomen and has migrated to the right lower abdomen. It began gradually as a dull ache and is now described as sharp, rating 8/10. Moving worsens the pain, and the patient has vomited three times, especially after eating, with loss of appetite. There is no diarrhoea, constipation, or urinary symptoms and bowel movements are normal.\n\nObjective\n\nExamination reveals tenderness in the right lower abdomen with rebound tenderness.\n\nA positive Rovsing's sign is present.\n\nPain increases on release of pressure during palpation.\n\nPain intensity reported as 8 out of 10.\n\nAssessment\n\nFindings are highly suggestive of acute appendicitis.\n\nPlan\n\nMedications::\n\nIV Felodipine for relief.\n\nAntibiotics (unspecified).\n\nOrder blood work including CBC and CRP.\n\nArrange abdominal ultrasound or CT to confirm diagnosis.\n\nAdmit the patient and involve the surgical team for likely laparoscopic appendectomy.\n\nAdvise the patient to call family and provide supportive care during admission.","review":160.38157894736844,"saved":118.61842105263156,"clean":false,"effort":41.66666666666667,"sig":[["missing","Records fever last night with measured temperature 38 degrees, without inventing other measured vitals.","Measured fever of 38C is a key finding in suspected appendicitis and is absent."],["missing","Plans IV fluids, analgesia and antibiotics.","IV fluids omitted and analgesia replaced by a wrong drug."]],"mb":17.492238,"latency":19.094,"signable":179.47557894736843}]}},{"id":"day1_consultation01","name":"Gastroenteritis","dictation":false,"language":false,"stress":false,"reference":"Hello? Hi. Um, should we start? Yeah, okay. Hello how um. Good morning sir, how can I help you this morning?\n\n Hello, how are you?\n\n Oh hey, um, I've just had some diarrhea for the last three days, um, and it's been affecting me I need to stay close to the toilet. And, um, yeah, it's been affecting my day-to-day activities.\n\n Sorry to hear that. Um, and and when you say diarrhea, what'd you mean by diarrhea? Do you mean you're going to the toilet more often? Or are your stools more loose?\n\n Yeah, so it's like loose and watery stool, going to the toilet quite often, uh and like some pain in my, like, lower stomach?\n\n Okay. And how many times a day are you going, let's say, in the last couple of days?\n\n Um, probably like six or seven times a day? Yeah.\n\n Six, seven times a day. And you mention it's mainly watery. Have you noticed any other things, like blood in your stools?\n\n No, no blood, yeah, just watery and loose stool.\n\n Okay. And you mentioned you've had some pain in your tummy as well. Whereabouts is the pain, exactly?\n\n Yep.\n\n So in my lower abdomen, so, uh, like, um...yeah, just to one side.\n\n One side. And what side is that?\n\n Uh, on the left side.\n\n Left side. Okay, and can you describe the pain to me?\n\n Yeah, it feels, um, like a cramp, like a muscular cramp, and, um, yeah i feel a bit uh weak and shaky.\n\n Okay. And is the pain, is that, is it there all the time, or does it come and go?\n\n Uh, it comes and goes.\n\n Come and go. Does the pain move anywhere else, for example towards your back?\n\n Uh...no, just maybe my stomach.\n\n Okay, fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh have you been feeling feverish, for example?\n\n Yeah.\n\n Um, yeah, it doesn't feel like -- yeah, it just makes me feel weak. I haven't had a fever, um, at the moment, but I did notice um a temperature when the symptoms started, so, um, yeah around about three or four days ago.\n\n You measure your temperature then?\n\n Yeah, I uh I didn't mention my temperature, no, but I felt, um, just a bit hot. And, y'know.\n\n Okay. Okay. Any other symptoms like sweating, or um, night sweats? No? And, uh, any vomiting at all?\n\n Uh, no.\n\n Yeah, so um, I vomited at the start of the symptoms but now um I've stopped vomiting.\n\n You stopped vomiting, okay. And was your vomit, I know it's not a nice thing to talk about, but was it just normal food colour Yeah. And there was no blood in your vomit, is that right?\n\n Yeah, yeah, just normal vomit, yeah. No no blood, no. Yeah.\n\n No, okay. Um, and um, any any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned your vomiting, uh, anything else that comes to mind?\n\n Yep. Um, I had a loss of appetite, um, so I haven't been eating as much, but I've been able to hold down fluids.\n\n Okay.\n\n Okay, so you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n Yep.\n\n Um, just soups, and, uh, yeah, light foods. Like smoothies and, yeah, liquid foods mainly.\n\n Okay. Fine. Um, and sir these started three days ago the symptoms. Are you aware of any triggers which may have caused the symptoms uh to kick on. So for example, think like takeaway foods or eating out or being around other people with similar symptoms.\n\n Yeah, so I had takeaway about four days ago, um, uh, but other than that I've, yeah, been, uh, eating normally. Nothing unusual here.\n\n Okay.\n\n Do you remember where you ate?\n\n Um, yeah, I ate at a Chinese restaurant with friends. Yeah.\n\n Okay. Anyone else unwell with similar symptoms?\n\n Um, so no one else in the family, so a wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n Okay, okay. Fine. Um, alright. And uh, in terms of your , your overall health, are you normally fit and well? Or, uh\n\n Um, yeah, I mean, other than um athsma, um I use an inhaler, everything uh else is fine.\n\n Okay. And, is your asthma well-controlled?\n\n Uh, yeah, that's fine. I just, yeah, use an inhaler, and uh that's under control.\n\n Fine. And you don't have any other tummy problem, bowel problems I should be aware of?\n\n No.\n\n No, okay. Um, and apart from the inhalers, do you take any other medications?\n\n Uh, no, no other medications.\n\n Okay, fine. And in terms of just your day to day life, you said it's been affecting your life, um, in what way has it been affecting your life?\n\n Yeah.\n\n Uh, so, I need to stay close to the toilet 'cause I go quite frequently during the these past three days. Um, yeah, other than that, it's uh, yeah, the main concern.\n\n Okay.\n\n Yeah.\n\n And have you, are you currently working at the moment?\n\n Uh, yes, yeah. I I work, er. Um, I'm an accountant.\n\n Would, would work.\n\n Okay. Have you been going into work the last three days, or have you been at home?\n\n Uh, yeah, I've been going to work. Yeah. Yeah, it's been quite difficult.\n\n okay. That must be difficult for you then.\n\n fine. And you said, you mentioned you live with your wife and two children, is that right?\n\n Yes, yeah.\n\n Right, alright. Um, just a couple of other question we need to ask, sir. Um, do you smoke at all?\n\n Uh, no, I don't smoke.\n\n And do you drink much in the way of alcohol?\n\n Uh, no, I I don't drink alcohol, no.\n\n Okay. so um, er normally at this stage I like to um, examine you if that's okay, but um, um, but but having listened to your story, sir, I think uh, um, just to recap for the last three days you've been having loose stool, diarrhea, a bit of tummy pain uh mainly on the left-hand side, um and vomiting and fever and you're quite weak and lethargic um, you mentioned you had this Chinese takeaway as little as three days ago and I wondered whether that might be the cause of your problems.\n\n Yeah.\n\n Okay.\n\n Um, it seems like you may have something, uh, called gastroenteritis, which essentially just a tummy bug or infection of your uh of your tummy.\n\n Uh, mainly caused by viruses but there can be a possibility of bacteria uh causing its symptoms. Um.\n\n Yeah.\n\n Yeah.\n\n At this stage, uh, what, what we'd recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated, so drinking fluids.\n\n Mm-hmm.\n\n Um, there are things like Dioralyte you can get from the pharmacy, which uh it's um it helps helps replenish your minerals and vitamins.\n\n Okay.\n\n Um, and if you are having vomiting diarrhea I would say recommend that in the first, you know, first couple of days.\n\n Yep.\n\n If you are feeling feverish and weak, eh taking some paracetamol, uh, two tablets up to four times a day for the first few days can also help.\n\n Yep.\n\n I will certainly advise you to take some time off work, actually I know you're quite keen to work but I would say the next two, two to three days as the infection clears from your system to take some time off and rest.\n\n Okay.\n\n Yeah.\n\n Um, I'll admit if your symptoms haven't got better, you know, in in three to four days, I'd like to come and see you again.\n\n Okay, sure.\n\n Because if it is ongoing then we have to wonder whether something else caused your symptoms.\n\n Yep.\n\n Uh, and we may need to do further tests like um taking a sample of your stool so we can test that.\n\n Um, etcetera etcetera.\n\n Yep, sure, yep.\n\n How's that sound?\n\n That sounds great, yeah. Yeah.\n\n Do you have any questions for me?\n\n Um, no, no further questions, no.\n\n Okay, and is uh is the treatment plan clear?\n\n Uh, yes, yeah, that's that's very clear. Thank you.\n\n Great. Well, I wish you all the best.\n\n Okay, thank you. Bye.\n\n Thank you. Bye 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1","wer":14.940098661028895,"text":"Hello.\n\n  Hello, how are you?\n\n  Hi. Um, should we stop?\n\n  Yeah.\n\n  Yeah, okay. Hello, um, good morning, sir. How can I help you this morning?\n\n  Hi, um, I've just had some, um, diarrhea for the last 3 days, um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities.\n\n  Okay. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\n  Yeah, so it's like loose and watery stool, going to the toilet quite often, um, and like some pain in my, like, lower stomach.\n\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n\n  Um, probably like 6 or 7 times a day.\n\n  6 or 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n\n  No, no blood. Yeah, just watery and loose stool.\n\n  Okay. And you mentioned you've had some pain in your tummy as well.\n\n  Yeah.\n\n  Whereabouts is the pain exactly?\n\n  So it's like in my lower abdomen, so, uh, like, um, yeah, just to one side.\n\n  One side. And what side is that?\n\n  Uh, on the left side.\n\n  Left side, okay. And can you describe the pain to me?\n\n  Yeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky.\n\n  Okay. And is the pain is that is it there all the time, or does it come and go?\n\n  Uh, it comes and goes.\n\n  Comes and go. Does the pain move anywhere else, for example towards your back?\n\n  Um, no, just mainly in my stomach.\n\n  Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example?\n\n  Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\n\n  Did you measure your temperature then?\n\n  Yeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\n  Okay, okay. Any other symptoms, like sweating or, um, night sweats?\n\n  Um, no.\n\n  No? And, uh, any vomiting at all?\n\n  Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\n  You've stopped vomiting. Okay. And was your vomit I know it's not a nice thing to talk about, but was it just normal food colour?\n\n  Yeah, yeah, just normal vomit. Yeah.\n\n  Yeah. And there was no blood in your vomit. Is that right?\n\n  No blood, no.\n\n  No. Okay. Um.\n\n  Yeah.\n\n  And, um, any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned the vomiting. Um.\n\n  Yeah.\n\n  Anything else that comes to mind?\n\n  Um, I had a loss of appetite, um, so I haven't been eating as much.\n\n  Okay.\n\n  Um, but I've been able to hold down fluids.\n\n  Okay. So you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n  Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly.\n\n  Okay. Fine. Um, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would sim the symptoms?\n\n  Yeah, so I had takeaway about 4 days ago, um, uh, but other than that, I've yeah, I've been eating normally.\n\n  Okay.\n\n  I think, I think, uh, unusual, yeah.\n\n  Do you remember what you ate?\n\n  Um, yeah, I, I ate at a Chinese restaurant with friends.\n\n  Okay. Anyone else unwell with similar symptoms?\n\n  Um, so no one else in the family, so I, uh, wife and 2 kids and 1, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n  Okay. Okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or?\n\n  Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine.\n\n  Okay. And is your asthma well controlled?\n\n  Uh, yeah, that's fine.\n\n  Okay.\n\n  Uh, just, yeah, use an inhaler and, uh, that's under control.\n\n  Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\n  No.\n\n  No. Okay. Um, and apart from the inhalers, do you take any other medications?\n\n  Uh, no, no other medications.\n\n  Okay. Fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um.\n\n  Yeah.\n\n  In what way has it been affecting your life?\n\n  Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days.\n\n  Okay.\n\n  Um, yeah, other than that, it's, uh, yeah, the main concern.\n\n  Yeah. And have you are you currently working at the moment?\n\n  Uh, yes. Yeah, I, I work, uh.\n\n  Working at the work?\n\n  Um, I'm an accountant.\n\n  Okay. Have you been going into work the last 3 days, or have you been at home?\n\n  Uh, yeah, I've been going to work.\n\n  Okay. That must be difficult for you then.\n\n  Yeah, it's been quite difficult.\n\n  Right. And you said you mentioned you live with a wife and 2 children. Is that right?\n\n  Yes, yeah.\n\n  All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\n\n  Uh, no, I don't smoke.\n\n  And do you drink much in the way of alcohol?\n\n  Uh, no, I, I don't drink alcohol, no.\n\n  Okay. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay, but, um, um.\n\n  Yeah.\n\n  But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Um.\n\n  Yeah.\n\n  You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems.\n\n  Okay.\n\n  Um, it seems like you may have something called gastroenteritis.\n\n  Okay.\n\n  Which essentially just, uh, tummy bug or an infection of your, of your tummy. Uh.\n\n  Yeah.\n\n  Mainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms.\n\n  Yeah.\n\n  Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking.\n\n  Yeah.\n\n  Plenty of fluids. Um, uh, there, there are things like Dioralyte you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins.\n\n  Okay.\n\n  Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days.\n\n  Yeah.\n\n  Um, if you are feeling feverish and weak, taking some paracetamol, uh.\n\n  Yeah.\n\n  2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say next 2, 2 to 3 days, um, as.\n\n  Yeah.\n\n  Infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\n\n  Okay, sure.\n\n  Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms.\n\n  Yeah.\n\n  Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc.\n\n  Yeah, sure, yeah.\n\n  How does that sound?\n\n  That sounds great, yeah, yeah.\n\n  Do you have any questions for me?\n\n  Um, no, no further questions, no.\n\n  Okay. Is it, is the treatment plan clear?\n\n  Uh, yeah, yeah, that's, that's very clear, thank you.\n\n  Great. 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It does not assert a measured temperature.","yes","\"felt hot at onset... but no measured temp. No current fever\" and \"Feels weak/shaky\"."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"↓ appetite; tolerating fluids. Eating soups, smoothies and other light/liquid foods\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","\"Chinese takeaway with friends 4 days ago\" and \"1 child vomiting without diarrhoea\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"asthma, controlled with inhaler\" and \"Meds: inhaler only\"."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"Staying near toilet; affecting daily activities/work\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute gastroenteritis, likely viral; bacterial cause possible\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","\"Conservative management; antibiotics not indicated\" and \"oral fluids and Dioralyte\"."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol 2 tablets up to 4 times/day... if feverish/weak\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Advise rest and time off work for next 2–3 days\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Return if not improving within 3–4 days; consider further tests, including stool sample\"."]],"claims":[],"note":"Subjective\nWatery, loose diarrhoea x3 days; 6–7 stools/day. Staying near toilet; affecting daily activities/work.\nIntermittent cramping L lower abdominal pain; non-radiating.\nInitial vomiting, now resolved; vomitus normal in appearance, no blood.\nFeels weak/shaky; felt hot at onset 3–4 days ago but no measured temp. No current fever, sweats or night sweats.\nNo blood in stool.\n↓ appetite; tolerating fluids. Eating soups, smoothies and other light/liquid foods.\nChinese takeaway with friends 4 days ago. No household member with same sx; 1 child vomiting without diarrhoea.\nPMH: asthma, controlled with inhaler. No other GI/bowel problems.\nMeds: inhaler only. No smoking or alcohol.\nWorks as an accountant; has continued attending work despite sx.\nObjective\nNo physical examination or observations documented.\nAssessment\nAcute gastroenteritis, likely viral; bacterial cause possible given recent takeaway.\nSupported by acute watery diarrhoea, transient vomiting, intermittent abdominal cramping and reduced appetite; no reported blood in stool/vomit and able to retain fluids.\nPlan\nConservative management; antibiotics not indicated at present.\nEncourage oral fluids and Dioralyte for fluid/mineral replacement.\nParacetamol 2 tablets up to 4 times/day for first few days if feverish/weak.\nAdvise rest and time off work for next 2–3 days.\nReturn if not improving within 3–4 days; consider further tests, including stool sample, if ongoing.","review":68.84210526315789,"saved":314.1578947368421,"clean":true,"effort":0.0,"sig":[]},{"label":"Run 2","wer":15.433403805496829,"text":"Hello.\n\n  Hello, how are you?\n\n  Hi. Um, should we start?\n\n  Yeah.\n\n  Yeah, okay. Hello, how— um, good morning, sir. How can I help you this morning?\n\n  Hi, um, I've just had some, um, diarrhea for the last 3 days, um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities.\n\n  Oh, yeah. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\n  Yeah, so it's like loose and watery stool, going to the toilet quite often, um, and like some pain in my, like, lower stomach.\n\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n\n  Um, probably like 6 or 7 times a day.\n\n  6 or 7 times a day. And you maybe mentioned this is mainly watery. Have you noticed any other things, like blood in your stools?\n\n  No, no blood. Yeah, just watery and loose stool.\n\n  Okay. And you mentioned you've had some pain in your tummy as well.\n\n  Yeah.\n\n  Whereabouts is the pain exactly?\n\n  So it's like in my lower abdomen, so, uh, like, um, yeah, just to one side.\n\n  One side. And what side is that?\n\n  Uh, on the left side.\n\n  Left side, okay. And can you describe the pain to me?\n\n  Yeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky.\n\n  Okay. And does the pain— is that— is it there all the time, or does it come and go?\n\n  Uh, it comes and goes.\n\n  It comes and goes. Does the pain move anywhere else, for example, towards your back?\n\n  Um, no, just mainly in my stomach.\n\n  Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example?\n\n  Um, yeah, it doesn't feel like— uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\n\n  Did you measure your temperature then?\n\n  Yeah, I— I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\n  Okay, okay. Any other symptoms, like sweating or, um, night sweats?\n\n  Um, no.\n\n  No? And, uh, any vomiting at all?\n\n  Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\n  You've stopped vomiting, okay. And was your vomit— I know it's not nice to talk about, but was it just normal food colour?\n\n  Yeah, yeah, just normal vomit. Yeah.\n\n  Yeah. And there was no blood in your vomit. Is that right?\n\n  No blood, no.\n\n  No. Okay. Um.\n\n  Yeah.\n\n  And, um, any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned your vomiting. Um.\n\n  Yeah.\n\n  Anything else that comes to mind?\n\n  Um, I had a loss of appetite, um, so I haven't been eating as much.\n\n  Okay.\n\n  Um, but I've been able to hold down fluids.\n\n  Okay. So you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n  Um, just soups. And, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly.\n\n  Okay. Fine. Um, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would send the symptoms?\n\n  Yeah, so I had takeaway about 4 days ago, um, uh, but other than that, I've— yeah, I've been eating normally.\n\n  Okay.\n\n  I think, yeah, unusual, yeah.\n\n  Do you remember what you ate?\n\n  Um, yeah, I ate at a Chinese restaurant with friends.\n\n  Okay. Anyone else unwell with similar symptoms?\n\n  Um, so no one else in the family, so I, uh, wife and 2 kids and 1, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n  Okay, okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally feeling well, or?\n\n  Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine.\n\n  Okay. And does your asthma well controlled?\n\n  Uh, yeah, that's fine.\n\n  Okay.\n\n  Uh, just, yeah, use an inhaler and, uh, that's under control.\n\n  Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\n  No.\n\n  No. Okay. Um, and apart from the inhalers, do you take any other medications?\n\n  Uh, no, no other medications.\n\n  Okay. Fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um.\n\n  Yeah.\n\n  In what way has it been affecting your life?\n\n  Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days.\n\n  Okay.\n\n  Um, yeah, other than that, it's, uh, yeah, that's the main concern.\n\n  And have you— are you currently working at the moment?\n\n  Uh, yes, yeah, I, I work, um.\n\n  Working at the work?\n\n  Um, I'm an accountant.\n\n  Okay. Have you been going into work the last 3 days, or have you been at home?\n\n  Uh, yeah, I've been going to work.\n\n  Okay. That must be difficult for you then.\n\n  Yeah, it's been quite difficult.\n\n  Right. And you said you mentioned you live with a wife and 2 children. Is that right?\n\n  Yes, yeah.\n\n  All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\n\n  Uh, no, I don't smoke.\n\n  And do you drink much in the way of alcohol?\n\n  Uh, no, I, I don't drink alcohol, no.\n\n  Okay. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay, but, um, um.\n\n  Yeah.\n\n  But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Um.\n\n  Yeah.\n\n  You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems.\n\n  Okay.\n\n  Um, it seems like you may have something called gastroenteritis.\n\n  Okay.\n\n  Which essentially just, uh, tummy bug or an infection of your, of your tummy. Um.\n\n  Yeah.\n\n  Mainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms.\n\n  Yeah.\n\n  Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Um, uh, there, there are things like Dioralyte you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins.\n\n  Okay.\n\n  Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days.\n\n  Yeah.\n\n  Um, if you are feeling feverish and weak, taking some paracetamol, uh.\n\n  Yeah.\n\n  To, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\n\n  Okay, sure.\n\n  Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms.\n\n  Yeah.\n\n  Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc.\n\n  Yeah, sure, yeah.\n\n  How does that sound?\n\n  That sounds great, yeah, yeah.\n\n  Do you have any questions for me?\n\n  Um, no, no further questions, no.\n\n  Okay. Is there, is the treatment plan clear?\n\n  Uh, yeah, yeah, that's, that's very clear, thank you.\n\n  Great. Well, I wish you all the best.\n\n  Okay, thank you.\n\n  Thank you.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":10,"end":28,"said":"","significant":false},{"start":153,"end":155,"said":"Hello how are you Oh hey","significant":false},{"start":346,"end":359,"said":"","significant":false},{"start":411,"end":418,"said":"what'd","significant":false},{"start":713,"end":717,"said":"in","significant":false},{"start":789,"end":791,"said":"","significant":false},{"start":815,"end":838,"said":"mention it's","significant":false},{"start":1082,"end":1082,"said":"Yep.","significant":false},{"start":1090,"end":1099,"said":"","significant":false},{"start":1402,"end":1406,"said":"is","significant":false},{"start":1505,"end":1513,"said":"Come","significant":false},{"start":1518,"end":1523,"said":"go.","significant":false},{"start":1593,"end":1599,"said":"Uh...no","significant":false},{"start":1606,"end":1615,"said":"maybe","significant":false},{"start":1854,"end":1856,"said":"--","significant":false},{"start":1871,"end":1877,"said":"makes me","significant":false},{"start":2042,"end":2045,"said":"","significant":false},{"start":2102,"end":2109,"said":"mention","significant":false},{"start":2161,"end":2161,"said":"And y'know.","significant":false},{"start":2236,"end":2243,"said":"","significant":false},{"start":2279,"end":2279,"said":"Uh no.","significant":false},{"start":2377,"end":2383,"said":"You","significant":false},{"start":2448,"end":2448,"said":"thing","significant":false},{"start":2503,"end":2539,"said":"","significant":false},{"start":2600,"end":2600,"said":"Yeah yeah just normal vomit yeah. 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Okay.","significant":false},{"start":3578,"end":3582,"said":"where","significant":false},{"start":3889,"end":3895,"said":"alright.","significant":false},{"start":3961,"end":3968,"said":"fit and","significant":false},{"start":4016,"end":4022,"said":"athsma","significant":false},{"start":4088,"end":4092,"said":"is","significant":false},{"start":4266,"end":4274,"said":"problem","significant":false},{"start":4476,"end":4491,"said":"day to day","significant":false},{"start":4644,"end":4651,"said":"'cause","significant":false},{"start":4760,"end":4766,"said":"","significant":false},{"start":4872,"end":4898,"said":"er.","significant":false},{"start":4925,"end":4925,"said":"Would would work.","significant":false},{"start":5045,"end":5045,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":5095,"end":5137,"said":"fine.","significant":false},{"start":5179,"end":5180,"said":"your","significant":false},{"start":5234,"end":5237,"said":"","significant":false},{"start":5244,"end":5244,"said":"alright.","significant":false},{"start":5272,"end":5281,"said":"question","significant":false},{"start":5298,"end":5300,"said":"sir.","significant":false},{"start":5486,"end":5489,"said":"I","significant":false},{"start":5589,"end":5600,"said":"story sir","significant":false},{"start":5754,"end":5758,"said":"","significant":false},{"start":5772,"end":5789,"said":"fever and you're","significant":false},{"start":5846,"end":5859,"said":"you had","significant":false},{"start":5885,"end":5889,"said":"little as","significant":false},{"start":5908,"end":5914,"said":"wondered","significant":false},{"start":6178,"end":6180,"said":"there","significant":false},{"start":6230,"end":6234,"said":"its","significant":false},{"start":6291,"end":6300,"said":"we'd","significant":false},{"start":6482,"end":6491,"said":"","significant":false},{"start":6499,"end":6499,"said":"Mm-hmm.","significant":false},{"start":6504,"end":6513,"said":"","significant":false},{"start":6608,"end":6610,"said":"helps","significant":false},{"start":6621,"end":6628,"said":"","significant":false},{"start":6726,"end":6735,"said":"say","significant":false},{"start":6796,"end":6807,"said":"Yep.","significant":false},{"start":6845,"end":6845,"said":"eh","significant":false},{"start":6959,"end":6959,"said":"Yep.","significant":false},{"start":6962,"end":6967,"said":"will","significant":false},{"start":7190,"end":7198,"said":"I'll admit","significant":false},{"start":7288,"end":7292,"said":"","significant":false},{"start":7301,"end":7303,"said":"you","significant":false},{"start":7386,"end":7393,"said":"","significant":false},{"start":7409,"end":7416,"said":"caused","significant":false},{"start":7435,"end":7440,"said":"Yep.","significant":false},{"start":7549,"end":7567,"said":"etcetera etcetera. Yep","significant":false},{"start":7575,"end":7592,"said":"yep. How's","significant":false},{"start":7725,"end":7730,"said":"uh","significant":false},{"start":7878,"end":7878,"said":"Bye.","significant":false},{"start":7904,"end":7912,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","3-day loose/watery diarrhoea ~6-7/day; denies blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"Intermittent cramping LLQ abdominal pain; non-radiating\"."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomited at onset, now resolved; denies haematemesis."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt hot at onset, no measured temperature, denies current fever; weakness/shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, soups/smoothies/light foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway ~4 days ago; 1 child had vomiting but no diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"asthma, reported controlled with inhaler. Meds: inhaler only\"."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Impacting ADLs/work due to need to remain near toilet."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute gastroenteritis, clinically suspected\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, antibiotics not recommended, ORS (Dioralyte)."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"2 tablets up to 4 times/day for first few days\"."],["The plan captures rest and approximately two to three days off work.","yes","Rest and time off work for next 2-3 days."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if not improving within 3-4 days; stool sample if persisting."]],"claims":[],"note":"Subjective\n3-day hx frequent loose/watery diarrhoea, ~6–7 episodes/day; impacting ADLs/work due to need to remain near toilet.\nIntermittent cramping LLQ abdominal pain; non-radiating.\nReports weakness/shakiness and reduced appetite.\nVomited at symptom onset; now resolved. Vomitus normal colour; denies haematemesis.\nDenies blood in stool.\nFelt hot at onset 3–4 days ago; no measured temperature. Denies current fever, sweats or night sweats.\nTolerating fluids. Eating mainly soup, smoothies and other light/liquid foods.\nAte Chinese takeaway with friends ~4 days ago. Wife and 2 children at home; 1 child had vomiting but no diarrhoea. No other similar illness reported.\nPMH: asthma, reported controlled with inhaler.\nMeds: inhaler only.\nDenies previous GI/bowel problems.\nSH: accountant; continued attending work despite symptoms. Non-smoker; no alcohol intake.\nObjective\nNo examination, observations or measured vital signs documented.\nAssessment\nAcute gastroenteritis, clinically suspected.\nAcute watery diarrhoea, transient vomiting, crampy abdominal pain and possible feverishness following recent takeaway support infectious gastroenteritis.\nViral cause considered most likely; bacterial infection also discussed.\nIntermittent LLQ abdominal cramping associated with diarrhoeal illness.\nReduced oral intake/appetite, but maintaining fluids.\nPlan\nConservative management discussed; antibiotics not recommended at this stage.\nEncourage adequate oral fluids.\nAdvise oral rehydration solution (e.g. Dioralyte) to replace fluids/minerals, particularly with ongoing diarrhoea.\nParacetamol for feverishness/weakness: 2 tablets up to 4 times/day for first few days, as discussed.\nAdvise rest and time off work for next 2–3 days.\nReview if not improving within 3–4 days.\nIf symptoms persist, consider further assessment including stool sample testing.","review":82.42105263157895,"saved":300.57894736842104,"clean":true,"effort":0.0,"sig":[],"mb":9.706256,"latency":19.993,"signable":102.41405263157894},{"label":"Run 3","wer":15.221987315010571,"text":"Hello.\n\n  Hello, how are you?\n\n  Hi. Um, should we start?\n\n  Yeah.\n\n  Yeah, okay. Hello, how— um, good morning, sir. How can I help you this morning?\n\n  Hi, um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities.\n\n  Oh, yeah. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\n  Yeah, so it's like loose and watery stool, going to the toilet quite often, um, and like some pain in my— like lower stomach.\n\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n\n  Um, probably like 6 or 7 times a day.\n\n  6, 7 times a day. And you mentioned— you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n\n  No, no blood. Yeah, just watery and loose stool.\n\n  Okay. And you mentioned you've had some pain in your tummy as well.\n\n  Yeah.\n\n  Where about is the pain?\n\n  Exactly. So it's like in my lower abdomen, so, uh, like— um, yeah, just to one side.\n\n  One side. And what side is that?\n\n  Uh, on the left side.\n\n  Left side, okay. And can you describe the pain to me?\n\n  Yeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky.\n\n  Okay. And is the pain— is that— is it there all the time, or does it come and go?\n\n  Uh, it comes and goes.\n\n  Comes and goes. Does the pain move anywhere else, for example towards your back?\n\n  Um, no, just mainly in my stomach.\n\n  Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having— have you been feeling feverish, for example?\n\n  Um, yeah, it doesn't feel like— uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\n\n  Did you measure your temperature then?\n\n  Yeah, I— I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\n  Okay, okay. Any other symptoms, like sweating or, um, night—\n\n  Um, no.\n\n  No? And, uh, any vomiting at all?\n\n  Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\n  You've stopped vomiting, okay. And was your vomit— I know it's not nice to talk about, but was it just normal food color, blood?\n\n  Yeah, yeah, just normal vomit. Yeah.\n\n  Yeah. And there was no blood in your vomit. Is that right?\n\n  No blood, no.\n\n  No. Okay. Um, and, um, any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Um.\n\n  Yeah.\n\n  Anything else that comes to mind?\n\n  Um, I had a loss of appetite, um, so I haven't been eating as much.\n\n  Okay.\n\n  Um, but I've been able to hold down fluids.\n\n  Okay. So you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n  Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly.\n\n  Okay. Fine. Um, and so, uh, you started 3 days ago, the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would simulate symptoms?\n\n  Yeah, so I had takeaway about 4 days ago. Um, uh, but other than that, I've— yeah, I've been eating normally.\n\n  Okay.\n\n  I think, I think, uh, unusual, yeah.\n\n  Do you remember what you ate?\n\n  Um, yeah, I ate at a Chinese restaurant with friends.\n\n  Okay. Anyone else unwell with similar symptoms?\n\n  Um, so no one else in the family, so I, uh, wife and 2 kids and 1, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n  Okay. Okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally feeling well, or?\n\n  Um, yeah, I mean, other than, um, asthma, um, I'm using an inhaler. Everything, uh, else is fine.\n\n  Okay. And is your asthma well controlled?\n\n  Uh, yeah, that's fine.\n\n  Okay.\n\n  Uh, just, yeah, use an inhaler and, uh, that's under control.\n\n  Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\n  No.\n\n  No. Okay. Um, and apart from the inhalers, do you take any other medications?\n\n  Uh, no, no other medications.\n\n  Okay. Fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um.\n\n  Yeah.\n\n  In what way has it been affecting your life?\n\n  Uh, so I need to stay close to the toilet because I go quite frequently during the— these past 3 days.\n\n  Okay.\n\n  Um, yeah, other than that, it's, uh, yeah, that's the main concern.\n\n  And have you— are you currently working at the moment?\n\n  Uh, yes. Yeah, I, I work, um.\n\n  Working at the work?\n\n  Um, I'm an accountant.\n\n  Okay. Have you been going into work the last 3 days, or have you been at home?\n\n  Uh, yeah, I've been going to work.\n\n  Okay. That must be difficult for you then.\n\n  Yeah, it's been quite difficult.\n\n  Right. And you said you mentioned you live with a wife and 2 children. Is that right?\n\n  Yes, yeah.\n\n  All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\n\n  Uh, no, I don't smoke.\n\n  And do you drink much in the way of alcohol?\n\n  Uh, no, I, I don't drink alcohol, no.\n\n  Okay. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay, but, um, um.\n\n  Yeah.\n\n  But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Um.\n\n  Yeah.\n\n  You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems.\n\n  Okay.\n\n  Um, it seems like you may have something called gastroenteritis.\n\n  Okay.\n\n  Which essentially just, uh, tummy bug or infection of your— of your tummy. Uh.\n\n  Yeah.\n\n  Mainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms.\n\n  Yeah.\n\n  Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Um, uh, there are things like Dioralyte you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins.\n\n  Okay.\n\n  Um, and if you are having vomiting and diarrhea, I would say you recommend that at first, you know, first couple of days.\n\n  Yeah.\n\n  Um, if you are feeling feverish and weak, taking some paracetamol, uh.\n\n  Yeah.\n\n  2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as the infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\n\n  Okay, sure.\n\n  Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms.\n\n  Yeah.\n\n  Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc.\n\n  Yeah, sure, yeah.\n\n  How does that sound?\n\n  That sounds great, yeah, yeah.\n\n  Do you have any questions for me?\n\n  Um, no, no further questions, no.\n\n  Okay. Is it— is the treatment plan clear?\n\n  Uh, yeah, yeah, that's, that's very clear, thank you.\n\n  Great. Well, I wish you all the best.\n\n  Okay, thank you.\n\n  Thank you.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":10,"end":28,"said":"","significant":false},{"start":153,"end":155,"said":"Hello how are you Oh hey","significant":false},{"start":346,"end":359,"said":"","significant":false},{"start":411,"end":418,"said":"what'd","significant":false},{"start":712,"end":716,"said":"in","significant":false},{"start":812,"end":836,"said":"mention","significant":false},{"start":1045,"end":1065,"said":"Whereabouts","significant":false},{"start":1090,"end":1090,"said":"Yep.","significant":false},{"start":1094,"end":1103,"said":"","significant":false},{"start":1507,"end":1512,"said":"Come","significant":false},{"start":1517,"end":1522,"said":"go.","significant":false},{"start":1591,"end":1597,"said":"Uh...no","significant":false},{"start":1604,"end":1613,"said":"maybe","significant":false},{"start":1848,"end":1850,"said":"--","significant":false},{"start":1865,"end":1871,"said":"makes me","significant":false},{"start":2036,"end":2039,"said":"","significant":false},{"start":2096,"end":2103,"said":"mention","significant":false},{"start":2155,"end":2155,"said":"And y'know.","significant":false},{"start":2223,"end":2230,"said":"sweats","significant":false},{"start":2266,"end":2266,"said":"Uh no.","significant":false},{"start":2364,"end":2370,"said":"You","significant":false},{"start":2435,"end":2435,"said":"thing","significant":false},{"start":2479,"end":2532,"said":"colour","significant":false},{"start":2593,"end":2593,"said":"Yeah yeah just normal vomit yeah. No","significant":false},{"start":2636,"end":2636,"said":"any","significant":false},{"start":2795,"end":2795,"said":"Yep.","significant":false},{"start":3019,"end":3019,"said":"Yep.","significant":false},{"start":3137,"end":3148,"said":"sir these","significant":false},{"start":3235,"end":3239,"said":"the","significant":false},{"start":3286,"end":3292,"said":"think","significant":false},{"start":3356,"end":3374,"said":"with similar","significant":false},{"start":3471,"end":3475,"said":"","significant":false},{"start":3501,"end":3530,"said":"Nothing","significant":false},{"start":3541,"end":3546,"said":"here. Okay.","significant":false},{"start":3566,"end":3570,"said":"where","significant":false},{"start":3877,"end":3883,"said":"alright.","significant":false},{"start":3949,"end":3956,"said":"fit and","significant":false},{"start":4004,"end":4010,"said":"athsma","significant":false},{"start":4016,"end":4025,"said":"I use","significant":false},{"start":4257,"end":4265,"said":"problem","significant":false},{"start":4467,"end":4482,"said":"day to day","significant":false},{"start":4635,"end":4642,"said":"'cause","significant":false},{"start":4751,"end":4757,"said":"","significant":false},{"start":4863,"end":4889,"said":"er.","significant":false},{"start":4916,"end":4916,"said":"Would would work.","significant":false},{"start":5036,"end":5036,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":5086,"end":5128,"said":"fine.","significant":false},{"start":5170,"end":5171,"said":"your","significant":false},{"start":5225,"end":5228,"said":"","significant":false},{"start":5235,"end":5235,"said":"alright.","significant":false},{"start":5263,"end":5272,"said":"question","significant":false},{"start":5289,"end":5291,"said":"sir.","significant":false},{"start":5477,"end":5480,"said":"I","significant":false},{"start":5580,"end":5591,"said":"story sir","significant":false},{"start":5745,"end":5749,"said":"","significant":false},{"start":5763,"end":5780,"said":"fever and you're","significant":false},{"start":5837,"end":5850,"said":"you had","significant":false},{"start":5876,"end":5880,"said":"little as","significant":false},{"start":5899,"end":5905,"said":"wondered","significant":false},{"start":6166,"end":6168,"said":"there","significant":false},{"start":6218,"end":6222,"said":"its","significant":false},{"start":6279,"end":6288,"said":"we'd","significant":false},{"start":6470,"end":6479,"said":"","significant":false},{"start":6487,"end":6487,"said":"Mm-hmm.","significant":false},{"start":6589,"end":6591,"said":"helps","significant":false},{"start":6602,"end":6609,"said":"","significant":false},{"start":6775,"end":6786,"said":"Yep.","significant":false},{"start":6824,"end":6824,"said":"eh","significant":false},{"start":6934,"end":6934,"said":"Yep.","significant":false},{"start":6937,"end":6942,"said":"will","significant":false},{"start":7169,"end":7177,"said":"I'll admit","significant":false},{"start":7267,"end":7271,"said":"","significant":false},{"start":7280,"end":7282,"said":"you","significant":false},{"start":7365,"end":7372,"said":"","significant":false},{"start":7388,"end":7395,"said":"caused","significant":false},{"start":7414,"end":7419,"said":"Yep.","significant":false},{"start":7528,"end":7546,"said":"etcetera etcetera. Yep","significant":false},{"start":7554,"end":7571,"said":"yep. How's","significant":false},{"start":7854,"end":7854,"said":"Bye.","significant":false},{"start":7880,"end":7888,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","3-day loose/watery stools ~6-7/day; denies blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"Intermittent cramping LLQ/lower abdominal pain; non-radiating.\""],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Initial vomiting resolved; denies blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt hot at onset, no measured temperature, denies current fever; weakness/shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, retaining fluids, tolerating soups/smoothies/light foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway with friends; 1 child vomiting without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma controlled with inhaler; \"Meds: inhaler only.\""],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Symptoms affecting daily activities/work; needing to remain close to toilet."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute diarrhoeal illness, likely gastroenteritis.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, antibiotics not recommended, oral fluids and Dioralyte."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"2 tablets up to 4 times daily for first few days\"."],["The plan captures rest and approximately two to three days off work.","yes","Time off work and rest for next 2-3 days."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if not improved within 3-4 days; stool sample testing if persistent."]],"claims":[],"note":"Subjective\n3-day h/o frequent loose/watery stools, approx. 6–7 episodes/day.\nIntermittent cramping LLQ/lower abdominal pain; non-radiating.\nReports weakness/shakiness and reduced appetite.\nInitial vomiting, now resolved; able to retain fluids.\nFelt hot at symptom onset 3–4 days ago; no measured temperature. Denies current fever, sweats/night sweats.\nDenies blood in stool or vomit.\nTolerating soups, smoothies and other light/liquid foods.\nAte Chinese takeaway with friends approx. 4 days ago. No household contacts with same symptoms; 1 child had vomiting without diarrhoea.\nSymptoms affecting daily activities/work; needing to remain close to toilet. Has continued work as accountant.\nPMH: asthma, reported controlled with inhaler.\nMeds: inhaler only.\nDenies previous GI/bowel problems.\nDenies smoking and alcohol use.\nLives with wife and 2 children.\nObjective\nNo examination documented.\nNo temperature or other observations documented.\nAssessment\nAcute diarrhoeal illness, likely gastroenteritis.\nWatery diarrhoea, transient vomiting, intermittent abdominal cramping and possible food exposure support infective gastroenteritis; viral vs bacterial aetiology discussed.\nNo reported blood in stool/vomit. Vomiting has resolved and patient is retaining fluids.\nPlan\nConservative management discussed; antibiotics not recommended at present.\nEncourage adequate oral fluids.\nAdvised oral rehydration solution (e.g. Dioralyte) from pharmacy to replace fluids/minerals, particularly with vomiting/diarrhoea.\nParacetamol discussed if feverish/weak: 2 tablets up to 4 times daily for first few days.\nAdvised time off work and rest for next 2–3 days while symptoms settle.\nReview if not improved within 3–4 days; consider further assessment and stool sample testing if persistent.","review":80.84210526315789,"saved":302.1578947368421,"clean":true,"effort":0.0,"sig":[],"mb":9.655137,"latency":14.295,"signable":95.13710526315789},{"label":"Run 4","wer":15.221987315010571,"text":"Hello.\n\n  Hello, how are you?\n\n  Hi. Um, should we start?\n\n  Yeah.\n\n  Yeah, okay. Hello, how— um, good morning, sir. How can I help you this morning?\n\n  Hi, um, I've just had some, um, diarrhea for the last 3 days, um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities.\n\n  Okay, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\n  Yeah, so it's like loose and watery stool, going to the toilet quite often, um, and like some pain in my, like, lower stomach.\n\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n\n  Um, probably like 6 or 7 times a day.\n\n  6 or 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n\n  No, no blood. Yeah, just watery and loose stool.\n\n  Okay. And you mentioned you've had some pain in your tummy as well.\n\n  Yeah.\n\n  Whereabouts is the pain exactly?\n\n  So it's like in my lower abdomen, so, uh, like, um, yeah, just to one side.\n\n  One side. And what side is that?\n\n  Uh, on the left side.\n\n  Left side, okay. And can you describe the pain to me?\n\n  Yeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky.\n\n  Okay. And does the pain— is it there all the time, or does it come and go?\n\n  Uh, it comes and goes.\n\n  Comes and goes. Does the pain move anywhere else, for example towards your back?\n\n  Um, no, just mainly in my stomach.\n\n  Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having— have you been feeling feverish, for example?\n\n  Um, yeah, it doesn't feel like— yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\n\n  Did you measure your temperature then?\n\n  Yeah, I— I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\n  Okay, okay. Any other symptoms, like sweating or, um, night sweats?\n\n  Uh, no.\n\n  No? And, uh, any vomiting at all?\n\n  Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\n  You've stopped vomiting, okay. And was your vomit— I know it's not nice to talk about, but was that just normal food color, blood?\n\n  Yeah, yeah, just normal vomit, yeah.\n\n  Yeah. And there was no blood in your vomit, is that right?\n\n  No blood, no.\n\n  No. Okay. Um, and, um, any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned your vomiting. Um.\n\n  Yeah.\n\n  Anything else that comes to mind?\n\n  Um, I had a loss of appetite, um, so I haven't been eating as much.\n\n  Okay.\n\n  Um, but I've been able to hold down fluids.\n\n  Okay, so you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n  Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly.\n\n  Okay. Fine. Um, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would simulate symptoms?\n\n  Yeah, so I had takeaway about 4 days ago, um, uh, but other than that, I've— yeah, I've been eating normally.\n\n  Okay.\n\n  I think, I think, yeah, unusual, yeah.\n\n  Do you remember what you ate?\n\n  Um, yeah, I ate at a Chinese restaurant with friends.\n\n  Okay. Anyone else unwell with similar symptoms?\n\n  Um, so no one else in the family, so I, uh, wife and 2 kids and 1, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n  Okay, okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally feeling well, or?\n\n  Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine.\n\n  Okay. And does your asthma well controlled?\n\n  Uh, yeah, that's fine.\n\n  Okay.\n\n  Uh, just, yeah, use an inhaler and, uh, that's under control.\n\n  Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\n  No.\n\n  No. Okay. Um, and apart from the inhalers, do you take any other medications?\n\n  Uh, no, no other medications.\n\n  Okay. Fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um.\n\n  Yeah.\n\n  In what way has it been affecting your life?\n\n  Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days.\n\n  Okay.\n\n  Um, yeah, other than that, it's, uh, yeah, that's the main concern.\n\n  Yeah. And have you— are you currently working at the moment?\n\n  Uh, yes, yeah, I, I work, um.\n\n  You're working at work?\n\n  Um, I'm an accountant.\n\n  Okay. Have you been going into work the last 3 days? Have you been at home?\n\n  Uh, yeah, I've been going to work.\n\n  Okay. That must be difficult for you then.\n\n  Yeah, it's been quite difficult.\n\n  Right. And you said you mentioned you live with a wife and 2 children, is that right?\n\n  Yes, yeah.\n\n  All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\n\n  Uh, no, I don't smoke.\n\n  And do you drink much in the way of alcohol?\n\n  Uh, no, I, I don't drink alcohol, no.\n\n  Okay. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay, but, um, um.\n\n  Yeah.\n\n  But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Um.\n\n  Yeah.\n\n  You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems.\n\n  Okay.\n\n  Um, it seems like you may have something called gastroenteritis.\n\n  Okay.\n\n  Which essentially just, uh, tummy bug or infection of your, of your tummy. Uh.\n\n  Yeah.\n\n  Mainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms.\n\n  Yeah.\n\n  Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Um, uh, there, there are things like Dioralyte you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins.\n\n  Okay.\n\n  Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days.\n\n  Yeah.\n\n  Um, if you are feeling feverish and weak, taking some paracetamol, uh, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\n\n  Okay, sure.\n\n  Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms.\n\n  Yeah.\n\n  Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc.\n\n  Yeah, sure, yeah.\n\n  How does that sound?\n\n  That sounds great, yeah, yeah.\n\n  Do you have any questions for me?\n\n  Um, no, no further questions, no.\n\n  Okay. Is there, is the treatment plan clear?\n\n  Uh, yeah, yeah, that's, that's very clear, thank you.\n\n  Great. Well, I wish you all the best.\n\n  Okay, thank you.\n\n  Thank you.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":10,"end":28,"said":"","significant":false},{"start":153,"end":155,"said":"Hello how are you Oh hey","significant":false},{"start":346,"end":355,"said":"","significant":false},{"start":407,"end":414,"said":"what'd","significant":false},{"start":709,"end":713,"said":"in","significant":false},{"start":785,"end":787,"said":"","significant":false},{"start":811,"end":820,"said":"mention","significant":false},{"start":1069,"end":1069,"said":"Yep.","significant":false},{"start":1077,"end":1086,"said":"","significant":false},{"start":1389,"end":1393,"said":"is","significant":false},{"start":1483,"end":1488,"said":"Come","significant":false},{"start":1493,"end":1498,"said":"go.","significant":false},{"start":1567,"end":1573,"said":"Uh...no","significant":false},{"start":1580,"end":1589,"said":"maybe","significant":false},{"start":1837,"end":1843,"said":"makes me","significant":false},{"start":2008,"end":2011,"said":"","significant":false},{"start":2068,"end":2075,"said":"mention","significant":false},{"start":2127,"end":2127,"said":"And y'know.","significant":false},{"start":2202,"end":2209,"said":"","significant":false},{"start":2245,"end":2245,"said":"Uh no.","significant":false},{"start":2343,"end":2349,"said":"You","significant":false},{"start":2414,"end":2414,"said":"thing","significant":false},{"start":2460,"end":2513,"said":"colour","significant":false},{"start":2574,"end":2574,"said":"Yeah yeah just normal vomit yeah. 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Yep","significant":false},{"start":7526,"end":7543,"said":"yep. How's","significant":false},{"start":7676,"end":7681,"said":"uh","significant":false},{"start":7829,"end":7829,"said":"Bye.","significant":false},{"start":7855,"end":7863,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","'3-day hx frequent loose/watery diarrhoea, ~6–7 episodes/day'; denies blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","'Intermittent cramping LLQ/lower abdominal pain; non-radiating.'"],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","'Initial vomiting, now resolved; vomitus reportedly normal in appearance, no blood.'"],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","'possible subjective fever at onset... no measured temperature' with weakness/shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, eating soup/smoothies/light foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and '1 child has vomited without diarrhoea' captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","'asthma, reported controlled with inhaler. Meds: inhaler only.'"],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","'Symptoms affecting work/daily activities due to need to remain near toilet.'"],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","'Acute gastroenteritis suspected.'"],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, oral fluids, ORS (Dioralyte), 'antibiotics not indicated at present.'"],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol if feverish/weak: 2 tablets up to 4 times/day.'"],["The plan captures rest and approximately two to three days off work.","yes","'Advise rest and time off work for next 2–3 days.'"],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if not improving within 3–4 days; stool sample testing if ongoing."]],"claims":[],"note":"Subjective\n3-day hx frequent loose/watery diarrhoea, ~6–7 episodes/day.\nIntermittent cramping LLQ/lower abdominal pain; non-radiating.\nInitial vomiting, now resolved; vomitus reportedly normal in appearance, no blood.\nDenies blood in stool or vomit.\nReports weakness/shakiness, reduced appetite and possible subjective fever at onset 3–4 days ago; no measured temperature. Denies sweats/night sweats.\nTolerating fluids; eating mainly soup, smoothies and other light/liquid foods.\nAte Chinese takeaway with friends ~4 days ago. No household members with similar diarrhoea; 1 child has vomited without diarrhoea.\nSymptoms affecting work/daily activities due to need to remain near toilet. Continues to attend work; accountant.\nPMH: asthma, reported controlled with inhaler.\nMeds: inhaler only.\nDenies prior GI/bowel problems, smoking and alcohol use.\nLives with wife and 2 children.\nObjective\nNo physical examination documented.\nNo measured observations or temperature documented.\nAssessment\nAcute gastroenteritis suspected, based on 3-day watery diarrhoea, transient vomiting, cramping lower abdominal pain, reduced appetite and possible food exposure.\nViral vs bacterial cause discussed; no reported blood in stool/vomit.\nOngoing diarrhoea with weakness raises concern for fluid/electrolyte loss; patient currently able to retain fluids.\nPlan\nConservative management discussed; antibiotics not indicated at present.\nEncourage increased oral fluids and oral rehydration solution (e.g. Dioralyte) to replace fluids/minerals.\nParacetamol if feverish/weak: 2 tablets up to 4 times/day for first few days.\nAdvise rest and time off work for next 2–3 days while symptoms settle.\nReview if symptoms not improving within 3–4 days.\nIf ongoing symptoms, consider further investigation including stool sample testing.","review":83.05263157894737,"saved":299.9473684210526,"clean":true,"effort":0.0,"sig":[],"mb":9.671829,"latency":15.461,"signable":98.51363157894737},{"label":"Run 5","wer":14.940098661028895,"text":"Hello.\n\n  Hello, how are you?\n\n  Hi. Um, should we start?\n\n  Yeah.\n\n  Yeah, okay. Hello, um, good morning, sir. How can I help you this morning?\n\n  Hi, um, I've just had some, um, diarrhea for the last 3 days, um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities.\n\n  Oh, yeah. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\n  Yeah, so it's like loose and watery stool, going to the toilet quite often, um, and like some pain in my, like, lower stomach.\n\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n\n  Um, probably like 6 or 7 times a day.\n\n  6 or 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n\n  No, no blood. Yeah, just watery and loose stool.\n\n  Okay. And you mentioned you've had some pain in your tummy as well.\n\n  Yeah.\n\n  Whereabouts is the pain exactly?\n\n  So it's like in my lower abdomen, so, uh, like, um, yeah, just to one side.\n\n  One side. And what side is that?\n\n  Uh, on the left side.\n\n  Left side, okay. And can you describe the pain to me?\n\n  Yeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky.\n\n  Okay. And does the pain is that is it there all the time, or does it come and go?\n\n  Uh, it comes and goes.\n\n  Comes and go. Does the pain move anywhere else, for example towards your back?\n\n  Um, no, just mainly in my stomach.\n\n  Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example?\n\n  Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\n\n  Did you measure your temperature then?\n\n  Yeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\n  Okay, okay. Any other symptoms, like sweating or, um, night sweats?\n\n  Um, no.\n\n  No? And, uh, any vomiting at all?\n\n  Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\n  You've stopped vomiting, okay. And was your vomit I know it's not a nice thing to talk about, but was it just normal food colour?\n\n  Yeah, yeah, just normal vomit. Yeah.\n\n  Yeah. And there was no blood in your vomit. Is that right?\n\n  No blood, no.\n\n  No. Okay. Um.\n\n  Yeah.\n\n  And, um, any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned the vomiting. Um.\n\n  Yeah.\n\n  Anything else that comes to mind?\n\n  Um, I had a loss of appetite, um, so I haven't been eating as much.\n\n  Okay.\n\n  Um, but I've been able to hold down fluids.\n\n  Okay. So you're drinking fluids. Um, what kind of foods have you managed to eat, if anything?\n\n  Um, just soups. And, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly.\n\n  Okay. Fine. Um, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would sim the symptoms?\n\n  Yeah, so I had takeaway about 4 days ago, um, uh, but other than that, I've yeah, I've been eating normally.\n\n  Okay.\n\n  I think, I think, uh, unusual, yeah.\n\n  Do you remember what you ate?\n\n  Um, yeah, I, I ate at a Chinese restaurant with friends.\n\n  Okay. Anyone else unwell with similar symptoms?\n\n  Um, so no one else in the family, so I, uh, wife and 2 kids and 1, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n\n  Okay, okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or?\n\n  Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine.\n\n  Okay. And does your asthma well controlled?\n\n  Uh, yeah, that's fine.\n\n  Okay.\n\n  Uh, just, yeah, use an inhaler and, uh, that's under control.\n\n  Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\n  No.\n\n  No. Okay. Um, and apart from the inhalers, do you take any other medications?\n\n  Uh, no, no other medications.\n\n  Okay. Fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um.\n\n  Yeah.\n\n  In what way has it been affecting your life?\n\n  Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days.\n\n  Okay.\n\n  Um, yeah, other than that, it's, uh, yeah, the main concern.\n\n  Yeah. And have you are you currently working at the moment?\n\n  Uh, yes, yeah, I, I work, um.\n\n  Working at the work?\n\n  Um, I'm an accountant.\n\n  Okay. Have you been going into work the last 3 days, or have you been at home?\n\n  Uh, yeah, I've been going to work.\n\n  Okay. That must be difficult for you then.\n\n  Yeah, it's been quite difficult.\n\n  Right. And you said you mentioned you live with a wife and 2 children. Is that right?\n\n  Yes, yeah.\n\n  All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\n\n  Uh, no, I don't smoke.\n\n  And do you drink much in the way of alcohol?\n\n  Uh, no, I, I don't drink alcohol, no.\n\n  Okay. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay, but, um, um.\n\n  Yeah.\n\n  But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Um.\n\n  Yeah.\n\n  You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems.\n\n  Okay.\n\n  Um, it seems like you may have something called gastroenteritis.\n\n  Okay.\n\n  Which essentially just, uh, tummy bug or infection of your, of your tummy. Uh.\n\n  Yeah.\n\n  Mainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms.\n\n  Yeah.\n\n  Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, uh, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Um, uh, there, there are things like Dioralyte you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins.\n\n  Okay.\n\n  Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days.\n\n  Yeah.\n\n  Um, if you are feeling feverish and weak, taking some paracetamol, uh, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\n\n  Okay, sure.\n\n  Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms.\n\n  Yeah.\n\n  Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc.\n\n  Yeah, sure, yeah.\n\n  How does that sound?\n\n  That sounds great, yeah, yeah.\n\n  Do you have any questions for me?\n\n  Um, no, no further questions, no.\n\n  Okay. Is there, is the treatment plan clear?\n\n  Uh, yeah, yeah, that's, that's very clear, thank you.\n\n  Great. Well, I wish you all the best.\n\n  Okay, thank you.\n\n  Thank you.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":10,"end":28,"said":"","significant":false},{"start":87,"end":87,"said":"how","significant":false},{"start":148,"end":150,"said":"Hello how are you Oh hey","significant":false},{"start":341,"end":354,"said":"","significant":false},{"start":406,"end":413,"said":"what'd","significant":false},{"start":708,"end":712,"said":"in","significant":false},{"start":784,"end":786,"said":"","significant":false},{"start":810,"end":819,"said":"mention","significant":false},{"start":1068,"end":1068,"said":"Yep.","significant":false},{"start":1076,"end":1085,"said":"","significant":false},{"start":1388,"end":1392,"said":"is","significant":false},{"start":1489,"end":1494,"said":"Come","significant":false},{"start":1571,"end":1577,"said":"Uh...no","significant":false},{"start":1584,"end":1593,"said":"maybe","significant":false},{"start":1831,"end":1833,"said":"--","significant":false},{"start":1848,"end":1854,"said":"makes me","significant":false},{"start":2019,"end":2022,"said":"","significant":false},{"start":2079,"end":2086,"said":"mention","significant":false},{"start":2138,"end":2138,"said":"And y'know.","significant":false},{"start":2213,"end":2220,"said":"","significant":false},{"start":2256,"end":2256,"said":"Uh no.","significant":false},{"start":2354,"end":2360,"said":"You","significant":false},{"start":2493,"end":2532,"said":"","significant":false},{"start":2584,"end":2584,"said":"Yeah yeah just normal vomit yeah. 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Yep","significant":false},{"start":7538,"end":7555,"said":"yep. How's","significant":false},{"start":7688,"end":7693,"said":"uh","significant":false},{"start":7841,"end":7841,"said":"Bye.","significant":false},{"start":7867,"end":7875,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","'3-day h/o frequent loose/watery diarrhoea, ~6–7 episodes/day' and 'No blood in stool.'"],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","'Intermittent cramping LLQ/lower abdominal pain; non-radiating.'"],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","'Vomited at symptom onset; now resolved... no blood', no bilious claim."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","'No current fever; felt hot at onset but temperature not measured' plus weakness/shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, eating soups/smoothies/light foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway with friends and '1 child has vomiting without diarrhoea' captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","'asthma, reported controlled with inhaler. Meds: inhaler only.'"],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","'Sx affecting daily activities/work due to need to remain near toilet.'"],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","'Acute gastroenteritis, clinically suspected.'"],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, oral hydration, Dioralyte/ORS, no antibiotics recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol if feverish/weak: 2 tablets up to 4 times/day.'"],["The plan captures rest and approximately two to three days off work.","yes","'Advise rest and time off work for next 2–3 days.'"],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","'Review if not improving within 3–4 days; consider... stool sample testing if symptoms persist.'"]],"claims":[],"note":"Subjective\n3-day h/o frequent loose/watery diarrhoea, ~6–7 episodes/day.\nIntermittent cramping LLQ/lower abdominal pain; non-radiating.\nReports weakness/shakiness and reduced appetite.\nVomited at symptom onset; now resolved. Vomitus reportedly normal in colour, no blood.\nNo blood in stool. No current fever; felt hot at onset but temperature not measured. No sweats/night sweats.\nTolerating fluids. Eating soups, smoothies and other light/liquid foods.\nAte Chinese takeaway with friends ~4 days ago. No household contacts with identical sx; 1 child has vomiting without diarrhoea.\nSx affecting daily activities/work due to need to remain near toilet. Continues to attend work as an accountant.\nPMH: asthma, reported controlled with inhaler.\nMeds: inhaler only.\nNo prior GI/bowel problems reported.\nDenies smoking and alcohol use.\nLives with wife and 2 children.\nObjective\nNo examination findings or measured observations documented.\nAssessment\nAcute gastroenteritis, clinically suspected.\n3-day acute watery diarrhoea with initial vomiting, intermittent lower abdominal cramps, reduced appetite and reported weakness.\nPossible food-associated onset following Chinese takeaway; viral vs bacterial aetiology discussed.\nNo reported blood in stool/vomit; vomiting has resolved and patient is tolerating fluids.\nPlan\nConservative management discussed; no antibiotics recommended at this stage.\nEncourage oral hydration.\nRecommend Dioralyte/oral rehydration solution from pharmacy to replace fluids/minerals.\nParacetamol if feverish/weak: 2 tablets up to 4 times/day for first few days.\nAdvise rest and time off work for next 2–3 days while infection clears.\nReview if not improving within 3–4 days; consider further assessment and stool sample testing if symptoms persist.","review":82.42105263157895,"saved":300.57894736842104,"clean":true,"effort":0.0,"sig":[],"mb":9.666158,"latency":16.5,"signable":98.92105263157895}],"heidi":[{"label":"Run 1","wer":16.4200140944327,"text":"Hello. Hello. How are you? Hi. Stop. Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, six, seven times a day. Six, seven times a day. And you may mention it's mainly watery. Have you noticed any other things, like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp. And, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? It comes and goes. Comes and goes. Does the pain move anywhere else? For example, towards your back?\n\nUm, no, just mainly my stomach. Okay. All right. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like, uh... Yeah, it just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature when the symptoms started. So, um, yeah, around about three or four days ago. Did you measure your temperature then? Yeah, I, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. Yeah. Any other symptoms like sweating or, um, right? Uh, no. No. And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting.\n\nYou stopped vomiting. Okay. And was your vomit? I know it's not nice to us to talk about, but was it just normal food color of blood? Yeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No blood. No. No. Okay. Yeah. And any other symptoms at all? So you mentioned the tummy pain. You mentioned diarrhea. You mentioned the vomiting. Yeah. Anything else that comes to mind? I had a loss of appetite, so I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. What kind of foods have you managed to eat, if anything? Just soups and, yeah, light foods, like smoothies and\n\nYeah. Liquid foods mainly. Okay. Fine. And so you started three days ago with symptoms. Are you aware of any triggers which may have caused your symptoms to to kick on? So, for example, things like takeaway foods or eating out or being around other people who had similar symptoms? Yeah. So I had takeaway about four days ago. But other than that, I've, yeah, been eating normally. I think unusual. Yeah. Do you remember where you ate? Yeah. I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no one else in the family. So I have a wife and two kids, and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay. Fine.\n\nRight. And, uh, in terms of your, your overall health, are you normally fitting well? Or Um, yeah, I mean, other than, um, asthma, um, I use an inhaler, everything, uh, else is fine. Okay. And is your asthma well controlled? Uh, yeah, that's fine. Uh, just, yeah, use an inhaler, and, uh, that's under control. Right. And you don't have any other tummy problems, bowel problems I should be aware of? No. No. Okay. Um, and t- apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay, fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um- Yeah. In what way has it been affecting your life?\n\nUh, so I need to stay close to the toilet because I go quite frequently during the these past three days. Okay. Um, yeah, other than that, it's, uh, yeah, the main concern. And have you, are you currently working at the moment? Uh, yes. Yeah, I, I work. Uh- What work? Um, I'm an accountant. Okay. Have you been going to work the last three days, or have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then? Yeah, it's been quite difficult. Right. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. All right. Um, just a couple of other questions we need to ask, uh, um, do you smoke at all? Uh, no, I don't smoke. And do you drink much in a way of alcohol?\n\nUh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um- Yeah. But, but having listened to your story, so I think, uh, um, just to recap, you-- for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side, uh, and vomiting and feeling generally quite weak and lethargic. Um, you mentioned you're having this Chinese takeaway as well three days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something, uh, called gastroenteritis. Okay. Which is essentially just a tummy bug or infection of your, of your tummy. Yeah. Uh, mainly caused by viruses, but there can be a possibility of bacteria, uh, causing your symptoms. Yeah. Um,\n\nAt this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like dirolite you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol, two tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time to work. Actually, I know you're quite keen to work, but I would say next two two to three days\n\nYeah. Infection clears from your system. Just take some time off and rest. You know, if your symptoms haven't got better, you know, in in three to four days, I'd like to come back and see you again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yeah. Sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me? No. No further questions? Nope. Okay. Is is the treatment plan clear? Yeah. Yeah. That's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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Uh","significant":false},{"start":7023,"end":7028,"said":"Yep","significant":false},{"start":7035,"end":7040,"said":"yep.","significant":false},{"start":7150,"end":7155,"said":"no.","significant":false},{"start":7297,"end":7297,"said":"Bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","\"3 days of diarrhoea, loose and watery stools, 6-7 times daily\" and \"No blood in stools\"."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","Left-sided lower cramping intermittent pain captured; absence of radiation not documented."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","\"Vomiting at onset, now resolved; no blood in vomit.\""],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at onset (3-4 days ago), not measured\" plus generalised weakness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Loss of appetite; maintaining fluids (soups, smoothies, liquid foods).\""],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese restaurant takeaway and \"One child with vomiting, no diarrhoea\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","no","Asthma, inhaler and absence of other medications are not documented."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"Symptoms affecting daily activities, requiring proximity to toilet.\""],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Possible gastroenteritis, likely viral, bacterial cause considered.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management, hydration and Dioralyte captured, but no antibiotics not explicitly stated."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Two tablets up to four times daily captured, but adds an unstated \"500mg\" strength."],["The plan captures rest and approximately two to three days off work.","yes","\"Advised 2-3 days off work for rest and recovery.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Review in 3-4 days if symptoms do not improve...; consider stool sample testing.\""]],"claims":[["Paracetamol 500mg","Transcript says only \"two tablets up to four times a day\"; no tablet strength was stated."]],"note":"Subjective\n\n- 3 days of diarrhoea, loose and watery stools, 6-7 times daily.\n\n- Lower abdominal pain, left-sided, cramping, intermittent.\n\n- Generalised weakness and shakiness.\n\n- Vomiting at onset, now resolved; no blood in vomit.\n\n- Subjective fever at onset (3-4 days ago), not measured.\n\n- Loss of appetite; maintaining fluids (soups, smoothies, liquid foods).\n\n- Symptoms affecting daily activities, requiring proximity to toilet.\n\n- No blood in stools. No sweating.\n\n- Trigger: takeaway from Chinese restaurant with friends ~4 days prior to onset.\n\n- One child with vomiting, no diarrhoea; no other household members unwell.\n\n\n\n\nObjective\n\n- Not examined.\n\n\n\n\nAssessment\n\n- Possible gastroenteritis, likely viral, bacterial cause considered.\n\n\n\n\nPlan\n\n- Conservative management.\n\n- Ensure adequate hydration; consider oral rehydration solutions (e.g. Dioralyte) from pharmacy.\n\n- Paracetamol 500mg, two tablets up to four times daily for fever/weakness in initial days.\n\n- Advised 2-3 days off work for rest and recovery.\n\n- Review in 3-4 days if symptoms do not improve or worsen; consider stool sample testing.","review":139.01315789473685,"saved":243.98684210526315,"clean":false,"effort":26.923076923076923,"sig":[["missing","The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","Asthma, inhaler use and medication list entirely absent; relevant to prescribing."],["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Adds a 500mg strength never stated in the consultation."]],"mb":39.112912,"latency":24.904,"signable":163.91715789473685},{"label":"Run 2","wer":16.913319238900634,"text":"Hello. Hello. How are you? Hi. Stop. Yeah. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Probably, like, six, seven times a day. Six, seven times a day. And you may mention this mainly watery. Have you noticed any other things, like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp.\n\nLike a muscular cramp and, um, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? Uh, it comes and goes. Comes and goes. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. All right. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like, uh... Yeah, it just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature when the symptoms started. So, um, yeah, around about three or four days ago.\n\nMeasure your temperature then? Yeah, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. Yeah. Any other symptoms like sweating or, um, right? Uh, no. No. And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting, okay. And was your vomit? I know it's not a nice thing to talk about, but was it just normal food color? Yeah, yeah, just normal vomit. Yeah. Yeah. And there was no blood in your vomit, is that right? No blood, no. No. Okay. Um, and, um, a- any other symptoms at all? So you mentioned the tummy pain, you mentioned diarrhea, you mentioned the vomiting. Yeah. Um, anything else that comes to mind?\n\nUm, I had a loss of appetite, um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay, so you're drinking fluids. Um, what kind of foods have you managed to eat, if anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. Um, and so, uh, uh, you started three days ago, your symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So for example, things like takeaway foods or eating out or being around other people who would similar symptoms? Yeah, so I had takeaway about four days ago. Um-\n\nBut other than that, I've, yeah, been eating normally. I think unusual. Yeah. Do you remember where you ate? Yeah. I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no one else in the family side. A wife and two kids, and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay. Fine. Right. And in terms of your your overall health, are you normally fitting well? Or Yeah. I mean, other than asthma, I use an inhaler. Everything else is fine.\n\nOkay. And is your asthma well controlled? Uh, yeah, that's fine. I just, yeah, use an inhaler, and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No. No. Okay. Um, and ti- apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay, fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um- Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet'cause I go quite frequently during the, these past three days. Okay. Um, yeah, other than that, it's, uh- Yeah... yeah, the main concern. And have you, are you currently working at the moment? Uh, yes. Yeah, I, I work, uh- You work?\n\nI'm an accountant. Okay. Have you been going into work the last three days, or have you been at home? Yeah. I've been going to work. Okay. That must be difficult for you then? Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and two children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in the way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So, normally, at this stage, I'd like to examine you, if that's okay. But Yeah. But but having listened to your stories, I think just to recap, for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left hand side, and vomiting and feeling generally quite weak and lethargic. You mentioned you're having this Chinese takeaway as well three days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something\n\nCalled gastroenteritis, which is essentially just a tummy bug or infection of your of your tummy. Yeah. Mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Direlyte you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol\n\nTwo tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say next two, two to three days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in in three to four days, I'd like you to come back and see me again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests, like, um, taking a sample of your stool so we can test that, um, etcetera, etc.. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me?\n\nUm, no. No further questions. Nope. Okay. Is the treatment plan clear? Uh, yeah. Yeah, that's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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Yep","significant":false},{"start":6987,"end":6992,"said":"yep.","significant":false},{"start":7107,"end":7112,"said":"no.","significant":false},{"start":7255,"end":7255,"said":"Bye.","significant":false},{"start":7276,"end":7280,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","\"3 days of diarrhoea - loose, watery stools, 6-7x/day\" but no blood in stool not recorded."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","\"Lower abdominal pain, left-sided, cramping, intermittent\" but radiation status omitted."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","\"Initial vomiting (now resolved), normal food-coloured vomit, no blood\"."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at symptom onset... temp not measured; no current fever\" and \"Feeling weak and shaky\"."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Loss of appetite; tolerating fluids (soups, smoothies, liquid foods)\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","\"after Chinese takeaway with friends\" and \"one child vomited without diarrhoea\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","no","Asthma, inhaler and no other medications are not recorded."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"affecting daily activities - needing to stay close to toilet\"; continues work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"suggestive of gastroenteritis, likely viral aetiology\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with Dioralyte recorded, but no statement that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","\"two tablets up to QID\" correct, but adds unstated strength \"1g\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest - advised 2-3 days off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Return for review in 3-4 days if symptoms do not improve...; consider stool sample\"."]],"claims":[["Paracetamol 1g (two tablets)","Transcript gives only \"two tablets up to four times a day\"; no strength was stated."]],"note":"Subjective\n\n\n\n\n- 3 days of diarrhoea - loose, watery stools, 6-7x/day\n\n- Lower abdominal pain, left-sided, cramping, intermittent\n\n- Feeling weak and shaky\n\n- Initial vomiting (now resolved), normal food-coloured vomit, no blood\n\n- Subjective fever at symptom onset (~3-4 days ago), temp not measured; no current fever\n\n- No sweating\n\n- Loss of appetite; tolerating fluids (soups, smoothies, liquid foods)\n\n- Symptoms affecting daily activities - needing to stay close to toilet\n\n- Onset ~4 days ago after Chinese takeaway with friends\n\n- No household contacts with same symptoms; one child vomited without diarrhoea\n\n- Continues to attend work (accountant)\n\n\n\n\nObjective\n\n\n\n\n- Not examined\n\n\n\n\nAssessment\n\n\n\n\n- Clinical presentation suggestive of gastroenteritis, likely viral aetiology; bacterial cause remains possible\n\n\n\n\nPlan\n\n\n\n\n- Conservative management\n\n- Hydration - increase fluid intake; consider oral rehydration solution (e.g. Dioralyte)\n\n- Paracetamol 1g (two tablets) up to QID for fever/weakness\n\n- Rest - advised 2-3 days off work\n\n- Return for review in 3-4 days if symptoms do not improve or worsen; consider stool sample for testing","review":158.46052631578948,"saved":224.53947368421052,"clean":false,"effort":30.76923076923077,"sig":[["missing","The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","Asthma and inhaler use are absent, so the record has no comorbidity or current medication."],["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Invented a paracetamol tablet strength that was never stated."]],"mb":38.751402,"latency":28.949,"signable":187.4095263157895},{"label":"Run 3","wer":14.799154334038056,"text":"Hello. Hello. How are you? Hi. Stop. Yeah. Okay. Hello. Good morning, sir. How can I help you this morning? Hi. I've just had some, diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Probably, like, six or seven times a day. Six, seven times a day. And you may mention it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp. And\n\nUm, yeah, I feel a bit weak and shaky. Okay. And does the pain, is that, is it there all the time, or does it come and go? Uh, it comes and goes. Comes and goes. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. All right. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like, uh... Yeah, it just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature when the symptoms started. So, um, yeah, around about three or four days ago. Did you measure your temperature then? Yeah, I, I, I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\nOkay. Okay. Any other symptoms like sweating or, um, light? Uh, no. No. And, uh, any vomiting at all? Yeah. So, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit. I know it's not a nice thing to talk about, but was it just normal food color? Yeah, yeah, just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No blood. No. No. Okay. Um, and, um, any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Um, anything else that comes to mind? Um, I had a loss of appetite. Um, so I haven't been eating as much. Um, but I've been able to hold down fluids.\n\nOkay, so you're drinking fluids. Um, what kind of foods have you managed to eat, anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. Um, and so, uh, uh, you started three days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to, uh, to kick on? So for example, things like takeaway foods or eating out or being around other people who with similar symptoms? Yeah, so I had takeaway about four days ago. Um, uh, but other than that, I've, yeah, been, uh, eating normally. I think, uh, unusual, yeah. Do you remember where you ate?\n\nUm, yeah, I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? Um, so no one else in the family, so I have a wife and two kids, and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay, fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler, everything, uh, else is fine. Okay, and is your asthma well controlled? Uh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler, and, uh, that's under control.\n\nAnd you don't have any other tummy problems, bowel problems I should be aware of? No. No. Okay. And apart from the inhalers, do you take any other medications? No. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past three days. Okay. Yeah. Other than that, it's Yeah. Yeah. The main concern. And have you are you currently working at the moment? Yes. Yeah. I I work. Work? I'm an accountant. Okay. Have you been going into work the last three days, or have you been at home?\n\nUh, yeah, I've been going to work. Okay. That must be difficult for you then? Yeah, it's been quite difficult. Right. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. All right. Um, just a couple of other questions we need to ask, uh, um, do you smoke at all? Uh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you, if that's okay. But, um, um- Yeah. But, but having listened to your stories, uh, I think, uh, um, just to recap, you-- for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side, uh, um, and vomiting and feeling generally quite weak and lethargic. Um, you mentioned you're having this Chinese takeaway as well as three days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something-\n\nCalled gastroenteritis, which is essentially just a tummy bug or infection of your of your tummy. Yeah. Mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Direlyte you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol\n\nTwo tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, I would say next two two to three days, as clears from your system, just take some time off and rest. You know, if your symptoms haven't got better, you know, in in three to four days, I'd like to come back and see you again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests, like, taking a sample of your stool so we can test that, etcetera, etcetera. Yeah. Sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me?\n\nUm, no. No further questions. Nope. Okay. And is the treatment plan clear? Uh, yeah. Yeah, that's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway and one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"Asthma, well-controlled with inhaler\"; no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Requires proximity to toilet, daily activities affected, work difficult."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Symptoms suggestive of gastroenteritis, likely viral\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management, hydration and ORS captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol 2 tabs up to QID\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest; 2-3/7 off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return if no improvement within 3-4/7 with possible stool sample."]],"claims":[["Denies ... light-headedness","Light-headedness was never asked about or mentioned in the transcript; invented negation."]],"note":"Subjective:\n\n- 3/7 Hx of diarrhoea - loose, watery stools, 6-7x/day\n\n- Lower abdominal pain, L side, cramping, intermittent, no radiation\n\n- General weakness and shakiness\n\n- Vomiting at symptom onset, now resolved; vomit normal food colour, no blood\n\n- Subjective fever at onset (~3-4/7 ago), not measured; no current fever\n\n- Loss of appetite; intake limited to soups, smoothies, light/liquid foods; maintaining fluids\n\n- Denies blood in stool or vomit, light-headedness, sweating\n\n- Possible trigger: Chinese takeaway 4/7 prior to onset\n\n- No other family members with similar symptoms; one child vomited without diarrhoea\n\n- Symptoms affecting daily activities, requiring proximity to toilet; attending work (accountant) but finding it difficult\n\n\n\n\nObjective:\n\n- PMHx: Asthma, well-controlled with inhaler\n\n- Denies other abdominal/bowel issues\n\n- Medications: Inhaler for asthma; no other regular medications\n\n- Social: Lives with wife and two children; non-smoker; non-drinker of alcohol\n\n\n\n\nAssessment:\n\n- Symptoms suggestive of gastroenteritis, likely viral, though bacterial aetiology possible\n\n\n\n\nPlan:\n\n- Conservative management; maintain good hydration\n\n- Oral rehydration solution (e.g. Direlyte) from pharmacy\n\n- Paracetamol 2 tabs up to QID for feverishness/weakness\n\n- Rest; 2-3/7 off work\n\n- Return if no improvement within 3-4/7 for further assessment and possible stool sample","review":91.64473684210526,"saved":291.35526315789474,"clean":false,"effort":15.384615384615385,"sig":[["fabrication","Denies ... light-headedness","Light-headedness never asked; invented negative on a dehydration-relevant symptom."]],"mb":34.757383,"latency":29.926,"signable":121.57073684210526},{"label":"Run 4","wer":15.926708949964762,"text":"Hello. Hello. How are you? Hi. Should you stop? Yep. Okay. Hello. Good morning, sir. How can I help you this morning? Hi. I've just had some, diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Probably, like, six, seven times a day. Six, seven times a day. And you may mention it's mainly watery. Have you noticed any other things, like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp. And\n\nYeah. I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? It comes and goes. Comes and goes. Does the pain move anywhere else, for example, towards your back? No. Just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having have you've been feeling feverish, for example? Yeah. It doesn't feel like yeah. It just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. So, yeah, around about three or four days ago. Did you measure your temperature then? Yeah. I I I didn't measure my temperature. No. But I felt just a bit hot.\n\nOkay. Okay. Any other symptoms like sweating or, um, light? Uh, no. No. And, uh, any vomiting at all? Yeah. So, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You stopped vomiting. Okay. And was your vomit. I know it's not nice things to talk about, but was it just normal food color? Yeah, yeah, just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No blood. No. No. Okay. Um, and, um, any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Um, anything else that comes to mind? Um, I had a loss of appetite. Um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids.\n\nOkay, so you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat, anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay, fine. Um, and so, uh, uh, you started three days ago, the symptoms. Are you aware of any triggers which may have caused the symptoms to, uh, to kick on? So for example, things like takeaway foods or eating out or being around other people who had similar symptoms? Yeah, so I had takeaway about four days ago. Um, uh, but other than that, I've, yeah, been, uh, eating normally. I think, uh, unusual, yeah. Do you remember what you ate?\n\nUm, yeah, I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? Um, so no one else in the family, so I have a wife and two kids, and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay, fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler, everything, uh, else is fine. Okay, and is your asthma well controlled? Uh, yeah, that's fine. Uh, just, yeah, use an inhaler, and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of?\n\nNo. No. Okay. And apart from the inhalers, do you take any other medications? No. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past three days. Okay. Yeah. Other than that, it's Yeah. Yeah. The main concern. And have you are you currently working at the moment? Yes. Yeah. I I work. Work? I'm an accountant. Okay. Have you been going to work the last three days, or have you been at home? Yeah. I've been going to work. Okay.\n\nThat must be difficult for you then. Yeah, it's been quite difficult. Right. And you say you mentioned you live with a wife and two children. Is that right? Yes. Yeah. All right. Um, just a couple of other questions we need to ask. Uh, do you smoke at all? Uh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um, but but having listened to your stories, uh, I think, um, just to recap, for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left hand side, um, and vomiting and feeling generally quite weak and lethargic. Um, you mentioned you're having this Chinese takeaway as well as three days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something.\n\nCalled gastroenteritis, which is essentially just a tummy bug or infection of your of your tummy. Yeah. Mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Direlyte you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, you're taking some paracetamol.\n\nYeah. Two tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work, but, I would say next two two to three days, clears from your system, to take some time off and rest. You know, if your symptoms haven't got better, you know, in in three to four days, I'd like to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yeah. Sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me?\n\nUm, no. No further questions. Nope. Okay. Is the is the treatment plan clear? Uh, yeah. Yeah, that's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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It does not require or invent bilious vomiting.","yes","\"Vomiting at symptom onset, now resolved; no blood.\""],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at onset 3-4 days ago, not measured\" plus weakness and shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite; maintaining fluids; tolerating soups, smoothies, liquid foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway 4 days prior; one child vomiting without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma well-controlled with inhaler; no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"requiring close proximity to toilet\" and daily activities affected."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely gastroenteritis.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and Dioralyte, but no mention that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol 2 tablets up to 4 times daily for fever/weakness\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Advised 2-3 days off work for rest and recovery.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if not improved within 3-4 days; consider stool sample testing."]],"claims":[],"note":"SOAP Note\n\n\n\n\nDate of Consult: 22/09/2026\n\n\n\n\nSubjective:\n\n- Diarrhoea, abdominal pain, weakness x 3 days.\n\n- Loose, watery stools, 6-7 times daily.\n\n- Lower left abdominal cramping pain, intermittent, no radiation.\n\n- Vomiting at symptom onset, now resolved; no blood.\n\n- Subjective fever at onset 3-4 days ago, not measured.\n\n- Generalised weakness and shakiness.\n\n- Loss of appetite; maintaining fluid intake; tolerating soups, smoothies, liquid foods.\n\n- No blood in stool.\n\n- Possible trigger: Chinese takeaway 4 days prior.\n\n- No household contacts with similar symptoms; one child had vomiting without diarrhoea.\n\n- Symptoms affecting daily activities; requiring close proximity to toilet; attended work throughout.\n\n\n\n\nPast Medical History:\n\n- Asthma, well-controlled with inhaler.\n\n\n\n\nMedications:\n\n- Inhaler for asthma. No other regular medications.\n\n\n\n\nSocial History:\n\n- Accountant.\n\n- Lives with wife and two children.\n\n- Non-smoker.\n\n- Non-drinker of alcohol.\n\n\n\n\nObjective:\n\n- \n\n\n\n\nAssessment:\n\n- Likely gastroenteritis.\n\n\n\n\nPlan:\n\n- Conservative management.\n\n- Ensure adequate hydration; oral rehydration solutions (e.g. Dioralyte).\n\n- Paracetamol 2 tablets up to 4 times daily for fever/weakness for first few days.\n\n- Advised 2-3 days off work for rest and recovery.\n\n- Review if symptoms do not improve within 3-4 days; consider stool sample testing.\n\n- Counselled on likely viral aetiology with possible bacterial cause, importance of hydration, and signs for review.","review":81.22368421052632,"saved":301.7763157894737,"clean":false,"effort":3.8461538461538463,"sig":[],"mb":35.192074,"latency":29.193,"signable":110.41668421052631},{"label":"Run 5","wer":15.856236786469344,"text":"Hello. Hello. How are you? Hi. Should we stop? Yeah. Okay. Hello. Good morning, sir. How can I help you this morning? Hi. I've just had some, diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, six, seven times a day. Six, seven times a day. And you may mention it's mainly watery. Have you noticed any other things, like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp.\n\nLike a muscular cramp. And, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? It comes and goes. Comes and goes. Does the pain move anywhere else, for example, towards your back? No. Just mainly in my stomach. Okay. Alright. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. It just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. So, yeah, around about three or four days ago.\n\nMeasure your temperature then? Yeah, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. Yeah. Any other symptoms like sweating or, um, right? Uh, no. No. And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting, okay. And was your vomit... I know it's not a nice thing to talk about, but was it just normal food color of blood? Yeah, yeah, just normal vomit. Yeah. Yeah, and there was no blood in your vomit, is that right? No blood, no. No. Okay. Yeah. Um- Yeah. And, um, a- any other symptoms at all? So you mentioned the tummy pain, you mentioned diarrhea, you mentioned the vomiting. Yeah. Um, anything else that comes to mind?\n\nUm, I had a loss of appetite. Um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay, so you're drinking fluids. What kind of foods have you managed to eat anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. Um, and so, uh, you started three days ago, your symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So for example, things like takeaway foods or eating out or being around other people who would similar symptoms. Yeah. So I had takeaway about four days ago. Um.\n\nUh, but other than that, I've, yeah, been, uh, eating normally. I think, uh, unusual, yeah. Do you remember where you ate? Um, yeah, I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? Um, so no one else in the family, so I have a wife and two kids, and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay, fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler, everything, uh, else is fine.\n\nOkay. And is your asthma well controlled? Uh, yeah, that's fine. I just, yeah, use an inhaler, and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No. No. Okay. Um, and ta- apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay, fine. And in terms of just your, your day-to-day life, you said it's been affecting your life. Um- Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet,'cause I go quite frequently during the, these past three days. Okay. Um, yeah, other than that, it's, uh- Yeah... yeah, the main concern. And have you, are you currently working at the moment? Uh, uh, yes. Yeah, I, I work, uh- Work?\n\nUm, I'm an accountant. Okay. Have you been going into work the last three days, or have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. Right. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. All right. Um, just a couple of other questions we need to ask, uh, um, do you smoke at all? Uh, no, I don't smoke. And do you drink much in a way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, uh, examine you, if that's okay. But, um, um- Yeah. But, but having listened to your story, so I think, uh, um, just to recap, you-- for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side, uh, and vomiting and being generally quite weak and lethargic. Yeah. Um, you mentioned you're having this Chinese takeaway as well, three days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something-\n\nCalled gastroenteritis, which is essentially just a tummy bug or infection of your of your tummy. Yeah. Mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Dirolyte you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol\n\nTwo tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say next two two to three days, um, clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in in three to four days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests like, um, taking a sample of your stool so we can test that, um, etcetera, etcetera. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me?\n\nUm, no. No further questions. Nope. Okay. And is the treatment plan clear? Uh, yeah. Yeah, that's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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Uh","significant":false},{"start":7088,"end":7092,"said":"Yep","significant":false},{"start":7100,"end":7105,"said":"yep.","significant":false},{"start":7220,"end":7225,"said":"no.","significant":false},{"start":7372,"end":7372,"said":"Bye.","significant":false},{"start":7393,"end":7397,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","3/7 loose watery stools, 6-7x/day, no blood in stools."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Left lower abdominal pain, cramping, intermittent, localised."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved; normal appearance, no blood."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Denies current fever, felt hot at onset, not measured; weakness and shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids, soups, smoothies, liquid foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway 4 days ago and one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma well-controlled with inhaler; denies other medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"affecting daily activities, requiring proximity to toilet\" and work difficulty."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Symptoms suggestive of gastroenteritis.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management, hydration and ORS captured, but no mention that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol 2 tablets up to QID.\""],["The plan captures rest and approximately two to three days off work.","yes","\"Advised 2-3 days off work for rest.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Review in 3-4 days if no improvement; consider stool sample testing.\""]],"claims":[],"note":"Subjective\n\n- 3/7 diarrhoea, affecting daily activities, requiring proximity to toilet\n\n- Loose, watery stools, 6-7x/day\n\n- No blood in stools\n\n- Lower abdominal pain, left-sided, cramping, intermittent, localised to abdomen\n\n- Weakness and shakiness\n\n- Denies current fever; felt hot at symptom onset 3-4 days ago, temperature not measured\n\n- Denies sweating\n\n- Vomiting at onset, now resolved; vomit normal appearance, no blood\n\n- Loss of appetite, reduced intake; tolerating fluids (water, soups, smoothies, liquid foods)\n\n- Possible trigger: takeaway Chinese food 4 days ago with friends\n\n- No household contacts with similar symptoms; one child vomited without diarrhoea\n\n\n\n\nPast Medical History\n\n- Asthma, well-controlled with inhaler\n\n- Denies other abdominal/bowel problems\n\n\n\n\nMedications\n\n- Inhaler for asthma\n\n- Denies other medications\n\n\n\n\nSocial History\n\n- Accountant; continued working past 3 days despite symptoms, finding it difficult\n\n- Lives with wife and two children\n\n- Non-smoker\n\n- Denies alcohol\n\n\n\n\nObjective\n\n- Not examined\n\n\n\n\nAssessment\n\n- Symptoms suggestive of gastroenteritis, possibly related to recent takeaway food\n\n\n\n\nPlan\n\n- Conservative management\n\n- Ensure adequate hydration; oral rehydration solution (e.g. Dirolyte) from pharmacy, especially if ongoing vomiting/diarrhoea\n\n- Paracetamol 2 tablets up to QID for feverishness/weakness\n\n- Advised 2-3 days off work for rest\n\n- Review in 3-4 days if no improvement; consider stool sample testing","review":80.59210526315789,"saved":302.4078947368421,"clean":false,"effort":3.8461538461538463,"sig":[],"mb":35.651684,"latency":27.37,"signable":107.9621052631579},{"label":"Run 6","wer":15.29245947850599,"text":"Hello. Hello. How are you? Hi. Stop. Yeah. Okay. Hello. Good morning, sir. How can I help you this morning? Hi. I've just had some, diarrhea for the last three days.\n\nUm, and it's been affecting me. I need to stay close to the toilet. And, um, yeah, it's been affecting my day to day activities. Yeah, I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool going to the toilet quite often.\n\nAnd like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Probably, like, six, seven times a day. Six, seven times a day. And you may mention it's mainly watery. Have you noticed any other things, like blood in your stools? No. No blood. Yeah. Just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain? Is that clear? So it's like in my lower abdomen. So, like, yeah, just to one side. One side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp. And\n\nUm, yeah, I feel a bit weak and shaky. Okay. And does the pain, is that, is it there all the time, or does it come and go? Uh, it comes and goes. Comes and goes. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. All right. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like, uh... Yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature when the symptoms started. So, um, yeah, around about three or four days ago. Did you measure your temperature then? Yeah, I, I, I didn't measure my temperature, no, but I felt, um, just a bit hot.\n\nOkay. Okay. Any other symptoms like sweating or, um, light? Uh, no. No. And, uh, any vomiting at all? Yeah. So, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit. I know it's not a nice thing to talk about, but was it just normal food color? Yeah, yeah, just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No blood. No. No. Okay. Um, and, um, any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Um, anything else that comes to mind? Um, I had a loss of appetite. Um, so I haven't been eating as much. Um, but I've been able to hold down fluids.\n\nOkay, so you're drinking fluids. Yeah. What kind of foods have you managed to eat, anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. Um, and so, uh, uh, you started three days ago, your symptoms. Are you aware of any triggers which may have caused the symptoms to, uh, to kick on? So for example, things like takeaway foods or eating out or being around other people who had similar symptoms? Yeah, so I had takeaway about four days ago. Um, uh, but other than that, I've, yeah, been, uh, eating normally. I think, uh, unusual, yeah. Do you remember what you ate?\n\nUm, yeah, I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? Um, so no one else in the family. So I have a wife and two kids, and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay. Fine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler. Everything, uh, else is fine. Okay. And is your asthma well controlled? Uh, yeah, that's fine. Uh, just, yeah, use an inhaler, and, uh, that's under control.\n\nAnd you don't have any other tummy problems, bowel problems I should be aware of? No. No. Okay. And apart from the inhalers, do you take any other medications? No. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past three days. Okay. Yeah. Other than that, it's Yeah. Yeah. The main concern. And have you are you currently working at the moment? Yes. Yeah. I I work. Work? I'm an accountant. Okay. Have you been going into work the last three days, or have you been at home?\n\nUh, yeah, I've been going to work. Okay. That must be difficult for you then? Yeah, it's been quite difficult. Right. And you say you mentioned you live with a wife and two children, is that right? Yes. Yep. All right. Um, just a couple of other questions we need to ask, uh, um, do you smoke at all? Uh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you, if that's okay. But, um, um- Yeah. But, but having listened to your story, so I think, you know, um, just to recap, you-- for the last three days, you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side, uh, and vomiting and feeling generally quite weak and lethargic. Um, you mentioned you're having this Chinese takeaway as well as three days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something-\n\nCalled gastroenteritis, which is essentially just a tummy bug or infection of your of your tummy. Yeah. Mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Dirolyte you can get from the pharmacy, which it's it helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would certainly recommend that in the first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol\n\nTwo tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next two two to three days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in in three to four days, I'd like you to come back and see me again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing the symptoms. Yeah. And we may need to do further tests, like, um, taking a sample of your stool so we can test that, um, etcetera, etc.. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me?\n\nUm, no. No further questions. Nope. Okay. And is the treatment plan clear? Uh, yeah. Yeah. That's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. 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Okay.","significant":false},{"start":3359,"end":3363,"said":"where","significant":false},{"start":3513,"end":3519,"said":"","significant":false},{"start":3666,"end":3672,"said":"alright.","significant":false},{"start":3738,"end":3745,"said":"fit and","significant":false},{"start":3789,"end":3795,"said":"athsma","significant":false},{"start":3976,"end":3976,"said":"Fine.","significant":false},{"start":4013,"end":4021,"said":"problem","significant":false},{"start":4202,"end":4206,"said":"","significant":false},{"start":4353,"end":4360,"said":"'cause","significant":false},{"start":4556,"end":4560,"said":"er. Um","significant":false},{"start":4580,"end":4580,"said":"Would would work.","significant":false},{"start":4699,"end":4699,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":4743,"end":4782,"said":"fine.","significant":false},{"start":4791,"end":4794,"said":"said","significant":false},{"start":4823,"end":4824,"said":"your","significant":false},{"start":4868,"end":4876,"said":"yeah.","significant":false},{"start":4883,"end":4883,"said":"alright.","significant":false},{"start":4911,"end":4920,"said":"question","significant":false},{"start":4937,"end":4939,"said":"sir.","significant":false},{"start":5120,"end":5123,"said":"I","significant":false},{"start":5175,"end":5184,"said":"um","significant":false},{"start":5225,"end":5227,"said":"sir","significant":false},{"start":5237,"end":5245,"said":"uh","significant":false},{"start":5266,"end":5271,"said":"","significant":false},{"start":5411,"end":5428,"said":"fever and you're","significant":false},{"start":5473,"end":5486,"said":"you had","significant":false},{"start":5512,"end":5516,"said":"little","significant":false},{"start":5542,"end":5548,"said":"wondered","significant":false},{"start":5636,"end":5646,"said":"something uh","significant":false},{"start":5829,"end":5833,"said":"its","significant":false},{"start":6058,"end":6058,"said":"Mm-hmm. Um","significant":false},{"start":6081,"end":6089,"said":"Dioralyte","significant":false},{"start":6140,"end":6140,"said":"helps","significant":false},{"start":6151,"end":6158,"said":"","significant":false},{"start":6246,"end":6255,"said":"say","significant":false},{"start":6317,"end":6322,"said":"Yep.","significant":false},{"start":6359,"end":6359,"said":"eh","significant":false},{"start":6458,"end":6458,"said":"Yep.","significant":false},{"start":6461,"end":6466,"said":"will","significant":false},{"start":6696,"end":6704,"said":"I'll admit","significant":false},{"start":6800,"end":6804,"said":"","significant":false},{"start":6813,"end":6815,"said":"you","significant":false},{"start":6892,"end":6899,"said":"","significant":false},{"start":6915,"end":6926,"said":"caused your","significant":false},{"start":6937,"end":6942,"said":"Yep. Uh","significant":false},{"start":7055,"end":7065,"said":"etcetera. Yep","significant":false},{"start":7073,"end":7078,"said":"yep.","significant":false},{"start":7193,"end":7198,"said":"no.","significant":false},{"start":7345,"end":7345,"said":"Bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","3-day loose watery stools 6-7 times daily; no blood in stools."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Left-sided lower abdominal cramping, intermittent, no radiation."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","partial","Vomiting at onset resolved with no blood captured, but it is stated as \"One episode\", a count the transcript never gives."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Unmeasured temperature at onset, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite; tolerating soups/smoothies/liquid foods; maintaining fluids."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese restaurant takeaway; one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma controlled with inhaler; no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Notes continued working but omits needing to stay close to the toilet and daily-activity disruption."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely gastroenteritis, possibly viral or bacterial\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management, fluids and Dioralyte captured; no mention that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Paracetamol captured but dose written as \"1g up to QID\"; spoken instruction was two tablets and no strength was given."],["The plan captures rest and approximately two to three days off work.","yes","\"advised 2-3 days off work\" for rest."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return in 3-4 days if persisting; stool sample testing."]],"claims":[["One episode of vomiting at onset","Transcript says only \"I vomited at the start of the symptoms\"; the number of episodes is never stated."],["paracetamol 1g up to QID","Clinician said \"two tablets up to four times a day\"; no mg strength or 1 g dose was stated."]],"note":"Subjective\n\n- 3-day history of diarrhoea, loose and watery stools, 6-7 times daily\n\n- Lower abdominal cramping pain, predominantly left side, intermittent, no radiation\n\n- No blood in stools\n\n- Feeling weak and shaky\n\n- Unmeasured temperature at symptom onset (felt hot ~3-4 days ago); no fever currently\n\n- One episode of vomiting at onset, now resolved; vomitus normal colour, no blood\n\n- Loss of appetite; tolerating soups, smoothies and liquid foods; maintaining fluid intake\n\n- Trigger: takeaway from a Chinese restaurant ~4 days prior to symptom onset\n\n- Family: spouse and one child well; one child vomited but no diarrhoea\n\n- PMHx: asthma (controlled with inhaler); no other GI issues\n\n- Medications: inhaler for asthma; no other regular medications\n\n- Social: non-smoker; no alcohol; employed as accountant, continued working; lives with wife and two children\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- Likely gastroenteritis, possibly viral or bacterial, potentially linked to recent takeaway food consumption\n\n\n\n\nPlan\n\n- Conservative management\n\n- Hydration: encourage fluid intake; consider oral rehydration solution (e.g. Dioralyte) to replenish minerals and vitamins, especially with ongoing vomiting and diarrhoea\n\n- Symptomatic relief: paracetamol 1g up to QID for feverishness and weakness PRN\n\n- Rest: advised 2-3 days off work to aid recovery and prevent transmission\n\n- Review: return in 3-4 days if symptoms persist or worsen; consider further investigations including stool sample testing","review":168.3815789473684,"saved":214.6184210526316,"clean":false,"effort":30.76923076923077,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Paracetamol dose written as 1 g QID when only 'two tablets' was said; an invented dose strength in the record."]],"mb":34.916332,"latency":24.452,"signable":192.8335789473684}],"freed":[{"label":"Run 1","wer":21.141649048625794,"text":"Hello, how can I help you this morning?\n  I've just had some diarrhoea for the last 3 days and it's been affecting me, I need to stay close to the toilet and yeah it's been affecting my day-to-day activities.\n  I'm sorry to hear that. And when you say diarrhoea, what do you mean by diarrhoea? Do you mean you're going to the toilet more often or are your stools more loose?\n  Yeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my... Like lower stomach.\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n  Probably like 6-7 times a day. 6-7 times a day.\n  And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n  No, no blood. Yeah, just watery and loose stool.\n  Okay. And you mentioned you've had some pain in your tummy as well.\n  Yep.\n  Whereabouts was the pain, exactly?\n  In my lower abdomen. So, like, yeah, just to one side. One side, and what side is that? On the left side.\n  Left side, okay. And can you describe the pain to me?\n  Yeah, it feels like a cramp, like a muscular cramp, and yeah, I feel a bit weak and shaky.\n  Okay, and does the pain, is it there all the time, or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\n  No, just mainly my stomach. Okay, fine.\n  And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, have you been feeling feverish, for example?\n  Yeah, it doesn't feel like, yeah, I just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so yeah, around about 3 or 4 days ago.\n  Did you measure your temperature then?\n  Yeah, I didn't measure my temperature, no, but I felt just a bit hot.\n  Okay, okay. Any other symptoms like sweating or night? No. And any vomiting at all?\n  Yeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\n  You've stopped vomiting, okay. And was your vomit, I know it's not nice to talk about, but was it just normal food color?\n  Yeah, yeah, just normal vomit, yeah. And there was no blood in your vomit, is that right? No blood, no. No, okay.\n  And any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhoea, you mentioned vomiting. Anything else that comes to mind?\n  I had a loss of appetite, so I haven't been eating as much, but I've been able to hold down fluids.\n  Okay, so you're drinking fluids. What kind of foods have you managed to eat, anything?\n  Um, just soups and, uh, yeah, light foods like smoothies and, yeah, liquid foods mainly. Okay, fine.\n  Um, and so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused your symptoms to kick on? So, for example, things like takeaway foods or eating out or beating around other people with similar symptoms?\n  Yeah, so I had takeaway about 4 days ago, um, but other than that I've... Yeah, been eating normally. Nothing unusual, yeah.\n  Do you remember what you ate?\n  Yeah, I ate at a Chinese restaurant with friends.\n  Okay. Anyone else on well with similar symptoms?\n  So, no one else in the family, so I have a wife and 2 kids and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n  Okay, okay, fine. Right, and in terms of your overall health, are you normally fitting well?\n  Yeah, I mean other than asthma, I use an inhaler, everything else is fine.\n  Okay, and is your asthma well controlled?\n  Yeah, that's fine, I just use an inhaler and that's under control.\n  Fine, and you don't have any other tummy problems, bowel problems I should be aware of?\n  No.\n  No, okay. Apart from inhalers, do you take any other medications?\n  No, no other medications.\n  Okay, fine. In terms of just your day-to-day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\n  So I need to stay close to the toilet because I go quite frequently during these past 3 days. Okay. Yeah, other than that, it's, yeah, the main concern.\n  And are you currently working at the moment?\n  Yes, yeah, I work. What do you do for work? I'm an accountant.\n  Okay, have you been going into work the last 3 days or have you been at home?\n  Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult.\n  Right, and you mentioned you live with a wife and 2 children, is that right?\n  Yes, yeah.\n  Alright, just a couple of other questions we need to ask. Do you smoke at all?\n  No, I don't smoke.\n  And do you drink much and aware of alcohol?\n  No, I don't drink alcohol, no.\n  Okay, so normally at this stage I like to examine you, but having listened to your story, sir, I think just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side. and vomiting and being generally quite weak and lethargic. You mentioned you were having this Chinese takeaway as well 3 days ago and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or infection of your tummy, mainly caused by viruses but there can be a possibility of bacteria causing your symptoms. At this stage, what we recommend is just what we say conservative management, so I don't think you need anything like antibiotics, it's really just making sure you're well hydrated, drinking fluids. There are things like diuralite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that in the 1st couple of days. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work actually, I know you're quite keen to work. I would say next 2 to 3 days action clears from your system, take some time off and rest. If your symptoms haven't got better in 3 to 4 days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool, so we can test that, etc., etc. Yeah, sure, yeah. How does that sound? That sounds great, yeah, yeah. Do you have any questions for me? Um, no, no further questions, sir. Okay, is the treatment plan clear? Uh, yeah, yeah, that's very clear, thank you. Great, well I wish you all the best. Okay, thank you. Thank you. Bye.","marks":[{"start":5,"end":5,"said":"Hi. Um should we start Yeah okay. Hello how um. Good morning sir","significant":false},{"start":38,"end":38,"said":"Hello how are you Oh hey um","significant":false},{"start":61,"end":70,"said":"diarrhea","significant":false},{"start":211,"end":214,"said":"","significant":false},{"start":252,"end":270,"said":"diarrhea what'd","significant":false},{"start":283,"end":292,"said":"diarrhea","significant":false},{"start":558,"end":562,"said":"in","significant":false},{"start":604,"end":607,"said":"six or seven","significant":false},{"start":621,"end":624,"said":"Yeah. Six seven","significant":false},{"start":648,"end":657,"said":"mention","significant":false},{"start":863,"end":867,"said":"","significant":false},{"start":903,"end":903,"said":"Yep. 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Yeah it's been quite difficult.","significant":false},{"start":4401,"end":4441,"said":"fine.","significant":false},{"start":4446,"end":4446,"said":"you said","significant":false},{"start":4475,"end":4476,"said":"your","significant":false},{"start":4560,"end":4569,"said":"question","significant":false},{"start":4585,"end":4585,"said":"sir. Um","significant":false},{"start":4652,"end":4661,"said":"in the way","significant":false},{"start":4762,"end":4762,"said":"if that's okay but um um but","significant":false},{"start":4957,"end":4972,"said":"fever and you're","significant":false},{"start":5017,"end":5028,"said":"had","significant":false},{"start":5054,"end":5058,"said":"little as","significant":false},{"start":5076,"end":5082,"said":"wondered","significant":false},{"start":5258,"end":5258,"said":"uh of your","significant":false},{"start":5342,"end":5346,"said":"its","significant":false},{"start":5377,"end":5379,"said":"what we'd","significant":false},{"start":5555,"end":5555,"said":"Mm-hmm. 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Um I'll admit","significant":false},{"start":6135,"end":6135,"said":"you know in","significant":false},{"start":6169,"end":6173,"said":"","significant":false},{"start":6262,"end":6269,"said":"","significant":false},{"start":6285,"end":6292,"said":"caused your","significant":false},{"start":6303,"end":6308,"said":"Yep. Uh","significant":false},{"start":6403,"end":6418,"said":"Um etcetera etcetera. Yep","significant":false},{"start":6426,"end":6440,"said":"yep. How's","significant":false},{"start":6548,"end":6552,"said":"no.","significant":false},{"start":6598,"end":6602,"said":"that's","significant":false},{"start":6687,"end":6687,"said":"Bye.","significant":false},{"start":6703,"end":6703,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Captures 3 days of loose, watery stools 6-7 times daily with no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Captures intermittent cramping left lower abdominal pain that does not radiate."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved, 'normal in color with no blood'."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Asthma 'currently controlled with an inhaler' captured, but no explicit statement that he takes no other medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Records needing to stay close to a toilet and difficulty/disruption with work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[],"note":"Subjective\nCliniTech Benchmark c60497f0, a patient with a history of asthma, presents with a 3-day history of diarrhea, abdominal pain, and weakness.\n\nThe patient reports loose, watery stools occurring approximately 6-7 times per day over the past 3 days. He describes associated lower abdominal pain on the left side, characterized as cramp-like, muscular pain that is intermittent and does not radiate. He denies any blood in the stools. He also reports feeling weak and shaky, with a subjective feeling of fever at symptom onset approximately 3-4 days ago, though he did not measure his temperature at that time. He experienced vomiting at the start of symptoms, which has since resolved. The vomit was normal in color with no blood. He reports loss of appetite and has been eating light foods such as soups and smoothies, and has been able to tolerate fluids. He denies night sweats.\n\nThe patient notes having had a Chinese takeaway approximately 4 days ago, which he suspects may have triggered his symptoms. One of his children has been vomiting but has not had diarrhea, and no other family members have similar symptoms. The patient has been going to work as an accountant despite his symptoms, which has been difficult due to the need to stay close to a toilet. He denies any prior bowel or tummy problems.\n\nMedical History  \n- Asthma, currently controlled with an inhaler\n\nMedications and Supplements  \n- Inhaler for asthma\n\nSocial History  \n- Tobacco: Denies tobacco use  \n- Alcohol: Denies alcohol use  \n- Occupation: Works as an accountant  \n- Living Situation: Lives at home with wife and 2 children\n\nReview of Systems  \n- General: Subjective fever at onset, decreased appetite, denies night sweats  \n- Gastrointestinal: Denies blood in stools, blood in vomit\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 3-day history of diarrhea, abdominal cramping, and weakness, likely secondary to gastroenteritis.\n\nGastroenteritis  \nAssessment: Patient presents with acute gastroenteritis characterized by loose watery stools 6-7 times daily, left lower abdominal cramping pain, weakness, and initial fever that has resolved. Symptoms began 3 days ago following consumption of Chinese takeaway food 4 days prior. Initial vomiting has resolved. No blood in stool or vomit. Patient has maintained fluid intake and reports loss of appetite. Family member has vomiting but no diarrhea. Clinical presentation is consistent with viral gastroenteritis, though bacterial etiology cannot be excluded given food exposure history.  \nPlan:  \n- Conservative management with focus on hydration and rest  \n- Maintain adequate fluid intake  \n- Consider oral rehydration solutions such as Diuralite from pharmacy to replenish minerals and vitamins  \n- Paracetamol 2 tablets up to 4 times daily for fever and weakness as needed  \n- Take time off work for next 2-3 days until symptoms resolve  \n- Return for reassessment if symptoms persist beyond 3-4 days  \n- If ongoing symptoms, further evaluation including stool sample analysis may be required\n","review":179.53947368421052,"saved":203.46052631578948,"clean":false,"effort":7.6923076923076925,"sig":[],"mb":14.292149,"latency":52.22,"signable":218.68747368421052},{"label":"Run 2","wer":22.48062015503876,"text":"Hello, how can I help you this morning?\n  I've just had some diarrhoea for the last 3 days and it's been affecting me, I need to stay close to the toilet and yeah it's been affecting my day-to-day activities.\n  Sorry to hear that and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\n  Yeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my like lower stomach.\n  Okay, and how many times a day are you going, let's say, over the last couple of days?\n  Probably like 6-7 times a day. 6-7 times a day.\n  And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\n  No, no blood. Yeah, just watery and loose stool.\n  Okay, and you mentioned you've had some pain in your tummy as well.\n  Yep.\n  Whereabouts is the pain exactly?\n  In my lower abdomen, so like, yeah, just to one side. One side, and what side is that? On the left side.\n  Left side, okay. And can you describe the pain to me?\n  Yeah, it feels like a cramp, like a muscular cramp and yeah, I feel a bit weak and shaky.\n  Okay, and does the pain, is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example towards your back?\n  No, just mainly in my stomach. Okay, fine.\n  And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, have you been feeling feverish, for example?\n  Yeah, it doesn't feel like, yeah, I just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so yeah, around about 3 or 4 days ago.\n  Did you measure your temperature then?\n  Yeah, I didn't measure my temperature, no, but I felt just a bit hot. Okay.\n  Any other symptoms like sweating or night? No. And any vomiting at all?\n  Yeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\n  You've stopped vomiting, okay. And was your vomit, I know it's not nice to talk about, but was it just normal food color?\n  Yeah, yeah, just normal vomit, yeah. And there was no blood in your vomit, is that right? No blood, no. No, okay.\n  And any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhoea, you mentioned vomiting. Anything else that comes to mind?\n  I had a loss of appetite, so I haven't been eating as much, but I've been able to hold down fluids.\n  Okay, so you're drinking fluids. What kind of foods have you managed to eat, anything?\n  Just soups and light foods like smoothies and liquid foods mainly. Okay, fine.\n  And so you started 3 days ago with symptoms, are you aware of any triggers which may have caused your symptoms to kick on? So for example, things like take-away foods or eating out or beating around other people with similar symptoms?\n  Yeah, so I had take-away about 4 days ago, but other than that I've... Yeah, I've been eating normally. I think it's unusual here.\n  Do you remember where you ate?\n  Yeah, I ate at a Chinese restaurant with friends.\n  Okay. Anyone else on well with similar symptoms?\n  So no one else in the family, so I have a wife and 2 kids, and one child was vomiting, but they haven't got diarrhea. It's no one with the same symptoms.\n  Okay, okay, fine. Right, and in terms of your overall health, are you normally fitting well?\n  Yeah, I mean other than asthma, I use an inhaler, everything else is fine.\n  Okay, and is your asthma well controlled?\n  Yeah, that's fine, I just use an inhaler and that's under control.\n  Fine, and you don't have any other tummy problems, bowel problems I should be aware of?\n  No. No, okay.\n  Apart from inhalers, do you take any other medications?\n  No, no other medications.\n  Okay, fine. In terms of just your day-to-day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\n  So I need to stay close to the toilet because I go quite frequently during these past 3 days. Okay. Yeah, other than that, it's, yeah, the main concern.\n  And are you currently working at the moment?\n  Yes, yeah, I work. What do you do for work? I'm an accountant.\n  Okay. Have you been going into work the last 3 days or have you been at home?\n  Yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult.\n  Right. And you said you mentioned you live with a wife and 2 children, is that right?\n  Yes, yeah.\n  Alright. Just a couple of other questions we need to ask. Do you smoke at all?\n  No, I don't smoke.\n  And do you drink much and aware of alcohol?\n  No, I don't drink alcohol, no.\n  Normally at this stage I like to examine you, but having listened to your story, just to recap, for the last 3 days you've been having loose stool, diarrhoea, a bit of tummy pain, mainly on the left-hand side. and vomiting and being generally quite weak and lethargic. You mentioned you were having this Chinese take-away, as well, 3 days ago, and I wonder whether that might be the cause of your problems. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or infection of your tummy, mainly caused by viruses, but there can be a possibility of bacteria causing your symptoms. At this stage, what we recommend is just what we say conservative management, so I don't think you need anything like antibiotics, it's really just making sure you're well hydrated, drinking fluids. There are things like diuralite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. If you are having vomiting and diarrhea, I would recommend that in the 1st couple of days. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work actually, I know you're quite keen to work. I would say next 2 to 3 days action clears from your system, take some time off and rest. If your symptoms haven't got better, you know, in 3 to 4 days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests like taking a sample of your stool so we can test that, etc., etc.\n  Yeah, sure, yeah.\n  How does that sound?\n  That sounds great, yeah, yeah.\n  Do you have any questions for me?\n  Um, no, no further questions, sir.\n  Okay, is the treatment plan clear?\n  Uh, yeah, yeah, that's very clear, thank you.\n  Great, well I wish you all the best.\n  Okay, thank you. Thank you. Bye.","marks":[{"start":5,"end":5,"said":"Hi. Um should we start Yeah okay. Hello how um. 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How's","significant":false},{"start":6504,"end":6508,"said":"no.","significant":false},{"start":6558,"end":6562,"said":"that's","significant":false},{"start":6651,"end":6651,"said":"Bye.","significant":false},{"start":6667,"end":6667,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Captures 3 days of loose, watery stools 6-7 times daily with no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Captures intermittent cramping left lower abdominal pain that does not radiate."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved, 'normal in color with no blood'."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma well controlled with inhaler and denies other medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Records needing to stay close to a toilet and difficulty/disruption with work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[],"note":"Subjective\nCliniTech Benchmark e10cf1df presents with a 3-day history of diarrhea, abdominal pain, and weakness. The patient reports loose, watery stools occurring approximately 6-7 times per day, requiring them to stay close to a toilet. The patient describes intermittent cramping pain in the left lower abdomen that comes and goes and does not radiate. The patient initially experienced vomiting at the onset of symptoms, which has since resolved. The patient reports the vomit was normal in color with no blood. The patient also reports feeling weak and shaky, with a subjective feeling of fever at symptom onset approximately 3-4 days ago, though temperature was not measured. The patient denies current fever, night sweats, or blood in stools.\n\nThe patient reports a loss of appetite and has been eating less, managing to tolerate fluids, soups, smoothies, and other light/liquid foods. The patient suspects the symptoms may have been triggered by a Chinese take-away meal approximately 4 days ago at a restaurant with friends. One of the patient's children was also vomiting around the same time but did not develop diarrhea, and no other family members have similar symptoms.\n\nThe patient has been continuing to go to work as an accountant despite symptoms, which has been quite difficult. The patient has asthma, which is well controlled with an inhaler, and denies any other medical conditions, bowel problems, or use of other medications. The patient denies smoking and alcohol use.\n\nMedical History  \n- Asthma, well controlled\n\nMedications and Supplements  \n- Inhaler for asthma\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: Does not drink alcohol  \n- Occupation: Works as an accountant; has been going to work despite symptoms over the past 3 days  \n- Living Situation: Lives at home with wife and 2 children\n\nReview of Systems  \n- General: Subjective fever at onset, denies current fever, night sweats  \n- Gastrointestinal: Denies blood in stools, blood in vomit\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with 3-day history of diarrhea, abdominal cramping, and weakness following consumption of Chinese take-away food.\n\nGastroenteritis  \nAssessment: Patient presents with acute gastroenteritis characterized by 3 days of loose, watery stools occurring 6-7 times daily, left lower abdominal cramping pain, and associated weakness. Symptoms began approximately 4 days ago following consumption of Chinese take-away food. Initial vomiting has resolved. No blood in stool or vomit. Patient reports subjective fever at symptom onset but no current fever. Symptoms are consistent with viral gastroenteritis, though bacterial etiology cannot be excluded given the food exposure history. Patient has been able to maintain fluid intake and tolerate light foods such as soups and smoothies.  \nPlan:  \n- Conservative management with focus on hydration and rest  \n- Maintain adequate fluid intake  \n- Consider oral rehydration solutions such as Diuralyte from pharmacy to replenish minerals and vitamins  \n- Paracetamol 2 tablets up to four times daily for fever and weakness as needed  \n- Take time off work for next 2-3 days until symptoms resolve  \n- Return for reassessment if symptoms persist beyond 3-4 days  \n- If symptoms ongoing, further evaluation may include stool sample testing\n","review":177.22368421052633,"saved":205.77631578947367,"clean":false,"effort":3.8461538461538463,"sig":[],"mb":14.529952,"latency":60.361,"signable":219.38368421052633},{"label":"Run 3","wer":21.141649048625794,"text":"Hello, how can I help you this morning?\n  I've just had some diarrhoea for the last 3 days and it's been affecting me, I need to stay close to the toilet and yeah it's been affecting my day-to-day activities.\n  I'm sorry to hear that. And when you say diarrhoea, what do you mean by diarrhoea? Do you mean you're going to the toilet more often or are your stools more loose?\n  Yeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my... Like lower stomach.\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n  Probably like 6-7 times a day. 6-7 times a day.\n  And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n  No, no blood. Yeah, just watery and loose stool.\n  Okay. And you mentioned you've had some pain in your tummy as well.\n  Yep.\n  Whereabouts was the pain, exactly?\n  In my lower abdomen. So, like, yeah, just to one side. One side, and what side is that? On the left side.\n  Left side, okay. And can you describe the pain to me?\n  Yeah, it feels like a cramp, like a muscular cramp, and yeah, I feel a bit weak and shaky.\n  Okay, and does the pain, is it there all the time, or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\n  No, just mainly my stomach. Okay, fine.\n  And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, have you been feeling feverish, for example?\n  Yeah, it doesn't feel like, yeah, I just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so yeah, around about 3 or 4 days ago.\n  Did you measure your temperature then?\n  Yeah, I didn't measure my temperature, no, but I felt just a bit hot.\n  Okay, okay. Any other symptoms like sweating or night? No. And any vomiting at all?\n  Yeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\n  You've stopped vomiting, okay. And was your vomit, I know it's not nice to talk about, but was it just normal food color?\n  Yeah, yeah, just normal vomit, yeah. And there was no blood in your vomit, is that right? No blood, no. No, okay.\n  And any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhoea, you mentioned vomiting. Anything else that comes to mind?\n  I had a loss of appetite, so I haven't been eating as much, but I've been able to hold down fluids.\n  Okay, so you're drinking fluids. What kind of foods have you managed to eat, anything?\n  Um, just soups and, uh, yeah, light foods like smoothies and, yeah, liquid foods mainly. Okay, fine.\n  Um, and so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused your symptoms to kick on? So, for example, things like takeaway foods or eating out or beating around other people with similar symptoms?\n  Yeah, so I had takeaway about 4 days ago, um, but other than that I've... Yeah, been eating normally. Nothing unusual, yeah.\n  Do you remember what you ate?\n  Yeah, I ate at a Chinese restaurant with friends.\n  Okay. Anyone else on well with similar symptoms?\n  So, no one else in the family, so I have a wife and 2 kids and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n  Okay, okay, fine. Right, and in terms of your overall health, are you normally fitting well?\n  Yeah, I mean other than asthma, I use an inhaler, everything else is fine.\n  Okay, and is your asthma well controlled?\n  Yeah, that's fine, I just use an inhaler and that's under control.\n  Fine, and you don't have any other tummy problems, bowel problems I should be aware of?\n  No.\n  No, okay. Apart from inhalers, do you take any other medications?\n  No, no other medications.\n  Okay, fine. In terms of just your day-to-day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\n  So I need to stay close to the toilet because I go quite frequently during these past 3 days. Okay. Yeah, other than that, it's, yeah, the main concern.\n  And are you currently working at the moment?\n  Yes, yeah, I work. What do you do for work? I'm an accountant.\n  Okay, have you been going into work the last 3 days or have you been at home?\n  Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult.\n  Right, and you mentioned you live with a wife and 2 children, is that right?\n  Yes, yeah.\n  Alright, just a couple of other questions we need to ask. Do you smoke at all?\n  No, I don't smoke.\n  And do you drink much and aware of alcohol?\n  No, I don't drink alcohol, no.\n  Okay, so normally at this stage I like to examine you, but having listened to your story, sir, I think just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side. and vomiting and being generally quite weak and lethargic. You mentioned you were having this Chinese takeaway as well 3 days ago and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or infection of your tummy, mainly caused by viruses but there can be a possibility of bacteria causing your symptoms. At this stage, what we recommend is just what we say conservative management, so I don't think you need anything like antibiotics, it's really just making sure you're well hydrated, drinking fluids. There are things like diuralite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that in the 1st couple of days. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work actually, I know you're quite keen to work. I would say next 2 to 3 days action clears from your system, take some time off and rest. If your symptoms haven't got better in 3 to 4 days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool, so we can test that, etc., etc. Yeah, sure, yeah. How does that sound? That sounds great, yeah, yeah. Do you have any questions for me? Um, no, no further questions, sir. Okay, is the treatment plan clear? Uh, yeah, yeah, that's very clear, thank you. Great, well I wish you all the best. Okay, thank you. Thank you. Bye.","marks":[{"start":5,"end":5,"said":"Hi. Um should we start Yeah okay. Hello how um. Good morning sir","significant":false},{"start":38,"end":38,"said":"Hello how are you Oh hey um","significant":false},{"start":61,"end":70,"said":"diarrhea","significant":false},{"start":211,"end":214,"said":"","significant":false},{"start":252,"end":270,"said":"diarrhea what'd","significant":false},{"start":283,"end":292,"said":"diarrhea","significant":false},{"start":558,"end":562,"said":"in","significant":false},{"start":604,"end":607,"said":"six or seven","significant":false},{"start":621,"end":624,"said":"Yeah. Six seven","significant":false},{"start":648,"end":657,"said":"mention","significant":false},{"start":863,"end":867,"said":"","significant":false},{"start":903,"end":903,"said":"Yep. 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Okay.","significant":false},{"start":3081,"end":3085,"said":"where","significant":false},{"start":3167,"end":3174,"said":"unwell","significant":false},{"start":3234,"end":3240,"said":"","significant":false},{"start":3377,"end":3382,"said":"Um alright.","significant":false},{"start":3399,"end":3399,"said":"your","significant":false},{"start":3438,"end":3445,"said":"fit and","significant":false},{"start":3450,"end":3450,"said":"Or uh Um","significant":false},{"start":3478,"end":3484,"said":"um athsma um","significant":false},{"start":3556,"end":3571,"said":"well-controlled Uh","significant":false},{"start":3685,"end":3693,"said":"problem","significant":false},{"start":4018,"end":4025,"said":"'cause","significant":false},{"start":4138,"end":4138,"said":"have you","significant":false},{"start":4201,"end":4224,"said":"er. Um","significant":false},{"start":4244,"end":4244,"said":"Would would work.","significant":false},{"start":4357,"end":4357,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":4401,"end":4441,"said":"fine.","significant":false},{"start":4446,"end":4446,"said":"you said","significant":false},{"start":4475,"end":4476,"said":"your","significant":false},{"start":4560,"end":4569,"said":"question","significant":false},{"start":4585,"end":4585,"said":"sir. Um","significant":false},{"start":4652,"end":4661,"said":"in the way","significant":false},{"start":4762,"end":4762,"said":"if that's okay but um um but","significant":false},{"start":4957,"end":4972,"said":"fever and you're","significant":false},{"start":5017,"end":5028,"said":"had","significant":false},{"start":5054,"end":5058,"said":"little as","significant":false},{"start":5076,"end":5082,"said":"wondered","significant":false},{"start":5258,"end":5258,"said":"uh of your","significant":false},{"start":5342,"end":5346,"said":"its","significant":false},{"start":5377,"end":5379,"said":"what we'd","significant":false},{"start":5555,"end":5555,"said":"Mm-hmm. Um","significant":false},{"start":5578,"end":5587,"said":"Dioralyte","significant":true},{"start":5624,"end":5624,"said":"uh it's um it helps","significant":false},{"start":5641,"end":5648,"said":"","significant":false},{"start":5756,"end":5759,"said":"first you know first","significant":false},{"start":5775,"end":5775,"said":"Yep.","significant":false},{"start":5812,"end":5812,"said":"eh","significant":false},{"start":5909,"end":5909,"said":"Yep.","significant":false},{"start":5912,"end":5917,"said":"will","significant":false},{"start":6026,"end":6026,"said":"two","significant":false},{"start":6039,"end":6045,"said":"as the infection","significant":false},{"start":6099,"end":6099,"said":"Okay. Yeah. Um I'll admit","significant":false},{"start":6135,"end":6135,"said":"you know in","significant":false},{"start":6169,"end":6173,"said":"","significant":false},{"start":6262,"end":6269,"said":"","significant":false},{"start":6285,"end":6292,"said":"caused your","significant":false},{"start":6303,"end":6308,"said":"Yep. Uh","significant":false},{"start":6403,"end":6418,"said":"Um etcetera etcetera. Yep","significant":false},{"start":6426,"end":6440,"said":"yep. How's","significant":false},{"start":6548,"end":6552,"said":"no.","significant":false},{"start":6598,"end":6602,"said":"that's","significant":false},{"start":6687,"end":6687,"said":"Bye.","significant":false},{"start":6703,"end":6703,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Captures 3 days of loose, watery stools 6-7 times daily with no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Captures intermittent cramping left lower abdominal pain that does not radiate."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved, 'normal in color with no blood'."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Asthma and inhaler captured, but controlled status and absence of other medications are not stated."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Records needing to stay close to a toilet and difficulty/disruption with work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[["Symptoms began approximately 4 days after consuming Chinese takeaway food.","Transcript places the takeaway about four days ago and symptom onset about three days ago; nothing supports a four-day gap between eating and onset."]],"note":"Subjective\nCliniTech Benchmark 39713ae9, a patient with a history of asthma, presents with a 3-day history of diarrhea, abdominal pain, and weakness.\n\nThe patient reports loose, watery stools occurring approximately 6-7 times per day over the past 3 days. He describes intermittent cramping pain in the left lower abdomen that comes and goes and does not radiate. He denies any blood in the stools. He initially experienced vomiting at the onset of symptoms but reports the vomiting has since resolved. The vomit was normal in color with no blood. He reports feeling weak and shaky, and he felt feverish at the onset of symptoms approximately 3-4 days ago, though he did not measure his temperature at that time. He denies night sweats. He reports loss of appetite and has been eating light foods such as soups and smoothies, and has been able to tolerate fluids.\n\nThe patient suspects the symptoms may have been triggered by a Chinese takeaway meal approximately 4 days ago. One of his children has been vomiting but without diarrhea, and no other family members have similar symptoms. The patient reports the diarrhea has significantly affected his day-to-day activities, requiring him to stay close to a toilet. He has continued going to work as an accountant over the past 3 days despite his symptoms.\n\nHe denies any other bowel problems. He denies smoking and alcohol use.\n\nMedical History  \n- Asthma\n\nMedications and Supplements  \n- Inhaler for asthma\n\nSocial History  \n- Tobacco: Denies tobacco use  \n- Alcohol: Denies alcohol use  \n- Occupation: Works as an accountant\n\nReview of Systems  \n- General: Subjective fever at onset, loss of appetite, denies night sweats  \n- Gastrointestinal: Denies blood in stools, blood in vomit\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 3-day history of diarrhea, abdominal cramping, and weakness, likely secondary to gastroenteritis.\n\nGastroenteritis  \nAssessment: Patient presents with acute gastroenteritis characterized by 3 days of loose, watery stools occurring 6-7 times daily, left lower abdominal cramping pain that comes and goes, and associated weakness. Initial fever and vomiting have resolved. Symptoms began approximately 4 days after consuming Chinese takeaway food. No blood in stool or vomit. Patient has maintained fluid intake and has been able to tolerate light foods such as soups and smoothies. One child in the household had vomiting but no diarrhea. Clinical presentation is consistent with viral gastroenteritis, though bacterial etiology cannot be ruled out.  \nPlan:  \n- Conservative management with focus on hydration and rest  \n- Maintain adequate fluid intake  \n- Consider oral rehydration solutions such as Diuralyte from pharmacy to replenish minerals and vitamins  \n- Paracetamol 2 tablets up to 4 times daily for fever and weakness if needed  \n- Take time off work for next 2-3 days until symptoms resolve  \n- Return for reassessment if symptoms persist beyond 3-4 days  \n- If ongoing symptoms, further evaluation may include stool sample testing\n","review":192.48684210526315,"saved":190.51315789473685,"clean":false,"effort":19.230769230769234,"sig":[],"mb":14.225394,"latency":52.77,"signable":233.19384210526314},{"label":"Run 4","wer":21.141649048625794,"text":"Hello, how can I help you this morning?\n  I've just had some diarrhoea for the last 3 days and it's been affecting me, I need to stay close to the toilet and yeah it's been affecting my day-to-day activities.\n  I'm sorry to hear that. And when you say diarrhoea, what do you mean by diarrhoea? Do you mean you're going to the toilet more often or are your stools more loose?\n  Yeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my... Like lower stomach.\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n  Probably like 6-7 times a day. 6-7 times a day.\n  And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n  No, no blood. Yeah, just watery and loose stool.\n  Okay. And you mentioned you've had some pain in your tummy as well.\n  Yep.\n  Whereabouts was the pain, exactly?\n  In my lower abdomen. So, like, yeah, just to one side. One side, and what side is that? On the left side.\n  Left side, okay. And can you describe the pain to me?\n  Yeah, it feels like a cramp, like a muscular cramp, and yeah, I feel a bit weak and shaky.\n  Okay, and does the pain, is it there all the time, or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\n  No, just mainly my stomach. Okay, fine.\n  And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, have you been feeling feverish, for example?\n  Yeah, it doesn't feel like, yeah, I just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so yeah, around about 3 or 4 days ago.\n  Did you measure your temperature then?\n  Yeah, I didn't measure my temperature, no, but I felt just a bit hot.\n  Okay, okay. Any other symptoms like sweating or night? No. And any vomiting at all?\n  Yeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\n  You've stopped vomiting, okay. And was your vomit, I know it's not nice to talk about, but was it just normal food color?\n  Yeah, yeah, just normal vomit, yeah. And there was no blood in your vomit, is that right? No blood, no. No, okay.\n  And any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhoea, you mentioned vomiting. Anything else that comes to mind?\n  I had a loss of appetite, so I haven't been eating as much, but I've been able to hold down fluids.\n  Okay, so you're drinking fluids. What kind of foods have you managed to eat, anything?\n  Um, just soups and, uh, yeah, light foods like smoothies and, yeah, liquid foods mainly. Okay, fine.\n  Um, and so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused your symptoms to kick on? So, for example, things like takeaway foods or eating out or beating around other people with similar symptoms?\n  Yeah, so I had takeaway about 4 days ago, um, but other than that I've... Yeah, been eating normally. Nothing unusual, yeah.\n  Do you remember what you ate?\n  Yeah, I ate at a Chinese restaurant with friends.\n  Okay. Anyone else on well with similar symptoms?\n  So, no one else in the family, so I have a wife and 2 kids and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n  Okay, okay, fine. Right, and in terms of your overall health, are you normally fitting well?\n  Yeah, I mean other than asthma, I use an inhaler, everything else is fine.\n  Okay, and is your asthma well controlled?\n  Yeah, that's fine, I just use an inhaler and that's under control.\n  Fine, and you don't have any other tummy problems, bowel problems I should be aware of?\n  No.\n  No, okay. Apart from inhalers, do you take any other medications?\n  No, no other medications.\n  Okay, fine. In terms of just your day-to-day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\n  So I need to stay close to the toilet because I go quite frequently during these past 3 days. Okay. Yeah, other than that, it's, yeah, the main concern.\n  And are you currently working at the moment?\n  Yes, yeah, I work. What do you do for work? I'm an accountant.\n  Okay, have you been going into work the last 3 days or have you been at home?\n  Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult.\n  Right, and you mentioned you live with a wife and 2 children, is that right?\n  Yes, yeah.\n  Alright, just a couple of other questions we need to ask. Do you smoke at all?\n  No, I don't smoke.\n  And do you drink much and aware of alcohol?\n  No, I don't drink alcohol, no.\n  Okay, so normally at this stage I like to examine you, but having listened to your story, sir, I think just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side. and vomiting and being generally quite weak and lethargic. You mentioned you were having this Chinese takeaway as well 3 days ago and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or infection of your tummy, mainly caused by viruses but there can be a possibility of bacteria causing your symptoms. At this stage, what we recommend is just what we say conservative management, so I don't think you need anything like antibiotics, it's really just making sure you're well hydrated, drinking fluids. There are things like diuralite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that in the 1st couple of days. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work actually, I know you're quite keen to work. I would say next 2 to 3 days action clears from your system, take some time off and rest. If your symptoms haven't got better in 3 to 4 days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool, so we can test that, etc., etc. Yeah, sure, yeah. How does that sound? That sounds great, yeah, yeah. Do you have any questions for me? Um, no, no further questions, sir. Okay, is the treatment plan clear? Uh, yeah, yeah, that's very clear, thank you. Great, well I wish you all the best. Okay, thank you. Thank you. Bye.","marks":[{"start":5,"end":5,"said":"Hi. Um should we start Yeah okay. Hello how um. Good morning sir","significant":false},{"start":38,"end":38,"said":"Hello how are you Oh hey um","significant":false},{"start":61,"end":70,"said":"diarrhea","significant":false},{"start":211,"end":214,"said":"","significant":false},{"start":252,"end":270,"said":"diarrhea what'd","significant":false},{"start":283,"end":292,"said":"diarrhea","significant":false},{"start":558,"end":562,"said":"in","significant":false},{"start":604,"end":607,"said":"six or seven","significant":false},{"start":621,"end":624,"said":"Yeah. Six seven","significant":false},{"start":648,"end":657,"said":"mention","significant":false},{"start":863,"end":867,"said":"","significant":false},{"start":903,"end":903,"said":"Yep. So","significant":false},{"start":938,"end":942,"said":"um...yeah","significant":false},{"start":1174,"end":1178,"said":"is","significant":false},{"start":1257,"end":1257,"said":"Come and go.","significant":false},{"start":1326,"end":1328,"said":"Uh...no","significant":false},{"start":1335,"end":1341,"said":"maybe","significant":false},{"start":1583,"end":1589,"said":"makes me","significant":false},{"start":1737,"end":1740,"said":"","significant":false},{"start":1793,"end":1800,"said":"mention","significant":false},{"start":1847,"end":1847,"said":"And y'know.","significant":false},{"start":1903,"end":1903,"said":"sweats","significant":false},{"start":1932,"end":1932,"said":"Uh no.","significant":false},{"start":2018,"end":2024,"said":"You","significant":false},{"start":2089,"end":2089,"said":"thing","significant":false},{"start":2133,"end":2171,"said":"colour","significant":false},{"start":2230,"end":2230,"said":"Yeah yeah just normal vomit yeah. No","significant":false},{"start":2261,"end":2261,"said":"um any","significant":false},{"start":2332,"end":2341,"said":"diarrhea","significant":false},{"start":2356,"end":2356,"said":"your","significant":false},{"start":2399,"end":2399,"said":"Yep. Um","significant":false},{"start":2580,"end":2580,"said":"if","significant":false},{"start":2590,"end":2590,"said":"Yep.","significant":false},{"start":2705,"end":2711,"said":"sir these","significant":false},{"start":2798,"end":2802,"said":"the","significant":false},{"start":2841,"end":2847,"said":"think","significant":false},{"start":2885,"end":2892,"said":"being","significant":false},{"start":3057,"end":3062,"said":"here. Okay.","significant":false},{"start":3081,"end":3085,"said":"where","significant":false},{"start":3167,"end":3174,"said":"unwell","significant":false},{"start":3234,"end":3240,"said":"","significant":false},{"start":3377,"end":3382,"said":"Um alright.","significant":false},{"start":3399,"end":3399,"said":"your","significant":false},{"start":3438,"end":3445,"said":"fit and","significant":false},{"start":3450,"end":3450,"said":"Or uh Um","significant":false},{"start":3478,"end":3484,"said":"um athsma um","significant":false},{"start":3556,"end":3571,"said":"well-controlled Uh","significant":false},{"start":3685,"end":3693,"said":"problem","significant":false},{"start":4018,"end":4025,"said":"'cause","significant":false},{"start":4138,"end":4138,"said":"have you","significant":false},{"start":4201,"end":4224,"said":"er. Um","significant":false},{"start":4244,"end":4244,"said":"Would would work.","significant":false},{"start":4357,"end":4357,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":4401,"end":4441,"said":"fine.","significant":false},{"start":4446,"end":4446,"said":"you said","significant":false},{"start":4475,"end":4476,"said":"your","significant":false},{"start":4560,"end":4569,"said":"question","significant":false},{"start":4585,"end":4585,"said":"sir. Um","significant":false},{"start":4652,"end":4661,"said":"in the way","significant":false},{"start":4762,"end":4762,"said":"if that's okay but um um but","significant":false},{"start":4957,"end":4972,"said":"fever and you're","significant":false},{"start":5017,"end":5028,"said":"had","significant":false},{"start":5054,"end":5058,"said":"little as","significant":false},{"start":5076,"end":5082,"said":"wondered","significant":false},{"start":5258,"end":5258,"said":"uh of your","significant":false},{"start":5342,"end":5346,"said":"its","significant":false},{"start":5377,"end":5379,"said":"what we'd","significant":false},{"start":5555,"end":5555,"said":"Mm-hmm. Um","significant":false},{"start":5578,"end":5587,"said":"Dioralyte","significant":true},{"start":5624,"end":5624,"said":"uh it's um it helps","significant":false},{"start":5641,"end":5648,"said":"","significant":false},{"start":5756,"end":5759,"said":"first you know first","significant":false},{"start":5775,"end":5775,"said":"Yep.","significant":false},{"start":5812,"end":5812,"said":"eh","significant":false},{"start":5909,"end":5909,"said":"Yep.","significant":false},{"start":5912,"end":5917,"said":"will","significant":false},{"start":6026,"end":6026,"said":"two","significant":false},{"start":6039,"end":6045,"said":"as the infection","significant":false},{"start":6099,"end":6099,"said":"Okay. Yeah. Um I'll admit","significant":false},{"start":6135,"end":6135,"said":"you know in","significant":false},{"start":6169,"end":6173,"said":"","significant":false},{"start":6262,"end":6269,"said":"","significant":false},{"start":6285,"end":6292,"said":"caused your","significant":false},{"start":6303,"end":6308,"said":"Yep. Uh","significant":false},{"start":6403,"end":6418,"said":"Um etcetera etcetera. Yep","significant":false},{"start":6426,"end":6440,"said":"yep. How's","significant":false},{"start":6548,"end":6552,"said":"no.","significant":false},{"start":6598,"end":6602,"said":"that's","significant":false},{"start":6687,"end":6687,"said":"Bye.","significant":false},{"start":6703,"end":6703,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Captures 3 days of loose, watery stools 6-7 times daily with no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Captures intermittent cramping left lower abdominal pain that does not radiate."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved, 'normal in color with no blood'."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Asthma and inhaler captured, but controlled status and absence of other medications are not stated."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Records needing to stay close to a toilet and difficulty/disruption with work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[["Symptoms began approximately 4 days after consuming Chinese takeaway food.","Transcript places the takeaway about four days ago and symptom onset about three days ago; nothing supports a four-day gap between eating and onset."]],"note":"Subjective\nCliniTech Benchmark 7924d758, a patient with a history of asthma, presents with a 3-day history of diarrhea, abdominal pain, and weakness.\n\nThe patient reports loose, watery stools occurring approximately 6-7 times per day for the past 3 days. He describes associated lower abdominal pain on the left side, characterized as a cramp-like, muscular sensation that is intermittent and does not radiate. He denies any blood in the stool. He reports feeling weak and shaky, and notes he felt feverish at the onset of symptoms approximately 3-4 days ago, though he did not measure his temperature at that time. He denies current fever, night sweats, or vomiting, though he did vomit at the start of his symptoms with normal-colored vomit and no blood. He reports loss of appetite and has been eating light foods such as soups and smoothies, and has been able to tolerate fluids.\n\nThe patient suspects a possible trigger of eating Chinese takeaway approximately 4 days ago. One of his children has been vomiting but has not had diarrhea, and no other family members have similar symptoms. The patient reports the diarrhea has significantly affected his day-to-day activities, requiring him to stay close to a toilet, and he has continued going to work as an accountant despite his symptoms.\n\nMedical History  \n- Asthma\n\nMedications and Supplements  \n- Inhaler for asthma\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: Does not drink alcohol  \n- Occupation: Works as an accountant\n\nReview of Systems  \n- General: Subjective fever at onset, decreased appetite, denies night sweats  \n- Gastrointestinal: Denies blood in stool, current vomiting\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 3-day history of diarrhea, abdominal pain, and weakness, likely secondary to gastroenteritis.\n\nGastroenteritis  \nAssessment: Patient presents with acute gastroenteritis characterized by loose, watery stools 6-7 times daily for 3 days, left lower abdominal cramping pain, initial vomiting that has resolved, weakness, and subjective fever at symptom onset. Symptoms began approximately 4 days after consuming Chinese takeaway food. No blood in stool or vomit. One child in household had vomiting but no diarrhea. Patient has been able to maintain fluid intake and consume light foods like soups and smoothies. Clinical presentation is consistent with viral gastroenteritis, though bacterial etiology cannot be ruled out given the food exposure history.  \nPlan:  \n- Conservative management with focus on hydration and rest  \n- Maintain adequate fluid intake  \n- Consider oral rehydration solutions like Diuralyte from pharmacy to replenish minerals and vitamins  \n- Paracetamol 2 tablets up to four times daily for fever and weakness as needed  \n- Take time off work for next 2-3 days until symptoms resolve  \n- Return for reassessment if symptoms persist beyond 3-4 days  \n- If symptoms ongoing, further evaluation may include stool sample testing\n","review":186.80263157894737,"saved":196.19736842105263,"clean":false,"effort":19.230769230769234,"sig":[],"mb":14.173378,"latency":55.895,"signable":230.44763157894738},{"label":"Run 5","wer":21.141649048625794,"text":"Hello, how can I help you this morning?\n  I've just had some diarrhoea for the last 3 days and it's been affecting me, I need to stay close to the toilet and yeah it's been affecting my day-to-day activities.\n  I'm sorry to hear that. And when you say diarrhoea, what do you mean by diarrhoea? Do you mean you're going to the toilet more often or are your stools more loose?\n  Yeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my... Like lower stomach.\n  Okay. And how many times a day are you going, let's say, over the last couple of days?\n  Probably like 6-7 times a day. 6-7 times a day.\n  And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools?\n  No, no blood. Yeah, just watery and loose stool.\n  Okay. And you mentioned you've had some pain in your tummy as well.\n  Yep.\n  Whereabouts was the pain, exactly?\n  In my lower abdomen. So, like, yeah, just to one side. One side, and what side is that? On the left side.\n  Left side, okay. And can you describe the pain to me?\n  Yeah, it feels like a cramp, like a muscular cramp, and yeah, I feel a bit weak and shaky.\n  Okay, and does the pain, is it there all the time, or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\n  No, just mainly my stomach. Okay, fine.\n  And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, have you been feeling feverish, for example?\n  Yeah, it doesn't feel like, yeah, I just mainly feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so yeah, around about 3 or 4 days ago.\n  Did you measure your temperature then?\n  Yeah, I didn't measure my temperature, no, but I felt just a bit hot.\n  Okay, okay. Any other symptoms like sweating or night? No. And any vomiting at all?\n  Yeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\n  You've stopped vomiting, okay. And was your vomit, I know it's not nice to talk about, but was it just normal food color?\n  Yeah, yeah, just normal vomit, yeah. And there was no blood in your vomit, is that right? No blood, no. No, okay.\n  And any other symptoms at all? So you mentioned tummy pain, you mentioned diarrhoea, you mentioned vomiting. Anything else that comes to mind?\n  I had a loss of appetite, so I haven't been eating as much, but I've been able to hold down fluids.\n  Okay, so you're drinking fluids. What kind of foods have you managed to eat, anything?\n  Um, just soups and, uh, yeah, light foods like smoothies and, yeah, liquid foods mainly. Okay, fine.\n  Um, and so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused your symptoms to kick on? So, for example, things like takeaway foods or eating out or beating around other people with similar symptoms?\n  Yeah, so I had takeaway about 4 days ago, um, but other than that I've... Yeah, been eating normally. Nothing unusual, yeah.\n  Do you remember what you ate?\n  Yeah, I ate at a Chinese restaurant with friends.\n  Okay. Anyone else on well with similar symptoms?\n  So, no one else in the family, so I have a wife and 2 kids and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\n  Okay, okay, fine. Right, and in terms of your overall health, are you normally fitting well?\n  Yeah, I mean other than asthma, I use an inhaler, everything else is fine.\n  Okay, and is your asthma well controlled?\n  Yeah, that's fine, I just use an inhaler and that's under control.\n  Fine, and you don't have any other tummy problems, bowel problems I should be aware of?\n  No.\n  No, okay. Apart from inhalers, do you take any other medications?\n  No, no other medications.\n  Okay, fine. In terms of just your day-to-day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\n  So I need to stay close to the toilet because I go quite frequently during these past 3 days. Okay. Yeah, other than that, it's, yeah, the main concern.\n  And are you currently working at the moment?\n  Yes, yeah, I work. What do you do for work? I'm an accountant.\n  Okay, have you been going into work the last 3 days or have you been at home?\n  Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult.\n  Right, and you mentioned you live with a wife and 2 children, is that right?\n  Yes, yeah.\n  Alright, just a couple of other questions we need to ask. Do you smoke at all?\n  No, I don't smoke.\n  And do you drink much and aware of alcohol?\n  No, I don't drink alcohol, no.\n  Okay, so normally at this stage I like to examine you, but having listened to your story, sir, I think just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left-hand side. and vomiting and being generally quite weak and lethargic. You mentioned you were having this Chinese takeaway as well 3 days ago and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or infection of your tummy, mainly caused by viruses but there can be a possibility of bacteria causing your symptoms. At this stage, what we recommend is just what we say conservative management, so I don't think you need anything like antibiotics, it's really just making sure you're well hydrated, drinking fluids. There are things like diuralite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that in the 1st couple of days. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time off work actually, I know you're quite keen to work. I would say next 2 to 3 days action clears from your system, take some time off and rest. If your symptoms haven't got better in 3 to 4 days, I'd like to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool, so we can test that, etc., etc. Yeah, sure, yeah. How does that sound? That sounds great, yeah, yeah. Do you have any questions for me? Um, no, no further questions, sir. Okay, is the treatment plan clear? Uh, yeah, yeah, that's very clear, thank you. Great, well I wish you all the best. Okay, thank you. Thank you. Bye.","marks":[{"start":5,"end":5,"said":"Hi. Um should we start Yeah okay. Hello how um. Good morning sir","significant":false},{"start":38,"end":38,"said":"Hello how are you Oh hey um","significant":false},{"start":61,"end":70,"said":"diarrhea","significant":false},{"start":211,"end":214,"said":"","significant":false},{"start":252,"end":270,"said":"diarrhea what'd","significant":false},{"start":283,"end":292,"said":"diarrhea","significant":false},{"start":558,"end":562,"said":"in","significant":false},{"start":604,"end":607,"said":"six or seven","significant":false},{"start":621,"end":624,"said":"Yeah. Six seven","significant":false},{"start":648,"end":657,"said":"mention","significant":false},{"start":863,"end":867,"said":"","significant":false},{"start":903,"end":903,"said":"Yep. 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Um I'll admit","significant":false},{"start":6135,"end":6135,"said":"you know in","significant":false},{"start":6169,"end":6173,"said":"","significant":false},{"start":6262,"end":6269,"said":"","significant":false},{"start":6285,"end":6292,"said":"caused your","significant":false},{"start":6303,"end":6308,"said":"Yep. Uh","significant":false},{"start":6403,"end":6418,"said":"Um etcetera etcetera. Yep","significant":false},{"start":6426,"end":6440,"said":"yep. How's","significant":false},{"start":6548,"end":6552,"said":"no.","significant":false},{"start":6598,"end":6602,"said":"that's","significant":false},{"start":6687,"end":6687,"said":"Bye.","significant":false},{"start":6703,"end":6703,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Captures 3 days of loose, watery stools 6-7 times daily with no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","Captures intermittent cramping left lower abdominal pain that does not radiate."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved, 'normal in color with no blood'."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Asthma and inhaler captured, but controlled status and absence of other medications are not stated."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Records needing to stay close to a toilet and difficulty/disruption with work."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[["Symptoms began approximately 4 days after consuming Chinese takeaway food.","Transcript places the takeaway about four days ago and symptom onset about three days ago; nothing supports a four-day gap between eating and onset."]],"note":"Subjective\nCliniTech Benchmark 45a197cb, a patient with a history of asthma, presents with a 3-day history of diarrhea, abdominal pain, and weakness.\n\nThe patient reports loose, watery stools occurring approximately 6-7 times per day for the past 3 days. The diarrhea has been accompanied by left lower abdominal cramping pain that is intermittent in nature and does not radiate. He denies any blood in the stools. He also reports an episode of vomiting at the onset of symptoms, which has since resolved. The vomit was normal in color with no blood. The patient reports feeling weak and shaky, and he felt feverish at the onset of symptoms approximately 3-4 days ago, though he did not measure his temperature at that time. He denies night sweats and current fever. He has experienced a loss of appetite and has been eating light foods such as soups and smoothies, and has been able to tolerate fluids.\n\nThe patient suspects the symptoms may have been triggered by a Chinese takeaway meal approximately 4 days ago. One of his children has been vomiting but has not developed diarrhea, and no other family members have similar symptoms. The patient reports the diarrhea has significantly affected his day-to-day activities, requiring him to stay close to a toilet. He has continued to go to work as an accountant over the past 3 days despite his symptoms.\n\nMedical History  \n- Asthma\n\nMedications and Supplements  \n- Inhaler for asthma\n\nSocial History  \n- Tobacco: Denies tobacco use  \n- Alcohol: Denies alcohol use  \n- Occupation: Works as an accountant\n\nReview of Systems  \n- General: Subjective fever at onset, decreased appetite, denies night sweats  \n- Gastrointestinal: Denies blood in stools, blood in vomit\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with 3-day history of diarrhea, abdominal cramping, and weakness following consumption of Chinese takeaway food.\n\nGastroenteritis  \nAssessment: Patient presents with acute gastroenteritis characterized by loose watery stools 6-7 times daily, left lower abdominal cramping pain, and weakness over 3 days. Initial vomiting has resolved. Symptoms began approximately 4 days after consuming Chinese takeaway food. One child in the household has vomiting but no diarrhea. No blood in stool or vomit. Patient reports subjective fever at symptom onset but no current fever. Able to tolerate fluids and light foods such as soups and smoothies. Clinical presentation is consistent with viral gastroenteritis, though bacterial etiology cannot be excluded given the food exposure history.  \nPlan:  \n- Conservative management with focus on hydration and rest  \n- Maintain adequate fluid intake  \n- Consider oral rehydration solutions such as Diuralyte from pharmacy to replenish minerals and vitamins  \n- Paracetamol 2 tablets up to 4 times daily for fever and weakness as needed  \n- Take time off work for next 2-3 days until symptoms resolve  \n- Return for reassessment if symptoms persist beyond 3-4 days  \n- If ongoing symptoms, further evaluation may include stool sample testing\n","review":192.48684210526315,"saved":190.51315789473685,"clean":false,"effort":19.230769230769234,"sig":[],"mb":14.366436,"latency":54.204,"signable":231.59684210526314}],"cliniscripts":[{"label":"Run 1","wer":16.842847075405214,"text":"Hello. Hello, how are you? Hi. Um, should we start? Yeah. Yeah, okay.\nHello, um, good morning.\nSo how can I help you this morning? Hi. Um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities. Okay. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool, going to the toilet quite often.\nOkay. Um, and like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Um, probably like 6 or 7 times a day. 6 or 7 times a day. And you may have mentioned this is mainly watery. Have you noticed any other things, like blood in your stools? No, no blood. Yeah, just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yeah. Whereabouts is the pain exactly? So it's like in my lower abdomen, so, uh,\nlike, um, yeah, just to one side. One side. And what side is that? Uh, on the left side. Left side. Okay. And can you describe the pain to me?\nYeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? Uh, it comes and goes.\nComes and go. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well.\nWhat do you mean by shaky? Do you mean you've been having uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so um, yeah, around about 3 or 4 days ago.\nDid you measure your temperature then?\nYeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. And, yeah. Any other symptoms, like sweating or, um, night? Um, no. No? And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food colour? Yeah, yeah, just normal vomit. Yeah.\nYeah. And there was no blood in your vomit. Is that right? No blood, no. No. Okay.\nUm. Yeah. And, um, a-any other symptoms at all? So you mentioned the tummy pain. You mentioned diarrhea. You mentioned the vomiting. Um. Yeah. Anything else that comes to mind? Um, I had a loss of appetite. Okay. Um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat? Anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine.\nUm, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would simulate symptoms? Yeah, so I had takeaway about 4 days ago. Um, uh, but other than that, I've yeah, I've been eating normally. Okay. I think, I think, uh, unusual, yeah. Do you remember what you ate? Um, yeah, I, I ate at a Chinese restaurant with friends. Okay. Anyone\nelse unwell with similar symptoms?\nUm, so no one else in the family, so I, uh, wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay.\nFine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler. Everything, uh, else is fine. Okay. And does your asthma well controlled?\nUh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No, no. No. Okay. Um, and apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay.\nFine. And in terms of just your, your day-to-day life, you said it's been affecting your life.\nUm. Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days. Okay. Um, yeah, other than that, it's, uh, yeah, the main concern. Yeah. And have you are you currently working at the moment? Uh, yes, yeah, I, I work, um. Working at the work?\nUm, I'm an accountant.\nOkay. Have you been going into work the last 3 days? Have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. Right. And you said you mentioned you live with a wife and two children. Is that right? Yes, yeah. Okay. All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\nUh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um. Yeah. But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, uh, um, and some vomiting and feeling generally quite weak and lethargic. Yeah. Um, you mentioned you're having this Chinese takeaway\nas well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something called gastroenteritis.\nOkay. Which essentially just, uh, tummy bug or infection of your of your tummy. Uh. Yeah.\nMainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms. Yeah. Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Yeah. Um, uh, there are things like diurolite you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins. Ok\nay. Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days. Yeah. Um, if you are feeling feverish and weak, taking some paracetamol, uh. Yeah. Two tablets up to 4 times a day for the first few days can also help.\nI would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms. Yeah. Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Yeah. Um, etc., etc. Yeah, sure, yeah.\nHow does that sound? That sounds great, yeah, yeah. Do you have any questions for me?\nUm, no, no further questions, no. Okay.\nIs it is the treatment plan clear?\nUh, yeah, yeah, that's, that's very clear, thank you. Great. Well, I wish you all the best.","marks":[{"start":7,"end":25,"said":"","significant":false},{"start":75,"end":75,"said":"how","significant":false},{"start":95,"end":97,"said":"sir","significant":false},{"start":131,"end":134,"said":"Hello how are you Oh hey","significant":false},{"start":321,"end":330,"said":"","significant":false},{"start":382,"end":389,"said":"what'd","significant":false},{"start":684,"end":688,"said":"in","significant":false},{"start":754,"end":756,"said":"","significant":false},{"start":780,"end":806,"said":"mention it's","significant":false},{"start":1038,"end":1038,"said":"Yep.","significant":false},{"start":1043,"end":1052,"said":"","significant":false},{"start":1340,"end":1344,"said":"is","significant":false},{"start":1435,"end":1440,"said":"Come","significant":false},{"start":1515,"end":1521,"said":"Uh...no","significant":false},{"start":1528,"end":1537,"said":"maybe","significant":false},{"start":1768,"end":1770,"said":"--","significant":false},{"start":1785,"end":1791,"said":"makes me","significant":false},{"start":1952,"end":1955,"said":"","significant":false},{"start":2009,"end":2016,"said":"mention","significant":false},{"start":2068,"end":2068,"said":"And y'know.","significant":false},{"start":2141,"end":2148,"said":"sweats","significant":false},{"start":2181,"end":2181,"said":"Uh no.","significant":false},{"start":2273,"end":2279,"said":"You","significant":false},{"start":2343,"end":2343,"said":"thing","significant":false},{"start":2395,"end":2431,"said":"","significant":false},{"start":2489,"end":2489,"said":"Yeah yeah just normal vomit yeah. No","significant":false},{"start":2534,"end":2539,"said":"any any","significant":false},{"start":2634,"end":2637,"said":"your","significant":false},{"start":2690,"end":2690,"said":"Yep.","significant":false},{"start":2901,"end":2901,"said":"if","significant":false},{"start":2911,"end":2911,"said":"Yep.","significant":false},{"start":3023,"end":3034,"said":"sir these","significant":false},{"start":3120,"end":3124,"said":"the","significant":false},{"start":3171,"end":3177,"said":"think","significant":false},{"start":3241,"end":3259,"said":"with similar","significant":false},{"start":3352,"end":3356,"said":"","significant":false},{"start":3379,"end":3405,"said":"Nothing","significant":false},{"start":3416,"end":3421,"said":"here. Okay.","significant":false},{"start":3438,"end":3442,"said":"where","significant":false},{"start":3744,"end":3750,"said":"alright.","significant":false},{"start":3816,"end":3823,"said":"fit and","significant":false},{"start":3868,"end":3874,"said":"athsma","significant":false},{"start":3938,"end":3942,"said":"is","significant":false},{"start":4104,"end":4112,"said":"problem","significant":false},{"start":4151,"end":4153,"said":"","significant":false},{"start":4306,"end":4321,"said":"day to day","significant":false},{"start":4465,"end":4472,"said":"'cause","significant":false},{"start":4679,"end":4702,"said":"er.","significant":false},{"start":4726,"end":4726,"said":"Would would work.","significant":false},{"start":4778,"end":4778,"said":"or","significant":false},{"start":4837,"end":4837,"said":"Yeah. Yeah it's been quite difficult.","significant":false},{"start":4881,"end":4920,"said":"fine.","significant":false},{"start":4962,"end":4963,"said":"your","significant":false},{"start":5013,"end":5022,"said":"","significant":false},{"start":5029,"end":5029,"said":"alright.","significant":false},{"start":5057,"end":5066,"said":"question","significant":false},{"start":5083,"end":5085,"said":"sir.","significant":false},{"start":5266,"end":5269,"said":"I","significant":false},{"start":5363,"end":5374,"said":"story sir","significant":false},{"start":5532,"end":5536,"said":"","significant":false},{"start":5550,"end":5567,"said":"fever and you're","significant":false},{"start":5618,"end":5631,"said":"you had","significant":false},{"start":5657,"end":5661,"said":"little as","significant":false},{"start":5680,"end":5686,"said":"wondered","significant":false},{"start":5928,"end":5930,"said":"there","significant":false},{"start":5980,"end":5984,"said":"its","significant":false},{"start":6035,"end":6044,"said":"we'd","significant":false},{"start":6226,"end":6235,"said":"","significant":false},{"start":6244,"end":6249,"said":"Mm-hmm.","significant":false},{"start":6280,"end":6289,"said":"Dioralyte","significant":true},{"start":6351,"end":6353,"said":"helps","significant":false},{"start":6364,"end":6371,"said":"","significant":false},{"start":6400,"end":6406,"said":"Okay.","significant":false},{"start":6464,"end":6473,"said":"say","significant":false},{"start":6531,"end":6539,"said":"Yep.","significant":false},{"start":6577,"end":6577,"said":"eh","significant":false},{"start":6683,"end":6683,"said":"Yep.","significant":false},{"start":6686,"end":6691,"said":"will","significant":false},{"start":6914,"end":6922,"said":"I'll admit","significant":false},{"start":7012,"end":7016,"said":"","significant":false},{"start":7025,"end":7027,"said":"you","significant":false},{"start":7104,"end":7111,"said":"","significant":false},{"start":7127,"end":7134,"said":"caused","significant":false},{"start":7150,"end":7155,"said":"Yep.","significant":false},{"start":7267,"end":7282,"said":"etcetera etcetera. Yep","significant":false},{"start":7290,"end":7304,"said":"yep. How's","significant":false},{"start":7548,"end":7548,"said":"Okay thank you. Bye. Thank you. Bye bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","Captures 3 days of loose watery stools 6-7 times daily but omits that there was no blood in the stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"crampy, muscular sensation, localized to the left side... intermittent... does not radiate\"."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","partial","Notes vomiting at onset \"which has since resolved\" but omits no blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"felt hot approximately 3-4 days ago when symptoms began, though no temperature was measured\" plus weak and shaky; no measured temp asserted."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, light foods (soups, smoothies), able to tolerate fluids."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway 4 days prior and a household child with vomiting but no diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"well-controlled asthma, managed with an inhaler, and takes no other medications\"."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"significantly affects their day-to-day activities and requires them to stay close to a toilet\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Gastroenteritis, likely viral or bacterial\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and ORS (misspelt \"Diurolite\"), but does not state that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"paracetamol (two tablets up to four times daily)\" with no invented mg strength."],["The plan captures rest and approximately two to three days off work.","yes","\"Recommend 2-3 days of rest and time off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return if no improvement within 3-4 days with potential stool sample testing."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 3-day history of diarrhea, experiencing loose and watery stools 6-7 times daily, which significantly affects their day-to-day activities and requires them to stay close to a toilet.\n- They report associated lower abdominal pain, described as a crampy, muscular sensation, localized to the left side of the abdomen. The pain is intermittent, coming and going, and does not radiate.\n- Patient also reports feeling weak and shaky, along with a loss of appetite. They experienced vomiting at the onset of symptoms, which has since resolved, and felt hot approximately 3-4 days ago when symptoms began, though no temperature was measured.\n- They have been consuming only light foods, such as soups and smoothies, but have been able to tolerate fluids.\n- Patient suspects a Chinese takeaway eaten 4 days prior as a potential trigger; a child in their household recently experienced vomiting but no diarrhea. Patient has a history of well-controlled asthma, managed with an inhaler, and takes no other medications. They do not smoke or drink alcohol.\n\nO (Objective):\n- The patient appeared cooperative during the interaction.\n- The patient reports being able to go to work despite symptoms.\n\nA (Assessment):\n- Gastroenteritis, likely viral or bacterial, possibly related to a recent Chinese takeaway.\n- Potential dehydration due to vomiting and diarrhea.\n\nP (Plan):\n- Conservative management for suspected gastroenteritis.\n- Encourage strict hydration with plenty of fluids, including oral rehydration solutions (e.g., Diurolite) to replenish minerals and vitamins.\n- Advise paracetamol (two tablets up to four times daily) for feverishness and weakness, if present.\n- Recommend 2-3 days of rest and time off work to allow for recovery.\n- If symptoms do not improve within 3-4 days or worsen, patient is advised to return for further evaluation and potential stool sample testing.\n","review":148.9736842105263,"saved":234.0263157894737,"clean":false,"effort":11.538461538461538,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Omits the stated absence of blood in stool, a red-flag negative that steers infective diarrhoea workup and antibiotic decisions."],["partial","The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","Omits the stated absence of blood in vomit, a red-flag negative for haematemesis."]],"mb":23.139986,"latency":22.846,"signable":160.0066842105263},{"label":"Run 2","wer":16.49048625792812,"text":"Hello. Hello, how are you? Hi. Um, should we start? Yeah. Yeah, okay.\nHello, h um, good morning.\nSo how can I help you this morning? Hi. Um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities. Okay. I'm sorry to hear that. Um, and, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool, going to the toilet quite often.\nOkay. Um, and like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Um, probably like 6 or 7 times a day. 6, 7 times a day. And you made you mentioned this is mainly watery. Have you noticed any other things, like blood in your stools? No, no blood. Yeah, just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yeah. Whereabouts is the pain exactly? So it's like in my lower abdomen, so, uh,\nlike um, yeah, just to one side. One side. And what side is that? Uh, on the left side. Left side. Okay. And can you describe the pain to me?\nYeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? Uh, it comes and goes.\nComes and go. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well.\nWhat do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so um, yeah, around about 3 or 4 days ago.\nDid you measure your temperature then?\nYeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. And, yeah. Any other symptoms, like sweating or, um, night? Um, no. No? And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food colour? Yeah, yeah, just normal vomit. Yeah.\nYeah. And there was no blood in your vomit. Is that right? No blood, no. No. Okay.\nUm. Yeah. And, um, a-any other symptoms at all? So you mentioned the tummy pain. You mentioned diarrhea. You mentioned your vomiting. Um. Yeah. Anything else that comes to mind? Um, I had a loss of appetite. Okay. Um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat, if anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine.\nUm, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused the symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would sing the symptoms? Yeah, so I had takeaway about 4 days ago. Um, uh, but other than that, I've yeah, I've been uh, eating normally. Okay. I think, I think, uh, unusual, yeah. Do you remember what you ate? Um, yeah, I, I ate at a Chinese restaurant with friends. Okay. Anyone\nelse unwell with similar symptoms?\nUm, so no one else in the family, so I, uh, wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay.\nFine. Um, right. And, uh, in terms of your, your overall health, are you normally feeling well, or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine. Okay. And does your asthma well controlled?\nUh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No.\nNo. Okay. Um, and apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay.\nFine. And in terms of just your, your day-to-day life, you said it's been affecting your life.\nUm. Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days. Okay. Um, yeah, other than that, it's, uh, yeah, the main concern. Yeah. And have you are you currently working at the moment? Uh, yes. Yeah, I, I work, um. Working at the work?\nUm, I'm an accountant.\nOkay. Have you been going into work the last 3 days, or have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. All right. And you said you mentioned you live with a wife and two children. Is that right? Yes, yeah. Okay. All right.\nUm, just a couple of other questions we need to ask. So, um, do you smoke at all?\nUh, no, I don't smoke. And do you drink much in a way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um. Yeah. But, but having listened to your stories, uh, I think, uh, um, just to recap, you for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, uh, um, and some vomiting and feeling generally quite weak and lethargic. Um.\nYeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something uh, called gastroenteritis.\nOkay. Which essentially just, uh, tummy bug or infection of your of your tummy. Uh. Yeah.\nMainly caused by viruses, but it can be, uh, possibly of bacteria, uh, causing your symptoms. Yeah. Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, uh, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Um, uh, th-there are things like diurolite you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins. Okay. Um, and if you are having vomiting and diarrhe\na, I would certainly recommend that in the first you know, first couple of days. Yeah. Um, if you are feeling feverish and weak, you're taking some paracetamol, uh. Yeah. Just 2 tablets up to 4 times a day for the first few days can also help.\nI would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms. Yeah. Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc. Yeah, sure, yeah.\nHow does that sound? That sounds great, yeah, yeah. Do you have any questions for me?\nUm, no, no further questions, no. Okay.\nIs it is the treatment plan clear?\nUh, yeah, yeah, that's, that's very clear, thank you. Great. Well, I wish you all the best.","marks":[{"start":7,"end":25,"said":"","significant":false},{"start":77,"end":78,"said":"how","significant":false},{"start":97,"end":99,"said":"sir","significant":false},{"start":133,"end":136,"said":"Hello how are you Oh hey","significant":false},{"start":323,"end":332,"said":"","significant":false},{"start":389,"end":396,"said":"what'd","significant":false},{"start":691,"end":695,"said":"in","significant":false},{"start":785,"end":811,"said":"mention it's","significant":false},{"start":1043,"end":1043,"said":"Yep.","significant":false},{"start":1048,"end":1057,"said":"","significant":false},{"start":1344,"end":1348,"said":"is","significant":false},{"start":1439,"end":1444,"said":"Come","significant":false},{"start":1519,"end":1525,"said":"Uh...no","significant":false},{"start":1532,"end":1541,"said":"maybe","significant":false},{"start":1773,"end":1775,"said":"--","significant":false},{"start":1790,"end":1796,"said":"makes me","significant":false},{"start":1957,"end":1960,"said":"","significant":false},{"start":2014,"end":2021,"said":"mention","significant":false},{"start":2073,"end":2073,"said":"And y'know.","significant":false},{"start":2146,"end":2153,"said":"sweats","significant":false},{"start":2186,"end":2186,"said":"Uh no.","significant":false},{"start":2278,"end":2284,"said":"You","significant":false},{"start":2348,"end":2348,"said":"thing","significant":false},{"start":2400,"end":2436,"said":"","significant":false},{"start":2494,"end":2494,"said":"Yeah yeah just normal vomit yeah. 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Yeah it's been quite difficult.","significant":false},{"start":4891,"end":4934,"said":"fine.","significant":false},{"start":4976,"end":4977,"said":"your","significant":false},{"start":5027,"end":5036,"said":"","significant":false},{"start":5043,"end":5043,"said":"alright.","significant":false},{"start":5071,"end":5080,"said":"question","significant":false},{"start":5097,"end":5099,"said":"sir.","significant":false},{"start":5278,"end":5281,"said":"I","significant":false},{"start":5375,"end":5386,"said":"story sir","significant":false},{"start":5548,"end":5552,"said":"","significant":false},{"start":5566,"end":5583,"said":"fever and you're","significant":false},{"start":5634,"end":5647,"said":"you had","significant":false},{"start":5673,"end":5677,"said":"little as","significant":false},{"start":5696,"end":5702,"said":"wondered","significant":false},{"start":5948,"end":5950,"said":"there","significant":false},{"start":5959,"end":5971,"said":"a possibility","significant":false},{"start":5997,"end":6001,"said":"its","significant":false},{"start":6052,"end":6061,"said":"we'd","significant":false},{"start":6243,"end":6252,"said":"","significant":false},{"start":6260,"end":6260,"said":"Mm-hmm.","significant":false},{"start":6265,"end":6277,"said":"there","significant":false},{"start":6294,"end":6303,"said":"Dioralyte","significant":true},{"start":6365,"end":6367,"said":"helps","significant":false},{"start":6378,"end":6385,"said":"","significant":false},{"start":6455,"end":6468,"said":"diarrhea","significant":false},{"start":6478,"end":6487,"said":"say","significant":false},{"start":6548,"end":6556,"said":"Yep.","significant":false},{"start":6596,"end":6602,"said":"eh","significant":false},{"start":6710,"end":6710,"said":"Yep.","significant":false},{"start":6713,"end":6718,"said":"will","significant":false},{"start":6941,"end":6949,"said":"I'll admit","significant":false},{"start":7039,"end":7043,"said":"","significant":false},{"start":7052,"end":7054,"said":"you","significant":false},{"start":7131,"end":7138,"said":"","significant":false},{"start":7154,"end":7161,"said":"caused","significant":false},{"start":7177,"end":7182,"said":"Yep.","significant":false},{"start":7288,"end":7303,"said":"etcetera etcetera. Yep","significant":false},{"start":7311,"end":7325,"said":"yep. How's","significant":false},{"start":7569,"end":7569,"said":"Okay thank you. Bye. Thank you. Bye bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","Captures 3 days of loose watery stools 6-7 times daily but omits no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","\"lower left-sided abdominal pain... cramping, muscular sensation that comes and goes\" but does not note absence of radiation."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","partial","Vomiting at onset \"which has since resolved\" but omits no blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"subjective feeling of warmth... at symptom onset 3-4 days prior, but no measured fever\" plus weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, light foods (soups, smoothies), \"able to hold down fluids\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway 4 days prior; a household child vomited but no diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Well-controlled asthma with inhaler captured, but does not state no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","no","Does not mention needing to stay close to a toilet or disruption to daily activities; only says attending work despite symptoms."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Primary diagnosis appears to be gastroenteritis\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, fluids, ORS (misspelt \"Diurolite\"), and \"No antibiotics are deemed necessary at this stage\"."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"paracetamol (2 tablets up to 4 times daily)\" with no mg strength invented."],["The plan captures rest and approximately two to three days off work.","yes","\"take 2-3 days off work for rest\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return if no improvement within 3-4 days with potential stool sample."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 3-day history of diarrhea, characterized by loose, watery stools, occurring 6-7 times daily.\n- Patient reports associated lower left-sided abdominal pain, described as a cramping, muscular sensation that comes and goes.\n- Patient experienced initial vomiting at the onset of symptoms, which has since resolved, and reported a subjective feeling of warmth (temperature) at symptom onset 3-4 days prior, but no measured fever.\n- Patient reports feeling weak and shaky, with a loss of appetite, consuming only light foods and fluids (soups, smoothies); they are able to hold down fluids.\n- Symptoms began approximately 3 days ago, potentially triggered by a Chinese takeaway meal consumed 4 days prior; a child in the household experienced vomiting but no diarrhea.\n\nO (Objective):\n- The patient appears cooperative and communicative during the interaction.\n- The patient's speech is clear and coherent, providing detailed accounts of their symptoms.\n- Patient states they live with a wife and two children.\n- Patient reports working as an accountant and has been attending work despite symptoms.\n- Patient reports a medical history of well-controlled asthma, managed with an inhaler, and denies any other chronic bowel problems.\n\nA (Assessment):\n- Primary diagnosis appears to be gastroenteritis, consistent with a \"tummy bug\" or infection of the digestive system.\n- Symptoms are likely caused by a viral infection, though bacterial etiology is a possibility.\n- The recent takeaway meal is identified as a potential trigger for the onset of symptoms.\n\nP (Plan):\n- Conservative management is recommended, focusing on hydration with plenty of fluids, including oral rehydration solutions like Diurolite.\n- Patient advised to take paracetamol (2 tablets up to 4 times daily) for feverishness and weakness.\n- Patient advised to take 2-3 days off work for rest to allow the infection to clear.\n- If symptoms do not improve within 3-4 days, patient should return for re-evaluation and potential further tests, such as a stool sample.\n- No antibiotics are deemed necessary at this stage.\n","review":191.81578947368422,"saved":191.18421052631578,"clean":false,"effort":23.076923076923077,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Omits the stated absence of blood in stool, a red-flag negative that steers infective diarrhoea workup and antibiotic decisions."],["partial","The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","Omits the stated absence of blood in vomit, a red-flag negative for haematemesis."]],"mb":23.336274,"latency":22.039,"signable":201.7957894736842},{"label":"Run 3","wer":15.997181113460183,"text":"Hello. Hello, how are you? Hi. Um, should we start? Yeah. Yeah, okay.\nHello, h um, good morning.\nSo how can I help you this morning? Hi. Um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities. Okay. I'm sorry to hear that. Um, and, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool, going to the toilet quite often.\nOkay. Um, and like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Um, probably like 6 or 7 times a day. 6 or 7 times a day. And you made a mention it's mainly watery. Have you noticed any other things, like blood in your stools? No, no blood. Yeah, just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yeah. Whereabouts is the pain exactly? So it's like in my lower abdomen, so, uh,\nlike, um, yeah, just to one side. One side. And what side is that? Uh, on the left side. Left side. Okay. And can you describe the pain to me?\nYeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? Uh, it comes and goes.\nComes and go. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well.\nWhat do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\nDid you measure your temperature then?\nYeah. I, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. And, yeah. Any other symptoms, like sweating or, um, night? Um, no. No? And, uh, any vomiting at all? Yeah. So, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food colour? Yeah, yeah, just normal vomit. Yeah.\nYeah. And there was no blood in your vomit. Is that right? No blood, no. No? Okay.\nUm. Yeah. And, um, a-any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Um. Yeah. Anything else that comes to mind? Um, I had a loss of appetite, um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat, if anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine.\nUm, and so, uh, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would simulate symptoms? Yeah. So I had takeaway about 4 days ago. Um, uh, but other than that, I've yeah, I've been eating normally. Okay. I think, I think, yeah, unusual, yeah. Do you remember what you ate? Um, yeah, I, I ate at a Chinese restaurant with friends. Okay. Anyone\nelse unwell with similar symptoms?\nUm, so no one else in the family, so I have, uh, wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay.\nFine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or? Um, yeah. I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine. Okay. And does your asthma well controlled?\nUh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No.\nNo? Okay. Um, and ti apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay.\nFine. And in terms of just your, your day-to-day life, you said it's been affecting your life.\nUm. Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days. Okay. Um, yeah, other than that, it's, uh, yeah, that's the main concern. Yeah. And have you are you currently working at the moment? Uh, yes. Yeah, I, I work, um. Working at the work?\nUm, I'm an accountant.\nOkay. Have you been going into work the last 3 days? Have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. Right. And you said you mentioned you live with a wife and two children. Is that right? Yes, yeah. Okay. All right.\nUm, just a couple of other questions we need to ask. So, um, do you smoke at all?\nUh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um. Yeah. But, but having listened to your story, so I think, uh, um, just to recap, you for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, uh, um, and some vomiting and feeling generally quite weak and lethargic. Yeah. Um, you mentioned you're having this Chinese takeaway\nas well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something, uh, called gastroenteritis.\nOkay. Which essentially just, uh, tummy bug or infection of your of your tummy. Uh. Yeah.\nMainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms. Yeah. Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, um, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking. Mm-hmm. Plenty of fluids. Um, uh, th-there are things like diurolite you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins. Ok\nay. Um, and if you are having vomiting and diarrhea, I would say and recommend that at first, you know, first couple of days. Yeah. Um, if you are feeling feverish and weak, you're taking some paracetamol, uh, 2 tablets up to 4 times a day for the first few days can also help.\nI would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms. Yeah. Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Yeah. Um, etc., etc. Yeah, sure, yeah.\nHow does that sound? That sounds great, yeah, yeah. Do you have any questions for me?\nUm, no, no further questions, no. Okay.\nIs th is the treatment plan clear?\nUh, yeah, yeah, that's, that's very clear, thank you. Great. Well, I wish you all the best. Okay, thank you. Thank you. Bye. Bye-bye.","marks":[{"start":7,"end":25,"said":"","significant":false},{"start":77,"end":78,"said":"how","significant":false},{"start":97,"end":99,"said":"sir","significant":false},{"start":133,"end":136,"said":"Hello how are you Oh hey","significant":false},{"start":323,"end":332,"said":"","significant":false},{"start":389,"end":396,"said":"what'd","significant":false},{"start":691,"end":695,"said":"in","significant":false},{"start":761,"end":763,"said":"","significant":false},{"start":787,"end":793,"said":"","significant":false},{"start":1038,"end":1038,"said":"Yep.","significant":false},{"start":1043,"end":1052,"said":"","significant":false},{"start":1340,"end":1344,"said":"is","significant":false},{"start":1435,"end":1440,"said":"Come","significant":false},{"start":1515,"end":1521,"said":"Uh...no","significant":false},{"start":1528,"end":1537,"said":"maybe","significant":false},{"start":1769,"end":1771,"said":"--","significant":false},{"start":1786,"end":1792,"said":"makes me","significant":false},{"start":1954,"end":1957,"said":"","significant":false},{"start":2014,"end":2021,"said":"mention","significant":false},{"start":2073,"end":2073,"said":"And y'know.","significant":false},{"start":2146,"end":2153,"said":"sweats","significant":false},{"start":2186,"end":2186,"said":"Uh no.","significant":false},{"start":2278,"end":2284,"said":"You","significant":false},{"start":2348,"end":2348,"said":"thing","significant":false},{"start":2400,"end":2436,"said":"","significant":false},{"start":2494,"end":2494,"said":"Yeah yeah just normal vomit yeah. 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Yep","significant":false},{"start":7314,"end":7328,"said":"yep. How's","significant":false},{"start":7449,"end":7451,"said":"uh","significant":false},{"start":7589,"end":7589,"said":"Bye.","significant":false},{"start":7606,"end":7614,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","Captures 3 days of loose watery stools 6-7 times daily but omits no blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","\"lower left-sided abdominal cramping pain, which is intermittent\" but does not note absence of radiation."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","\"Initial vomiting... has since ceased; no blood was noted in the vomit\"."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"initial feeling of being hot at symptom onset... but no measured fever\" plus weakness and shakiness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, light foods/soups/smoothies, able to maintain fluid intake."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway ~4 days ago; one child experienced vomiting, no one with identical symptoms."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"well-controlled asthma, managed with an inhaler; no other bowel problems or medications reported\"."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"need to stay close to a toilet, making work (as an accountant) difficult\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"consistent with gastroenteritis, likely a viral or bacterial infection\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative hydration and Dioralyte captured, but no statement that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol (2 tablets, up to 4 times daily)\" with no mg strength invented."],["The plan captures rest and approximately two to three days off work.","yes","\"take 2-3 days off work for rest and recovery\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Follow-up recommended in 3-4 days if symptoms do not improve... stool sample\"."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 3-day history of diarrhea, characterized by loose, watery stools, occurring 6-7 times daily.\n- Associated symptoms include lower left-sided abdominal cramping pain, which is intermittent, and general weakness and shakiness.\n- Patient reported an initial feeling of being hot at symptom onset 3-4 days prior, but no measured fever.\n- Initial vomiting occurred at the start of symptoms but has since ceased; no blood was noted in the vomit.\n- Patient reports loss of appetite, consuming only light foods, soups, and smoothies, but has been able to maintain fluid intake.\n- Patient attributes symptoms to a Chinese takeaway meal consumed approximately 4 days ago; no family members have identical symptoms, though one child experienced vomiting.\n- Patient's daily activities are affected due to the need to stay close to a toilet, making work (as an accountant) difficult.\n- Medical history includes well-controlled asthma, managed with an inhaler; no other bowel problems or medications reported.\n- Patient denies smoking and alcohol consumption.\n\nO (Objective):\n- The patient appeared cooperative during the interaction.\n- The patient described symptoms clearly and consistently.\n- No objective findings from equipment-backed observations were mentioned in the conversation.\n\nA (Assessment):\n- The patient's presentation is consistent with gastroenteritis, likely a viral or bacterial infection of the gastrointestinal tract.\n- The temporal association with a Chinese takeaway meal suggests a possible foodborne trigger.\n- Differential diagnoses include other causes of acute diarrhea, though the current presentation points towards an infectious etiology.\n\nP (Plan):\n- Conservative management is recommended, focusing on hydration with plenty of fluids.\n- Patient advised to consider oral rehydration solutions (e.g., Dioralyte) from a pharmacy to replenish minerals and vitamins.\n- Paracetamol (2 tablets, up to 4 times daily) suggested for feverishness and weakness during the initial days.\n- Patient advised to take 2-3 days off work for rest and recovery as the infection clears.\n- Follow-up recommended in 3-4 days if symptoms do not improve, which may necessitate further investigations such as a stool sample.\n","review":152.21052631578948,"saved":230.78947368421052,"clean":false,"effort":11.538461538461538,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Omits the stated absence of blood in stool, a red-flag negative that steers infective diarrhoea workup and antibiotic decisions."]],"mb":23.211015,"latency":21.506,"signable":162.20452631578948},{"label":"Run 4","wer":16.208597603946444,"text":"Hello. Hello, how are you? Hi. Um, should we start? Yeah. Yeah, okay.\nHello, um, good morning.\nSo how can I help you this morning? Hi. Um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities. Okay. I'm sorry to hear that. Um, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah, so it's like loose and watery stool, going to the toilet quite often.\nOkay. Um, and like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Um, probably like 6 or 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools? No, no blood. Yeah, just watery and loose stool.\nOkay. And you mentioned you've had some pain in your tummy as well. Yeah. Whereabouts is the pain exactly? So it's like in my lower abdomen, so, uh, like, um, yeah, just to one side. One side.\nAnd what side is that? Uh, on the left side. Left side. Okay. And can you describe the pain to me?\nYeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it there all the time, or does it come and go? Uh, it comes and goes.\nComes and goes. Does the pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so, um, yeah, around about 3 or 4 days ago.\nDid you measure your temperature then?\nYeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. And, yeah. Any other symptoms, like sweating or, um, night? Um, no. No? And, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food colour? Yeah, yeah, just normal vomit. Yeah. Yeah. And there was no blood in your vomit. Is that right? No blood, no. No? Okay.\nUm. Yeah. And, um, any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Um. Yeah. Anything else that comes to mind? Um, I had a loss of appetite, um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat, if anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine.\nUm, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would sim your symptoms? Yeah, so I had takeaway about 4 days ago. Um, uh, but other than that, I've yeah, I've been eating normally. Okay. I think, yeah, unusual, yeah. Do you remember what you ate? Um, yeah, I, I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms\n? Um, so no one else in the family, so I, uh, wife and two kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay.\nFine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler. Everything, uh, else is fine. Okay.\nAnd does your asthma well controlled?\nUh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No.\nNo? Okay. Um, and apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay.\nFine. And in terms of just your, your day-to-day life, you said it's been affecting your life.\nUm. Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days. Okay. Um, yeah, other than that, it's, uh, yeah, the main concern.\nYeah. And have you are you currently working at the moment? Uh, yes. Yeah, I, I work, uh. Working at the work?\nUm, I'm an accountant.\nOkay. Have you been going into work the last 3 days? Have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. Right. And you said you mentioned you live with a wife and two children. Is that right? Yes, yeah. Okay. All right. Um, just a couple of other questions we need to ask. So, um, do you smoke at all?\nUh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage I'd like to, um, examine you if that's okay. But, um, um. Yeah. But, but having listened to your stories, uh, I think, uh, um, just to recap, for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, um, and some vomiting and feeling generally quite weak and lethargic. Yeah. Um, you mentioned you're having this Chinese takeaw\nay as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay.\nUm, it seems like you may have something called gastroenteritis.\nOkay. Which essentially just, uh, tummy bug or infection of your of your tummy. Uh. Yeah.\nMainly caused by viruses, but it can be, uh, possibility of bacteria, uh, causing your symptoms. Yeah. Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So, uh, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking plenty of fluids. Mm-hmm. Um, uh, there, there are things like diurolite you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins. Ok\nay. Um, and if you are having vomiting and diarrhea, I would certainly recommend that at first, you know, first couple of days. Yeah. Um, if you are feeling feverish and weak, taking some paracetamol, uh, 2 tablets up to 4 times a day for the first few days can also help.\nI would certainly advise you to take some time off work, actually. I know you're quite keen to work, but, um, I would say next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I would like you to come back and see me again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms. Yeah. Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Um, etc., etc. Yeah, sure, yeah.\nHow does that sound? That sounds great, yeah, yeah. Do you have any questions for me?\nUm, no, no further questions, no. Okay.\nIs there, is the treatment plan clear?\nUh, yeah, yeah, that's, that's very clear, thank you. Great. Well, I wish you all the best.","marks":[{"start":7,"end":25,"said":"","significant":false},{"start":75,"end":75,"said":"how","significant":false},{"start":95,"end":97,"said":"sir","significant":false},{"start":131,"end":134,"said":"Hello how are you Oh hey","significant":false},{"start":321,"end":330,"said":"","significant":false},{"start":382,"end":389,"said":"what'd","significant":false},{"start":684,"end":688,"said":"in","significant":false},{"start":778,"end":787,"said":"mention","significant":false},{"start":1024,"end":1024,"said":"Yep.","significant":false},{"start":1029,"end":1038,"said":"","significant":false},{"start":1326,"end":1330,"said":"is","significant":false},{"start":1421,"end":1426,"said":"Come","significant":false},{"start":1431,"end":1436,"said":"go.","significant":false},{"start":1503,"end":1509,"said":"Uh...no","significant":false},{"start":1516,"end":1525,"said":"maybe","significant":false},{"start":1757,"end":1759,"said":"--","significant":false},{"start":1774,"end":1780,"said":"makes me","significant":false},{"start":1942,"end":1945,"said":"","significant":false},{"start":1999,"end":2006,"said":"mention","significant":false},{"start":2058,"end":2058,"said":"And y'know.","significant":false},{"start":2131,"end":2138,"said":"sweats","significant":false},{"start":2171,"end":2171,"said":"Uh no.","significant":false},{"start":2263,"end":2269,"said":"You","significant":false},{"start":2333,"end":2333,"said":"thing","significant":false},{"start":2385,"end":2421,"said":"","significant":false},{"start":2479,"end":2479,"said":"Yeah yeah just normal vomit yeah. 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Yep","significant":false},{"start":7250,"end":7264,"said":"yep. How's","significant":false},{"start":7385,"end":7390,"said":"uh","significant":false},{"start":7512,"end":7512,"said":"Okay thank you. Bye. Thank you. Bye bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","Captures 3 days of loose watery stools 6-7 times daily but omits the absence of blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","Intermittent cramping left lower abdominal pain captured, but absence of radiation not noted."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","partial","Initial vomiting now resolved captured, but no blood in vomit is omitted."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, temperature not measured, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","Asthma 'well-controlled with an inhaler' captured, but no statement that he takes no other medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Continued working despite difficulty captured, but need to stay close to a toilet is missing."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[],"note":"S (Subjective):\n- Patient presents with diarrhea for the past 3 days, characterized by loose, watery stools, occurring 6-7 times daily.\n- They report associated lower left abdominal cramping pain that comes and goes, described as a muscular cramp.\n- Patient also experienced initial vomiting at the onset of symptoms, which has since resolved, and reports feeling weak and shaky.\n- They had a subjective feeling of warmth (temperature) at the symptom onset 3-4 days ago but did not measure it, and denies fever currently.\n- Patient reports loss of appetite but has been able to maintain fluid intake with soups, smoothies, and light foods, and notes a Chinese takeaway 4 days ago as a possible trigger.\n\nO (Objective):\n- Patient reports living with a wife and two children; one child experienced vomiting but no diarrhea.\n- Patient has a medical history of asthma, well-controlled with an inhaler.\n- They deny smoking and alcohol consumption.\n- Patient is an accountant and has continued to go to work despite symptoms, finding it difficult.\n\nA (Assessment):\n- The patient's symptoms are consistent with gastroenteritis, likely caused by a viral or bacterial infection.\n- The Chinese takeaway 4 days prior is a potential contributing factor.\n- Differential diagnoses include other causes of acute diarrhea if symptoms persist.\n\nP (Plan):\n- Conservative management is recommended, focusing on hydration with plenty of fluids and oral rehydration solutions (e.g., Dioralyte).\n- Paracetamol (2 tablets up to 4 times a day) is advised for feverishness and weakness.\n- Patient is advised to take 2-3 days off work for rest to allow the infection to clear.\n- If symptoms do not improve within 3-4 days, the patient should return for re-evaluation and potential further tests, such as a stool sample.\n","review":186.43421052631578,"saved":196.56578947368422,"clean":false,"effort":23.076923076923077,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Absence of blood in stool is a pertinent red-flag negative that was asked; without it a reader cannot exclude dysentery, which would change investigation/treatment."]],"mb":23.257273,"latency":21.483,"signable":196.41621052631578},{"label":"Run 5","wer":16.983791402396054,"text":"Hello. Hello, how are you? Hi. Um, should we start? Yeah. Yeah, okay.\nHello, h um, good morning.\nSo how can I help you this morning? Hi. Um, I've just had some, um, diarrhea for the last 3 days. Um, and it's been affecting me. I need to stay close to the toilet and, um, yeah, it's been affecting my day-to-day activities. Okay. I'm sorry to hear that. Um, and, and when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool, going to the toilet quite often.\nOkay. Um, and like some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, over the last couple of days? Um, probably like 6, 7 times a day. 6, 7 times a day. And you made you mentioned it's mainly watery. Have you noticed any other things, like blood in your stools? No, no blood. Yeah, just watery and loose stool. Okay. And you mentioned you've had some pain in your tummy as well. Yeah. Whereabouts is the pain exactly? So it's like in my lower abdomen, so, uh,\nlike um, yeah, just to one side. One side. And what side is that? Uh, on the left side. Left side. Okay. And can you describe the pain to me?\nYeah, it feels, um, like a cramp, uh, like a muscular cramp, and, um, yeah, I feel a bit weak and shaky. Okay. And there's a pain is that is it there all the time, or does it come and go? Uh, it comes and goes.\nComes and go. There's a pain move anywhere else, for example, towards your back? Um, no, just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well.\nWhat do you mean by shaky? Do you mean you've been having, uh, have you been feeling feverish, for example? Um, yeah, it doesn't feel like uh, yeah, I just mainly feel weak. I haven't had a fever, um, at the moment, but I did notice, um, a temperature. When the symptoms started, so um, yeah, around about 3 or 4 days ago.\nDid you measure your temperature then?\nYeah, I, I didn't measure my temperature, no, but I felt, um, just a bit hot. Okay. Okay. And, yeah. Any other symptoms, like sweating or, um, night? Um, no. No?\nAnd, uh, any vomiting at all? Yeah, so, um, I vomited at the start of the symptoms, but now, um, I've stopped vomiting. You've stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food colour? Yeah, yeah, just normal vomit. Yeah.\nYeah. And there was no blood in your vomit. Is that right? No blood, no. No? Okay.\nUm. Yeah. And, um, a-any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Um. Yeah. Anything else that comes to mind? Um, I had a loss of appetite. Okay. Um, so I haven't been eating as much. Okay. Um, but I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. Um, what kind of foods have you managed to eat, if anything? Um, just soups and, uh, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine.\nUm, and so, uh, you started 3 days ago the symptoms. Are you aware of any triggers which may have caused your symptoms to, uh, to kick on? So, for example, things like takeaway foods or eating out or being around other people who would sim the symptoms? Yeah, so I had takeaway about 4 days ago. Um, uh, but other than that, I've yeah, I've been uh, eating normally. Okay. I think, I think, uh, unusual, yeah. Do you remember what you ate? Um, yeah, I, I ate at a Chinese restaurant with friends. Okay. Anyone\nelse unwell with similar symptoms?\nUm, so no one else in the family, so I have, uh, wife and 2 kids and one, um, child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms. Okay. Okay.\nFine. Um, right. And, uh, in terms of your, your overall health, are you normally fitting well, or? Um, yeah, I mean, other than, um, asthma, um, I use an inhaler everything, uh, else is fine. Okay. And does your asthma well controlled?\nUh, yeah, that's fine. Okay. Uh, just, yeah, use an inhaler and, uh, that's under control. Fine. And you don't have any other tummy problems, bowel problems I should be aware of? No.\nNo? Okay. Um, and ti apart from the inhalers, do you take any other medications? Uh, no, no other medications. Okay.\nFine. And in terms of just your, your day-to-day life, you said it's been affecting your life.\nUm. Yeah. In what way has it been affecting your life? Uh, so I need to stay close to the toilet because I go quite frequently during the, these past 3 days. Okay. Um, yeah, other than that, it's, uh, yeah, the main concern. Yeah. And have you are you currently working at the moment? Uh, yes. Yeah, I, I work, um. Working at the work?\nUm, I'm an accountant.\nOkay. Have you been going into work the last 3 days? Have you been at home? Uh, yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. Right. And you said you mentioned you live with a wife and 2 children. Is that right? Yes, yeah. Okay. All right.\nUm, just a couple of other questions we need to ask. So, um, do you smoke at all?\nUh, no, I don't smoke. And do you drink much in the way of alcohol? Uh, no, I, I don't drink alcohol, no. Okay. Yeah. So, um, uh, normally at this stage, I'd like to, um, examine you if that's okay. But, um, um. Yeah. But, but having listened to your stories, uh, I think, uh, um, just to recap, you for the last 3 days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left-hand side, uh, um, and some vomiting and feeling generally quite weak and lethargic. Um.\nYeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. Um, it seems like you may have something uh, called gastroenteritis.\nOkay. Which essentially just, uh, tummy bug or infection of your of your tummy. Uh. Yeah.\nMainly caused by viruses, but it can be, uh, possibly of bacteria, uh, causing your symptoms. Yeah. Um, at this stage, uh, what, what would you recommend is just what we say conservative management. So. Mm-hmm. Uh, I don't think you need anything like antibiotics. It's really just, um, making sure you're well hydrated. So drinking. Mm-hmm. Plenty of fluids. Um, uh, th-there are things like diurolite you can get from the pharmacy, which, uh, it's, um, it helps to replenish some of your minerals and vitamins. Ok\nay. Um, and if you are having vomiting and diarrhea, I would certainly recommend that in the first you know, first couple of days. Yeah. Um, if you are feeling feverish and weak, you're taking some paracetamol, uh. Yeah. 2 tablets up to 4 times a day for the first few days can also help.\nI would certainly advise you to take some time off work, actually. I know you're quite keen to work. Yeah. But, um, I would say in the next 2, 2 to 3 days, um, as infection clears from your system, just take some time off and rest. Um, you know, if your symptoms haven't got better, you know, in, in 3 to 4 days, I'd like you to come back and see me again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing your symptoms. Yeah. Uh, and we may need to do further tests like, um, taking a sample of your stool so we can test that. Yeah. Um, etc., etc. Yeah, sure, yeah.\nHow does that sound? That sounds great, yeah, yeah. Do you have any questions for me?\nUm, no, no further questions, no. Okay.\nIs th is the treatment plan clear?\nUh, yeah, yeah, that's, that's very clear, thank you. Great. Well, I wish you all the best.","marks":[{"start":7,"end":25,"said":"","significant":false},{"start":77,"end":78,"said":"how","significant":false},{"start":97,"end":99,"said":"sir","significant":false},{"start":133,"end":136,"said":"Hello how are you Oh hey","significant":false},{"start":323,"end":332,"said":"","significant":false},{"start":389,"end":396,"said":"what'd","significant":false},{"start":691,"end":695,"said":"in","significant":false},{"start":740,"end":740,"said":"or","significant":false},{"start":783,"end":801,"said":"mention","significant":false},{"start":1038,"end":1038,"said":"Yep.","significant":false},{"start":1043,"end":1052,"said":"","significant":false},{"start":1339,"end":1348,"said":"is the","significant":false},{"start":1435,"end":1440,"said":"Come","significant":false},{"start":1449,"end":1458,"said":"Does the","significant":false},{"start":1516,"end":1522,"said":"Uh...no","significant":false},{"start":1529,"end":1538,"said":"maybe","significant":false},{"start":1770,"end":1772,"said":"--","significant":false},{"start":1787,"end":1793,"said":"makes me","significant":false},{"start":1954,"end":1957,"said":"","significant":false},{"start":2011,"end":2018,"said":"mention","significant":false},{"start":2070,"end":2070,"said":"And y'know.","significant":false},{"start":2143,"end":2150,"said":"sweats","significant":false},{"start":2183,"end":2183,"said":"Uh no.","significant":false},{"start":2275,"end":2281,"said":"You","significant":false},{"start":2345,"end":2345,"said":"thing","significant":false},{"start":2397,"end":2433,"said":"","significant":false},{"start":2491,"end":2491,"said":"Yeah yeah just normal vomit yeah. 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It does not require or invent bilious vomiting.","partial","Vomiting at onset that has stopped is captured, but no blood in vomit is omitted."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","partial","Subjective fever at onset and weakness captured, but no statement that fever is absent currently."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids and light foods such as soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway exposure and a child vomiting without diarrhoea both captured."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","'well-controlled asthma, managed with an inhaler, and denies other bowel problems or medications'."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Work difficulty captured ('continued to work despite symptoms, indicating difficulty') but need to stay close to a toilet is missing."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","Assessment is acute gastroenteritis."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with hydration and oral rehydration solution captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","'Paracetamol 2 tablets up to four times daily' for fever/weakness matches the spoken instruction."],["The plan captures rest and approximately two to three days off work.","yes","'Take time off work for next 2-3 days' with rest captured."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if symptoms persist beyond 3-4 days and possible stool sample testing captured."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 3-day history of diarrhea, characterized by loose and watery stools, occurring 6-7 times a day.\n- They report associated lower left abdominal cramping pain that comes and goes, described as muscular.\n- Initial symptoms included a subjective feeling of fever (hot) and vomiting at the onset, which has since stopped.\n- Patient also reports feeling weak and shaky, along with a loss of appetite, consuming only soups, smoothies, and liquid foods, but maintaining fluid intake.\n- Symptoms began approximately 3 days ago, potentially triggered by a Chinese takeaway eaten 4 days prior with friends; however, no friends or family (wife, 2 children) have similar symptoms, although one child experienced vomiting without diarrhea.\n\nO (Objective):\n- The patient appears cooperative and communicative during the interaction.\n- The patient reports working as an accountant and has continued to work despite symptoms, indicating difficulty.\n- The patient lives with their wife and two children.\n- They deny smoking and alcohol consumption.\n- The patient has a history of well-controlled asthma, managed with an inhaler, and denies other bowel problems or medications.\n\nA (Assessment):\n- The patient's symptoms are consistent with gastroenteritis, which is a common \"tummy bug\" or infection of the digestive system.\n- The infection is likely viral but could potentially be bacterial, given the acute onset and associated symptoms.\n- The recent consumption of a Chinese takeaway is a potential trigger for the onset of symptoms, suggesting a possible foodborne illness.\n\nP (Plan):\n- Conservative management is recommended, focusing on maintaining good hydration by drinking plenty of fluids.\n- Oral rehydration solutions (e.g., Dioralyte) from a pharmacy are advised to replenish minerals and vitamins, especially with ongoing vomiting and diarrhea.\n- Paracetamol (2 tablets up to 4 times a day) is recommended for feverishness and weakness in the initial days.\n- The patient is advised to take 2-3 days off work for rest to allow the infection to clear from their system.\n- If symptoms do not improve within 3-4 days, the patient should return for a follow-up, which may include further investigations such as a stool sample test.\n","review":210.94736842105263,"saved":172.05263157894737,"clean":false,"effort":23.076923076923077,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Absence of blood in stool is a pertinent red-flag negative that was asked; without it a reader cannot exclude dysentery, which would change investigation/treatment."]],"mb":23.211527,"latency":28.06,"signable":220.93336842105262}],"lyrebird":[{"label":"Run 1","wer":19.943622269203665,"text":"Hello? Hello. Hi. Hi. Should we stop? Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last 3 days, and it's been affecting me. I need to stay close to the toilet. And, yeah, it's been affecting my day to day activities. Yeah. Sorry to hear that. And and when you say\n\nDiarrhea. What do mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool going to the toilet quite often and, like, some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, 6, 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose\n\nStool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain exactly? In my lower abdomen. So, like, yeah, just to 1 side. 1 side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp, and, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it\n\nAll the time, or does it come and go? It comes and goes. It goes. Does the pain move anywhere else? For example, towards your back? No. Just mainly my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. I just fainted for a week. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. Good. Yeah.\n\nAround about 3 or 4 days ago. You measure your temperature then? Yeah. I I didn't measure my temperature. No. But I felt just a bit hot. Okay. Okay. Any other symptoms like sweating or night? No. No. And any vomiting at all? Yeah. So I vomited at the start of the symptoms, but now I've stopped vomiting. You stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food color?\n\nYeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No. No. Right. Okay. Yeah. And any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind? I had a loss of appetite. So I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. And so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So for example, taking takeaway foods or eating out or being around other people who would see the symptoms. Yeah. So I had takeaway about 4 days ago. But other than that, I've\n\nYeah. I've been eating normally. I think unusual. Yeah. Do you remember what you ate? Yeah. I I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no 1 else in the family. So I have a wife and 2 kids, and 1 child was vomiting, but they haven't got diarrhea. It's no 1 with the same symptoms. Okay. Okay. Fine. Right. And in terms\n\nOf your your overall health, are you normally feeling well? Or Yeah. I mean, other than asthma, like using inhaler, everything else is fine. Okay. And is your asthma well controlled? Yeah. That's fine. Just yeah. You send inhaler, and that's under control. Alright. And you don't have any other tummy problem, bowel problem that I should be aware of? No. No. Okay. And apart from the inhalers, do you take any other medications?\n\nNo. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past 3 days. Okay. Yeah. Other than that, it's Yeah. The main concern. And have you are you currently working at the moment? Yeah. I I work. Where do work? I'm an accountant. Okay. Have you\n\nGoing to work the last 3 days, or you've been at home? Yeah. I've been going to work. Okay. That must be difficult for you then. Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and 2 children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in a way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So normally, at this stage, I'd like to examine you.\n\nOkay. But Yeah. But but having listened to your stories, I think you just to recap, for the last 3 days, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side, and vomiting and being generally quite weak and lethargic. Yeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis Okay. Which essentially just a tummy bug or infection of your of your tummy.\n\nMainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated, so drinking fluids. There are things like Diurilite you can get from the pharmacy, which it helps\n\nReplenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, would say recommend that at first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work. I would say next 2 2 to 3 days Yeah. Clears from your system. Just take some time off and rest.\n\nIf your symptoms haven't got better, you know, in in 3 to 4 days, I'd like you to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yep. Sure. Yep. How's that sound? That sounds great. Yeah. Yeah. 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Uh","significant":false},{"start":6832,"end":6832,"said":"Bye.","significant":false},{"start":6853,"end":6857,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","\"Loose, watery stools for 3 days, occurring 6-7 times per day\" and \"No blood in stool\"."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","\"Left lower abdominal cramping pain, intermittent\"; absence of radiation not documented."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomiting at onset now resolved and \"No blood in stool or vomit\"."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at symptom onset (not measured)\" plus generalised weakness."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite; \"Tolerating fluids; eating soups, smoothies and other liquid foods\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway and \"One child in household with vomiting only\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","\"Asthma, well controlled on inhaler\" captured but no statement of no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Affecting work attendance and \"requiring frequent toilet access\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute gastroenteritis, likely viral aetiology\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","\"Conservative management; no antibiotics indicated\", oral hydration and Dioralyte."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Two tablets up to four times daily captured, but adds an unstated \"1g\" strength."],["The plan captures rest and approximately two to three days off work.","partial","2-3 days off work captured but framed as an invented medical certificate; rest not mentioned."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if persisting beyond 3-4 days and stool sample if not resolving."]],"claims":[["Paracetamol 1g (2 tablets)","No tablet strength or total dose was stated; transcript says only \"two tablets up to four times a day\"."],["Medical certificate provided for 2-3 days work leave","Clinician only advised time off work; no certificate was mentioned or provided."]],"note":"Subjective:\n\nLoose, watery stools for 3 days, occurring 6-7 times per day\n\nLeft lower abdominal cramping pain, intermittent\n\nVomiting at onset of symptoms (3-4 days ago), now resolved\n\nSubjective fever at symptom onset (not measured)\n\nGeneralised weakness and shakiness\n\nLoss of appetite\n\nTolerating fluids; eating soups, smoothies and other liquid foods\n\nNo blood in stool or vomit\n\nNo night sweats\n\nAte Chinese takeaway approximately 4 days ago (17/09/2026)\n\nOne child in household with vomiting only (no diarrhoea); no other household members affected\n\nSymptoms affecting work attendance; patient has continued working as accountant despite symptoms, requiring frequent toilet access\n\nPast medical history: Asthma, well controlled on inhaler\n\nSocial history: Non-smoker, no alcohol consumption, lives with wife and 2 children\n\n\n\n\nObjective:\n\nPhysical examination deferred\n\n\n\n\nAssessment:\n\nAcute gastroenteritis, likely viral aetiology\n\nPossible bacterial gastroenteritis secondary to food consumption\n\n\n\n\nPlan:\n\nConservative management; no antibiotics indicated at this stage\n\nMaintain adequate oral hydration\n\nDioralyte sachets from pharmacy for electrolyte replacement\n\nParacetamol 1g (2 tablets) up to four times daily as required for fever and weakness\n\nMedical certificate provided for 2-3 days work leave\n\nReview if symptoms persist beyond 3-4 days for further assessment\n\nStool sample for microscopy, culture and sensitivity if symptoms do not resolve\n\nSafety netting advice provided regarding red flag symptoms","review":154.64473684210526,"saved":228.35526315789474,"clean":false,"effort":30.76923076923077,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Adds a 1g dose never stated in the consultation."],["partial","The plan captures rest and approximately two to three days off work.","Time off work recorded as a provided medical certificate, which did not happen."]],"mb":16.549373,"latency":20.071,"signable":174.71573684210526},{"label":"Run 2","wer":20.155038759689923,"text":"Hello? Hello. Hi. Hi. Should we stop? Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last 3 days, and it's been affecting me. I need to stay close to the toilet. And, yeah, it's been affecting my day to day activities. Yeah. Sorry to hear that. And and when you say\n\nDiarrhea. What do mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool going to the toilet quite often and, like, some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, 6, 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose\n\nStool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain exactly? In my lower abdomen. So, like, yeah, just to 1 side. 1 side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp, and, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it\n\nAll the time, or does it come and go? It comes and goes. It goes. Does the pain move anywhere else? For example, towards your back? No. Just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. I just fainted for a week. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. Good. Yeah.\n\nAround about 3 or 4 days ago. You measure your temperature then? Yeah. I I didn't measure my temperature. No. But I felt just a bit hot. Okay. Okay. Any other symptoms like sweating or night? No. No. And any vomiting at all? Yeah. So I vomited at the start of the symptoms, but now I've stopped vomiting. You stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food color?\n\nYeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No. No. Right. Okay. Yeah. And any other symptoms at all? You mentioned tummy pain. You mentioned diarrhea. You mentioned the vomiting. Yep. Anything else that comes to mind? I had a loss of appetite. So I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. And so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So for example, taking takeaway foods or eating out or being around other people who would see the symptoms. Yeah. So I had takeaway about 4 days ago. But other than that, I've\n\nYeah. I've been eating normally. I think unusual. Yeah. Do you remember what you ate? Yeah. I I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no 1 else in the family. So I have a wife and 2 kids, and 1 child was vomiting, but they haven't got diarrhea. It's no 1 with the same symptoms. Okay. Okay. Fine. Right. And in terms\n\nYour your overall health? Are you normally feeling well? Or Yeah. I mean, other than asthma, like, using inhaler, everything else is fine. Okay. And is your asthma well controlled? Yeah. That's fine. Just yeah. You send inhaler, and that's under control. Alright. And you don't have any other tummy problem, bowel problem that I should be aware of? No. No. Okay. And apart from inhalers, do you take any other medications?\n\nNo. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past 3 days. Okay. Yeah. Other than that, it's Yeah. The main concern. And have you are you currently working at the moment? Yeah. I I work. Where do work? I'm an accountant. Okay. Have you\n\nGoing to work the last 3 days, or you've been at home? Yeah. I've been going to work. Okay. That must be difficult for you then. Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and 2 children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in a way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So normally, at this stage, I'd like to examine you.\n\nK. But Yeah. But but having listened to your stories, I think you just to recap, for the last 3 days, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side, and vomiting and feeling generally quite weak and lethargic. Yeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis Okay. Which essentially just a tummy bug or infection of your of your tummy.\n\nMainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated, so drinking fluids. There are things like Diurilite you can get from the pharmacy which it helps\n\nReplenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, would say recommend that at first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work. I would say next 2 2 to 3 days as the infection clears from your system, just take some time off and rest.\n\nYou know, if your symptoms haven't got better, you know, in in 3 to 4 days, I'd like you to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yep. Sure. Yep. How's that sound? That sounds great. Yeah. 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Uh","significant":false},{"start":6838,"end":6838,"said":"Bye.","significant":false},{"start":6859,"end":6863,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","\"Diarrhoea for 3 days - loose, watery stools 6-7 times per day\" and \"No blood in stool\"."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"Left lower abdominal cramping pain, intermittent\" and \"No radiation of pain\"."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","\"Vomiting at onset... now resolved\" and \"No blood in stool or vomit\"; no bilious claim."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at onset... not measured, currently afebrile\" and \"Generalised weakness\"."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Reduced appetite\" and \"Tolerating fluids and light foods (soups, smoothies)\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","\"Consumed Chinese takeaway 4 days ago\" and \"One child at home with vomiting only\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","no","Asthma, inhaler use and absence of other medications are not recorded."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"Symptoms impacting work - accountant requiring frequent toilet access\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Gastroenteritis (likely viral, possible bacterial food poisoning)\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","\"Conservative management - no antibiotics indicated\", hydration and Dioralyte."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","\"2 tablets up to four times daily\" matches, but adds an unstated strength \"1g\"."],["The plan captures rest and approximately two to three days off work.","yes","\"2-3 days off work to rest and recover\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Review in 3-4 days if symptoms persist\" and stool sample if ongoing."]],"claims":[["Paracetamol 1g (2 tablets)","Transcript says only \"two tablets up to four times a day\"; no mg strength was stated."],["Medical certificate provided for 2-3 days off work","Clinician only advised taking time off; no medical certificate was mentioned or issued in the transcript."]],"note":"Subjective:\n\nDiarrhoea for 3 days - loose, watery stools 6-7 times per day\n\nLeft lower abdominal cramping pain, intermittent\n\nVomiting at onset of symptoms (3-4 days ago), now resolved\n\nSubjective fever at onset (3-4 days ago), not measured, currently afebrile\n\nGeneralised weakness and feeling shaky\n\nReduced appetite\n\nTolerating fluids and light foods (soups, smoothies)\n\nNo blood in stool or vomit\n\nNo radiation of pain\n\nNo night sweats\n\nConsumed Chinese takeaway 4 days ago\n\nOne child at home with vomiting only, no other household members affected\n\nSymptoms impacting work - accountant requiring frequent toilet access, has continued attending work despite symptoms\n\n\n\n\nObjective:\n\nExamination deferred\n\n\n\n\nAssessment:\n\nGastroenteritis (likely viral, possible bacterial food poisoning)\n\n\n\n\nPlan:\n\nConservative management - no antibiotics indicated\n\nMaintain adequate hydration\n\nDioralyte from pharmacy for electrolyte replacement\n\nParacetamol 1g (2 tablets) up to four times daily as required for fever and weakness\n\nMedical certificate provided for 2-3 days off work to rest and recover\n\nReview in 3-4 days if symptoms persist\n\nStool sample for microscopy, culture and sensitivity if symptoms ongoing at review","review":127.51315789473685,"saved":255.48684210526315,"clean":false,"effort":30.76923076923077,"sig":[["missing","The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","Asthma and inhaler use are absent, so the record has no comorbidity or current medication."],["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Invented a paracetamol tablet strength that was never stated."],["fabrication","Medical certificate provided for 2-3 days off work","Records a medical certificate as issued when only time off was advised, a false legal/administrative record."]],"mb":16.702687,"latency":22.132,"signable":149.64515789473685},{"label":"Run 3","wer":20.155038759689923,"text":"Hello? Hello. Hi. Hi. Should we stop? Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last 3 days, and it's been affecting me. I need to stay close to the toilet. And, yeah, it's been affecting my day to day activities. Yeah. Sorry to hear that. And and when you say\n\nDiarrhea. What do mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool going to the toilet quite often and, like, some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, 6, 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose\n\nStool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain exactly? In my lower abdomen. So, like, yeah, just to 1 side. 1 side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp, and, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it\n\nAll the time, or does it come and go? It comes and goes. It goes. Does the pain move anywhere else? For example, towards your back? No. Just mainly in my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. I just fainted for a week. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. Good. Yeah.\n\nAround about 3 or 4 days ago. You measure your temperature then? Yeah. I I didn't measure my temperature. No. But I felt just a bit hot. Okay. Okay. Any other symptoms like sweating or night? No. No. And any vomiting at all? Yeah. So I vomited at the start of the symptoms, but now I've stopped vomiting. You stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food color?\n\nYeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No. No. Right. Okay. Yeah. And any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind? I had a loss of appetite. So I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. And so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So for example, taking takeaway foods or eating out or being around other people who would see the symptoms. Yeah. So I had takeaway about 4 days ago. But other than that, I've\n\nYeah. I've been eating normally. I think unusual. Yeah. Do you remember what you ate? Yeah. I I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no 1 else in the family. So I have a wife and 2 kids, and 1 child was vomiting, but they haven't got diarrhea. It's no 1 with the same symptoms. Okay. Okay. Fine. Right. And in terms\n\nYour your overall health? Are you normally feeling well? Or Yeah. I mean, other than asthma, like, using inhaler, everything else is fine. Okay. And is your asthma well controlled? Yeah. That's fine. Just yeah. You send inhaler, and that's under control. Alright. And you don't have any other tummy problem, bowel problem that I should be aware of? No. No. Okay. And apart from inhalers, do you take any other medications?\n\nNo. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past 3 days. Okay. Yeah. Other than that, it's Yeah. The main concern. And have you are you currently working at the moment? Yeah. I I work. Where do work? I'm an accountant. Okay. Have you\n\nGoing to work the last 3 days, or you've been at home? Yeah. I've been going to work. Okay. That must be difficult for you then. Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and 2 children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in a way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So normally, at this stage, I'd like to examine you.\n\nOkay. But Yeah. But but having listened to your stories, I think you just to recap, for the last 3 days, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side, and vomiting and being generally quite weak and lethargic. Yeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis Okay. Which essentially just a tummy bug or infection of your of your tummy.\n\nMainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated, so drinking fluids. There are things like Diurilite you can get from the pharmacy, which it helps\n\nReplenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, would say recommend that at first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol. 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work. I would say next 2 2 to 3 days Yeah. Clears from your system. Just take some time off and rest.\n\nYou know, if your symptoms haven't got better, you know, in in 3 to 4 days, I'd like you to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yep. Sure. Yep. How's that sound? That sounds great. Yeah. Yeah. 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It does not assert a measured temperature.","partial","Subjective fever 3-4 days ago not measured plus weakness, but no current fever not stated."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, soups and smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway; one child with vomiting only."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","\"asthma, well controlled on inhaler\" but absence of other medications not stated."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Work impact noted as \"impacting work attendance\", but need to stay close to a toilet and daily-activity disruption omitted."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Gastroenteritis, likely viral aetiology, possible bacterial cause\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","Conservative management, no antibiotics, hydration, Dioralyte."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Two tablets up to four times daily captured, but adds an unstated strength \"1g\"."],["The plan captures rest and approximately two to three days off work.","yes","2-3 days off work."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review in 3-4 days; stool MC&S if ongoing."]],"claims":[["Paracetamol 1g (2 tablets)","Transcript only says \"two tablets up to four times a day\"; no strength in mg was stated."],["Medical certificate for 2-3 days off work","Clinician advised time off to rest; no medical certificate/sick note was discussed or issued."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n3-day history of diarrhoea with loose, watery stools\n\nBowel frequency 6-7 times per day\n\nLeft lower abdominal cramping pain, intermittent\n\nVomiting at symptom onset, now resolved\n\nSubjective fever 3-4 days ago (not measured)\n\nGeneralised weakness and shakiness\n\nReduced appetite\n\nTolerating fluids, consuming soups and smoothies\n\nNo blood in stool or vomit\n\nNo night sweats\n\nAte Chinese takeaway 4 days prior to symptom onset\n\nOne child in household with vomiting only, no other family members affected\n\nSymptoms impacting work attendance as accountant\n\nPast medical history: asthma, well controlled on inhaler\n\nNon-smoker, no alcohol consumption\n\nLives with wife and 2 children\n\n\n\n\nObjective:\n\nPhysical examination deferred\n\n\n\n\nAssessment:\n\nGastroenteritis, likely viral aetiology, possible bacterial cause\n\n\n\n\nPlan:\n\nConservative management, no antibiotics indicated\n\nMaintain adequate hydration\n\nDioralyte from pharmacy for electrolyte replacement\n\nParacetamol 1g (2 tablets) up to four times daily for fever and weakness\n\nMedical certificate for 2-3 days off work\n\nReview in 3-4 days if symptoms persist\n\nStool sample for microscopy, culture and sensitivity if symptoms ongoing","review":164.06578947368422,"saved":218.93421052631578,"clean":false,"effort":38.46153846153847,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Adds an unstated paracetamol strength (1g) to the dose instruction."],["fabrication","Medical certificate for 2-3 days off work","Records issuing a medical certificate that was never discussed; alters legal record."]],"mb":16.602722,"latency":19.132,"signable":183.19778947368422},{"label":"Run 4","wer":19.943622269203665,"text":"Hello? Hello. Hi. Hi. Should we stop? Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last 3 days, and it's been affecting me. I need to stay close to the toilet. And, yeah, it's been affecting my day to day activities. Yeah. Sorry to hear that. And and when you say\n\nDiarrhea. What do mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool going to the toilet quite often and, like, some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, 6, 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose\n\nStool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain exactly? In my lower abdomen. So, like, yeah, just to 1 side. 1 side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp, and, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it\n\nAll the time, or does it come and go? It comes and goes. It goes. Does the pain move anywhere else? For example, towards your back? No. Just mainly my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. I just fainted for a week. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. Good. Yeah.\n\nAround about 3 or 4 days ago. You measure your temperature then? Yeah. I I didn't measure my temperature. No. But I felt just a bit hot. Okay. Okay. Any other symptoms like sweating or night? No. No. And any vomiting at all? Yeah. So I vomited at the start of the symptoms, but now I've stopped vomiting. You stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food color?\n\nYeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No. No. Right. Okay. Yeah. And any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind? I had a loss of appetite. So I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. And so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So for example, things like takeaway foods or eating out or being around other people who would see the symptoms. Yeah. So I had takeaway about 4 days ago. But other than that, I've\n\nYeah. I've been eating normally. I think unusual. Yeah. Do you remember what you ate? Yeah. I I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no 1 else in the family. So I have a wife and 2 kids, and 1 child was vomiting, but they haven't got diarrhea. It's no 1 with the same symptoms. Okay. Okay. Fine. Right. And in term\n\nYour your overall health? Are you normally feeling well? Or Yeah. I mean, other than asthma, like, using inhaler, everything else is fine. Okay. And is your asthma well controlled? Yeah. That's fine. Just yeah. You send inhaler, and that's under control. Alright. And you don't have any other tummy problem, bowel problem that I should be aware of? No. No. Okay. And apart from inhalers, do you take any other medications?\n\nNo. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past 3 days. Okay. Yeah. Other than that, it's Yeah. The main concern. And have you are you currently working at the moment? Yeah. I I work. Where do work? I'm an accountant. Okay. Have you\n\nGoing to work the last 3 days, or you've been at home? Yeah. I've been going to work. Okay. That must be difficult for you then. Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and 2 children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in a way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So normally, at this stage, I'd like to examine you.\n\nK. But Yeah. But but having listened to your stories, I think you just to recap, for the last 3 days, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side, and vomiting and feeling generally quite weak and lethargic. Yeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis Okay. Which essentially just a tummy bug or infection of your of your tummy.\n\nMainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated, so drinking fluids. There are things like Diurilite you can get from the pharmacy which it helps\n\nReplenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, would say recommend that at first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work. I would say next 2 2 to 3 days as the infection clears from your system, just take some time off and rest.\n\nYou know, if your symptoms haven't got better, you know, in in 3 to 4 days, I'd like you to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yep. Sure. Yep. How's that sound? That sounds great. Yeah. 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Uh","significant":false},{"start":6849,"end":6849,"said":"Bye.","significant":false},{"start":6870,"end":6874,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","\"Diarrhoea for 3 days - loose, watery stools 6-7 times per day\" and \"No blood in stool\"."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"Left lower abdominal cramping pain, intermittent\" and \"Pain does not radiate to back\"."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","\"Vomiting at onset of symptoms... now resolved\" and \"No blood in stool or vomit\"; no bilious claim."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Subjective fever at onset (not measured), currently afebrile\" plus \"Generalised weakness and feeling shaky\"."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Reduced appetite\" and \"Tolerating fluids, eating soups and smoothies\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","\"Consumed Chinese takeaway 4 days ago\" and \"One child with vomiting only\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"asthma, well controlled on inhaler\" and \"Current medications: asthma inhaler only\"."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Notes \"Continuing to attend work despite symptoms\" but omits needing to stay close to the toilet and the disruption to daily activities."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Gastroenteritis (likely viral, possible bacterial aetiology)\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","yes","\"Conservative management - no antibiotics indicated\", hydration and \"Dioralyte from pharmacy\"."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Two tablets up to four times daily is captured, but \"Paracetamol 1g\" adds a strength that was never stated."],["The plan captures rest and approximately two to three days off work.","yes","\"time off work for 2-3 days to allow recovery\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Review if symptoms persist beyond 3-4 days\" and stool sample if symptoms do not resolve."]],"claims":[["Paracetamol 1g (2 tablets)","Transcript says only \"two tablets up to four times a day\"; no strength was stated."],["Medical certificate provided","Clinician advised time off work but never mentioned issuing a medical certificate."]],"note":"Subjective:\n\nDiarrhoea for 3 days - loose, watery stools 6-7 times per day\n\nLeft lower abdominal cramping pain, intermittent\n\nVomiting at onset of symptoms (3-4 days ago), now resolved\n\nSubjective fever at onset (not measured), currently afebrile\n\nGeneralised weakness and feeling shaky\n\nReduced appetite\n\nTolerating fluids, eating soups and smoothies\n\nNo blood in stool or vomit\n\nNo night sweats\n\nPain does not radiate to back\n\nConsumed Chinese takeaway 4 days ago (18/09/2026)\n\nOne child with vomiting only, no other household members affected\n\nContinuing to attend work despite symptoms\n\nPast medical history: asthma, well controlled on inhaler\n\nSocial history: accountant, lives with wife and 2 children, non-smoker, no alcohol consumption\n\nCurrent medications: asthma inhaler only\n\n\n\n\nObjective:\n\nPhysical examination deferred\n\n\n\n\nAssessment:\n\nGastroenteritis (likely viral, possible bacterial aetiology)\n\n\n\n\nPlan:\n\nConservative management - no antibiotics indicated at this stage\n\nMaintain adequate hydration\n\nDioralyte from pharmacy for electrolyte replacement\n\nParacetamol 1g (2 tablets) up to four times daily as required for fever and weakness\n\nMedical certificate provided - time off work for 2-3 days to allow recovery and prevent transmission\n\nReview if symptoms persist beyond 3-4 days for further assessment\n\nStool sample for microscopy, culture and sensitivity if symptoms do not resolve\n\nPatient advised regarding red flag symptoms requiring urgent review","review":131.06578947368422,"saved":251.93421052631578,"clean":false,"effort":26.923076923076923,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Paracetamol regimen kept but a 1g strength was added that was never stated."],["fabrication","Medical certificate provided","Records a medical certificate as issued when only time off was advised; alters legal record."]],"mb":16.666892,"latency":24.878,"signable":155.9437894736842},{"label":"Run 5","wer":19.873150105708245,"text":"Hello? Hello. Hi. Hi. Should we stop? Yep. Okay. Hello. Good morning. So how can I help you this morning? Hi. I've just had some diarrhea for the last 3 days, and it's been affecting me. I need to stay close to the toilet. And, yeah, it's been affecting my day to day activities. Yeah. Sorry to hear that. And and when you say\n\nDiarrhea. What do mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose? Yeah. So it's like loose and watery stool going to the toilet quite often and, like, some pain in my, like, lower stomach. Okay. And how many times a day are you going, let's say, for the last couple of days? Probably, like, 6, 7 times a day. 6, 7 times a day. And you mentioned it's mainly watery. Have you noticed any other things like blood in your stools? No. No blood. Yeah. Just watery and loose\n\nStool. Okay. And you mentioned you've had some pain in your tummy as well. Yep. Whereabouts is the pain exactly? In my lower abdomen. So, like, yeah, just to 1 side. 1 side. And what side is that? On the left side. Left side. Okay. And can you describe the pain to me? Yeah. It feels like a cramp, like a muscular cramp, and, yeah, I feel a bit weak and shaky. Okay. And does the pain is that is it\n\nAll the time, or does it come and go? It comes and goes. It goes. Does the pain move anywhere else? For example, towards your back? No. Just mainly my stomach. Okay. Fine. And you mentioned you've been feeling quite weak and shaky as well. What do mean by shaky? Do you mean you've been having have you been feeling feverish, for example? Yeah. It doesn't feel like yeah. I just fainted for a week. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started. Good. Yeah.\n\nAround about 3 or 4 days ago. You measure your temperature then? Yeah. I I didn't measure my temperature. No. But I felt just a bit hot. Okay. Okay. Any other symptoms like sweating or night? No. No. And any vomiting at all? Yeah. So I vomited at the start of the symptoms, but now I've stopped vomiting. You stopped vomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal food color?\n\nYeah. Yeah. Just normal vomit. Yeah. And there was no blood in your vomit. Is that right? No. No. Right. Okay. Yeah. And any other symptoms at all? So you mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind? I had a loss of appetite. So I haven't been eating as much. Okay. But I've been able to hold down fluids. Okay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods, like smoothies and, yeah, liquid foods mainly. Okay. Fine. And so you started 3 days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So for example, things like takeaway foods or eating out or being around other people who would see the symptoms. Yeah. So I had takeaway about 4 days ago. But other than that, I've\n\nYeah. I've been eating normally. I think unusual. Yeah. Do you remember what you ate? Yeah. I I ate at a Chinese restaurant with friends. Okay. Anyone else unwell with similar symptoms? So no 1 else in the family. So I have a wife and 2 kids, and 1 child was vomiting, but they haven't got diarrhea. It's no 1 with the same symptoms. Okay. Okay. Fine. Right. And in term\n\nYour your overall health? Are you normally feeling well? Or Yeah. I mean, other than asthma, like, using inhaler, everything else is fine. Okay. And is your asthma well controlled? Yeah. That's fine. Just yeah. You send inhaler, and that's under control. Alright. And you don't have any other tummy problem, bowel problem that I should be aware of? No. No. Okay. And apart from inhalers, do you take any other medications?\n\nNo. No other medications. Okay. Fine. And in terms of just your your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life? So I need to stay close to the toilet because I go quite frequently during the these past 3 days. Okay. Yeah. Other than that, it's Yeah. The main concern. And have you are you currently working at the moment? Yeah. I I work. Where do work? I'm an accountant. Okay. Have you\n\nGoing to work the last 3 days, or you've been at home? Yeah. I've been going to work. Okay. That must be difficult for you then. Yeah. It's been quite difficult. Right. And you say you mentioned you live with a wife and 2 children. Is that right? Yes. Yep. Alright. Just a couple of other questions we need to ask. Do you smoke at all? No. I don't smoke. And do you drink much in a way of alcohol? No. I I don't drink alcohol. No. Okay. Yeah. So normally, at this stage, I'd like to examine you.\n\nOkay. But Yeah. But but having listened to your stories, I think you just to recap, for the last 3 days, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side, and vomiting and being generally quite weak and lethargic. Yeah. You mentioned you're having this Chinese takeaway as well 3 days ago, and I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis Okay. Which essentially just a tummy bug or infection of your of your tummy.\n\nMainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. Yeah. At this stage, what what we'd recommend is just what we say conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated, so drinking fluids. There are things like Diurilite you can get from the pharmacy, which it helps\n\nReplenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, would say recommend that at first, you know, first couple of days. Yeah. If you are feeling feverish and weak, taking some paracetamol, 2 tablets up to 4 times a day for the first few days can also help. I would certainly advise you to take some time off work. Actually, I know you're quite keen to work. I would say next 2 2 to 3 days as the infection clears from your system, just take some time off and rest.\n\nYou know, if your symptoms haven't got better, you know, in in 3 to 4 days, I'd like you to come back and see me again. Okay. Sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etcetera, etcetera. Yep. Sure. Yep. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me? No. No further questions. No. Okay. Is is the treatment plan clear?\n\nYeah. Yeah. That's that's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye. Bye bye.","marks":[{"start":0,"end":5,"said":"","significant":false},{"start":18,"end":21,"said":"Um","significant":false},{"start":32,"end":42,"said":"start Yeah","significant":false},{"start":55,"end":55,"said":"how um.","significant":false},{"start":70,"end":72,"said":"sir","significant":false},{"start":106,"end":109,"said":"Hello how are you Oh hey um","significant":false},{"start":338,"end":345,"said":"what'd you","significant":false},{"start":672,"end":672,"said":"or","significant":false},{"start":715,"end":724,"said":"mention","significant":false},{"start":924,"end":928,"said":"","significant":false},{"start":960,"end":960,"said":"Yep. 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It does not assert a measured temperature.","partial","Subjective unmeasured fever at onset and weakness captured, but absence of current fever is not stated."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids, soups, smoothies and liquid foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway and one household child with vomiting only documented."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma well controlled on inhaler; inhaler is only medication."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","Effect on work documented, but need to stay close to the toilet is not captured."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Gastroenteritis (likely viral, possible bacterial aetiology).\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management, fluids and Dioralyte captured, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Frequency captured but dose given as \"1g\" rather than the spoken two tablets; strength was not stated."],["The plan captures rest and approximately two to three days off work.","yes","2-3 days off work for rest and recovery documented."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if no improvement in 3-4 days and stool sample if persisting."]],"claims":[["Medical certificate provided for 2-3 days work leave","Clinician only advised time off; no medical certificate was mentioned or provided in the transcript."],["Paracetamol 1g orally four times daily","Transcript states \"two tablets up to four times a day\" with no strength; 1g is not stated."]],"note":"Subjective:\n\nLoose, watery stools for 3 days, occurring 6-7 times per day\n\nLeft lower abdominal cramping pain, intermittent\n\nVomiting at onset of symptoms (3-4 days ago), now resolved\n\nSubjective fever at symptom onset (not measured)\n\nGeneralised weakness and shakiness\n\nLoss of appetite\n\nTolerating fluids; eating soups, smoothies and other liquid foods\n\nNo blood in stool or vomit\n\nNo night sweats\n\nConsumed Chinese takeaway 4 days ago (18/09/2026)\n\nOne child in household with vomiting only (no diarrhoea); no other household members affected\n\nSymptoms affecting ability to work (accountant); has continued attending work despite symptoms\n\nPast medical history: Asthma, well controlled on inhaler\n\nSocial history: Lives with wife and 2 children; non-smoker; no alcohol consumption\n\nCurrent medications: Asthma inhaler only\n\n\n\n\nObjective:\n\nPhysical examination deferred\n\n\n\n\nAssessment:\n\nGastroenteritis (likely viral, possible bacterial aetiology)\n\n\n\n\nPlan:\n\nConservative management advised\n\nMaintain adequate hydration with oral fluids\n\nOral rehydration solution (Dioralyte) recommended, available from pharmacy\n\nParacetamol 1g orally four times daily as needed for fever and weakness\n\nMedical certificate provided for 2-3 days work leave to allow rest and recovery\n\nReview appointment if no improvement within 3-4 days\n\nStool sample for microscopy, culture and sensitivity if symptoms persist beyond this timeframe","review":164.9078947368421,"saved":218.0921052631579,"clean":false,"effort":34.61538461538461,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Records an unstated 1 g dose instead of the spoken 'two tablets'."],["fabrication","Medical certificate provided for 2-3 days work leave","Invents the issuing of a medical certificate, a legal document, when only verbal advice to take time off was given."]],"mb":16.668632,"latency":19.974,"signable":184.8818947368421}],"preve":[{"label":"Run 1","wer":20.577871740662438,"text":"Hello? Hello. Hi. Hi. Should we stop?\n\nYep. Okay. Hello. Good morning, sir. How can I help you this morning?\n\nHi. I've just had some diarrhea for the last\n\nthree days, and it's been affecting me. I need to\n\nstay close to the toilet. And, yeah, it's been affecting my day to day activities.\n\nYeah. I'm sorry to hear that. And and when you say diarrhea, what do you mean by\n\ndiarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\nYeah. So it's like loose and watery stool going to the toilet quite often.\n\nAnd, like, some pain in my, like, lower stomach.\n\nOkay. And how many times a day are you going, let's say, for the last couple of days?\n\nProbably, like, six, seven times a\n\nday. Six, seven times a day.\n\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\n\nNo. No blood. Yeah. Just watery and loose stool.\n\nOkay. And you mentioned you've had some pain in your tummy as well.\n\nYep. Whereabouts is the\n\npain exactly? So it's like in my lower abdomen.\n\nSo, like, yeah, just to one side.\n\nOne side. And what side is that?\n\nOn the left side.\n\nLeft side. Okay. And\n\nyou describe the pain to me?\n\nYeah. It feels like a cramp.\n\nLike a muscular cramp. And\n\nyeah, I feel a bit weak and shaky.\n\nOkay.\n\nAnd does the pain is that is it there all the time, or does it come and go?\n\nIt comes and goes.\n\nDoes it go? Does the pain move anywhere else? For example, towards your back?\n\nNo. Just mainly my stomach.\n\nOkay. Fine. And you mentioned you'd feeling quite weak and shaky as well. What do mean by\n\nshaky? Do you mean you've been having have you been feeling feverish, for example?\n\nYeah. It doesn't feel like yeah. I just think\n\nfor the week. I haven't had a fever at the moment, but I did notice\n\nsome temperature when the symptoms started. So\n\nyeah, around about three or four days ago.\n\nYou measure your temperature then?\n\nYeah. I I didn't measure my temperature.\n\nNo. But I felt just a bit hot. Okay. Okay.\n\nOther symptoms like sweating or No. No.\n\nAnd any vomiting at all?\n\nYeah. So\n\nI vomited at the start of the symptoms, but now I've stopped vomiting.\n\nYou stopped vomiting. Okay. And was your vomit I know it's not nice. We've talked\n\nabout, but was it just normal food color\n\nYeah. Yeah. Just normal vomit.\n\nYeah. And there was no blood in your vomit?\n\nThat right?\n\nNo blood. No.\n\nRight. Okay. Yeah.\n\nAnd any other symptoms at all? So you mentioned tummy pain. You mentioned\n\ndiarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind?\n\nI had a loss of appetite, so I haven't been eating as much.\n\nBut I've been able to hold down fluids\n\nOkay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat if anything?\n\nJust soups and, yeah, light foods.\n\nLike smoothies and, yeah, liquid foods mainly. Okay.\n\nFine. And so the start is\n\ndays ago with symptoms. Are you aware of any triggers which may have caused the symptoms\n\nto kick on? So for example, thinking I take away\n\nfoods or eating out or beating around other people who would see the symptoms.\n\nYeah. So I had takeaway about four days ago.\n\nBut other than that, I've, yeah, been eating normally.\n\nI think unusual. Yeah. Do you remember what you ate?\n\nYeah. I I ate at a Chinese restaurant with friends.\n\nOkay.\n\nAnyone else unwell with similar symptoms?\n\nSo no one else in the family. So I have a wife and two kids and one child was vomiting, but they haven't got diarrhea. There's no one with the\n\nsame symptoms.\n\nOkay. Okay. Fine.\n\nRight. And in terms of your overall health,\n\nare you normally feeling well?\n\nOr\n\nYeah. I mean, other than\n\nlike, using inhaler, everything else is fine.\n\nOkay. And is your asthma well controlled?\n\nYeah. That's fine. Just yeah. You send inhaler.\n\nAnd that's under control.\n\nFine. And you don't have any other\n\ntummy problem, bowel problem that should be aware of?\n\nNo.\n\nNo. Okay.\n\nAnd apart from the inhalers, do you take any other medications?\n\nNo. No other medications.\n\nOkay. Fine.\n\nIn terms of just your your day to day life, you said it's been affecting your life.\n\nYeah. In what way has it been affecting your life?\n\nSorry. I need to stay close to the toilet because I go\n\nquite frequently during the these past three days. Okay.\n\nYeah. Other than that, it's Yeah. Yeah, the main concern.\n\nAnd have you are you currently working at the moment?\n\nYeah. I I work. You work? I'm an accountant.\n\nOkay. Have you been going to work the last three days, or you've been at home?\n\nYeah. I've been going to work. Okay.\n\nThat must be difficult for you then.\n\nYeah. It's\n\nbeen quite difficult.\n\nRight. And you say you mentioned you live with a wife and\n\ntwo children. Is that right?\n\nYes. Yep. Alright.\n\nJust a couple of other question we need to ask. Do you smoke at all?\n\nNo. I don't smoke.\n\nAnd do you drink much in the way of alcohol?\n\nNo. I I don't drink alcohol. No. Okay.\n\nYeah. So\n\nnormally, at this stage, I like to\n\nexamine you if that's okay. But\n\nYeah.\n\nBut but having listened to your stories, I think\n\njust to recap, the last three days you've been having loose stool, diarrhea, bit of\n\ntummy pain mainly on the left hand side, vomiting and being feeling quite weak and lethargic.\n\nYeah. You mentioned you had this Chinese takeaway as well three days ago, I wonder whether that might be\n\nthe cause of your problems.\n\nOkay.\n\nIt seems like you may have something\n\ncalled gastroenteritis. Okay.\n\nWhich essentially just a tummy bug or infection of your tummy.\n\nYep. Mainly caused by viruses, they can be\n\na possibility of bacteria causing your symptoms. Yeah.\n\nAt this stage, what we'd recommend is just\n\nwhat we say conservative management. So I don't think you need anything like\n\nantibiotics. It's really just making sure you're well hydrated.\n\nSo drinking Mhmm. Fluids.\n\nThere are things like Dairolite. You\n\nget from the pharmacy, which it's, it helps\n\nreplenish some of your minerals and vitamins.\n\nOkay.\n\nAnd if you are having vomiting and diarrhea, I would say recommend that in the first, you know, first couple of days.\n\nYeah. If you are\n\nfeeling\n\nfeverish and weak, taking some paracetamol two tablets up to four times a day for the first few days can also help.\n\nI'll certainly advise you to take some time at work. Actually, I know you're quite\n\nkeen to work. I would say next two two to three days,\n\naction clears from your system. Take some time off and rest.\n\nIf your symptoms haven't got better, you know, in in\n\nthree to four days, I'd like you to come back and see me again. Okay.\n\nSure.\n\nBecause if it is ongoing, then we have to wonder whether there's something else causing symptoms.\n\nYep. And we may need to do further tests like\n\ntaking a sample of your stool so we can test that, etcetera,\n\nYep. Sure. Yep.\n\nHow's that sound?\n\nThat sounds great. Yeah.\n\nYeah. Do you have any questions for me?\n\nNo. No further questions.\n\nNope. Okay. Is the is the treatment plan clear?\n\nYeah. Yeah. That's that's very clear. Thank\n\nyou. Great. Well, I wish you all the best.\n\nOkay. Thank\n\nyou. Thank you. Bye. 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It does not require or invent bilious vomiting.","yes","\"Initial vomiting at symptom onset; now resolved\" and \"Blood in vomit: denies\"."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Felt hot at onset...; no measured temperature; currently afebrile\" plus weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"reduced appetite; able to keep fluids down; eating soups/smoothies\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese restaurant takeaway and \"one child vomited, no diarrhoea\"."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","\"Asthma; uses inhaler; well controlled\"; Medications lists only the inhaler."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"Impact: must stay near toilet; attending work as an accountant but difficult\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely acute gastroenteritis (viral or bacterial)\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Hydration and Dioralyte with conservative management captured; no antibiotics not explicitly stated."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"paracetamol 2 tablets up to 4x/day short term if feverish/weak\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest; take 2-3 days off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Seek review if not improving in 3-4 days for possible stool tests\"."]],"claims":[],"note":"Presenting Condition\n\nLoose, watery stools 6–7×/day for 3 days\n\nLower abdominal pain, left‑sided; crampy; intermittent; non‑radiating\n\nInitial vomiting at symptom onset; now resolved\n\nFelt hot at onset 3–4 days ago; no measured temperature; currently afebrile\n\nFeels weak and shaky; reduced appetite; able to keep fluids down; eating soups/smoothies\n\nTrigger: ate takeaway (Chinese restaurant) ~4 days ago; family largely well (one child vomited, no diarrhoea)\n\nImpact: must stay near toilet; attending work as an accountant but difficult\n\n\n\n\nPast Medical History\n\nAsthma; uses inhaler; well controlled\n\n\n\n\nMedications\n\nInhaler for asthma\n\nAdvised: paracetamol 2 tablets up to 4×/day short term if feverish/weak\n\n\n\n\nRed Flag/Screening Questions\n\nBlood in stool: denies\n\nBlood in vomit: denies\n\nVomiting: present initially, now stopped\n\nFever: felt hot at onset; no current fever reported\n\nTummy/bowel problems history: denies\n\nSmoking: denies\n\nAlcohol: denies\n\n\n\n\nSocial History\n\nLives with wife and two children\n\nOccupation: accountant; has continued working past 3 days\n\n\n\n\nGoals\n\nSymptom relief and return to normal activities\n\n\n\n\nObjective\n\n(Consent obtained)\n\nNo physical examination details recorded in transcript\n\n\n\n\nDiagnosis\n\nLikely acute gastroenteritis (viral or bacterial)\n\nPrognosis: expected to improve with conservative care within a few days\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nMaintain hydration; consider oral rehydration salts (e.g., Dioralyte) especially early phase\n\nUse paracetamol as needed for fever/aches within safe limits\n\nRest; take 2–3 days off work\n\nSeek review if not improving in 3–4 days for possible stool tests\n\n\n\n\nPlan\n\nConservative management now; review if symptoms persist beyond 3–4 days\n\nTime off work for next 2–3 days\n\nIf ongoing or worsening: consider stool sample and further tests\n","review":103.01315789473684,"saved":279.9868421052632,"clean":false,"effort":3.8461538461538463,"sig":[],"mb":13.1958,"signable":128.13215789473685},{"label":"Run 2","wer":20.29598308668076,"text":"Hello? Hello. Hi. Hi. Should we stop?\n\nYep. Okay. Hello. Good morning, sir. How can I help you this morning?\n\nHi. I've just had some diarrhea for the last\n\nthree days, and it's been affecting me. I need to\n\nstay close to the toilet. And, yeah, it's been affecting my day to day activities.\n\nYeah. I'm sorry to hear that. And and when you say diarrhea,\n\ndo you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\nYeah. So it's like loose and watery stool going to the toilet quite\n\nand, like, some pain in my\n\nlike, lower stomach. Okay. And how many times a day are you going, let's say, for the last\n\ncouple of days?\n\nProbably, like, six, seven times a day.\n\nSix, seven times a day.\n\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\n\nNo. No blood. Yeah. Just watery and loose stool.\n\nOkay. And you mentioned you've had some pain in your tummy as well.\n\nYep. Whereabouts is the pain exactly? So it's\n\nlike in my lower abdomen.\n\nSo, like, yeah, just to one side.\n\nOne side. And what side is that?\n\nOn the left side.\n\nLeft side. Okay. And can you describe the pain to me?\n\nYeah. It feels like a cramp, like a muscle.\n\nCramp. And, yeah, I feel a bit weak and shaky.\n\nOkay. And does the pain is that is it there all the time, or does it come and go?\n\nIt comes and goes.\n\nDoes it go? Does the pain move anywhere else? For example, towards your back?\n\nNo. Just mainly my stomach.\n\nOkay. Fine. And you mentioned you'd feeling quite weak and shaky as well. What do mean by\n\nshaky? Do you mean you've been having have you been feeling feverish, for example?\n\nYeah. It doesn't feel like yeah. I just make feel weak. I haven't had\n\na fever at the moment, but I did notice a temperature\n\nwhen the symptoms started. So\n\nyeah, around about three or four days ago.\n\nYou measure your temperature then?\n\nYeah. I I didn't measure my temperature. No. But I felt just a bit hot.\n\nOkay.\n\nOkay. Any\n\nother symptoms like sweating or\n\nnight? No. No. And any vomiting at all?\n\nYeah. So I vomited at the start of the symptoms, but\n\nnow I've stopped vomiting.\n\nVomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal\n\nfood color?\n\nYeah. Yeah. Just normal vomit.\n\nYeah.\n\nAnd there was no blood in your vomit. Is that right?\n\nNo blood.\n\nNo. Right. Okay.\n\nYeah. And any other symptoms\n\nall? You mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting.\n\nYep. Anything else that comes to mind?\n\nI had a loss of appetite.\n\nSo I haven't been eating as much. Okay. But I've been able to\n\nhold down fluids.\n\nOkay. So you're drinking fluids.\n\nYeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods.\n\nLike smoothies and, yeah, liquid foods mainly. Okay.\n\nFine. And so\n\nyou started three days ago with symptoms. Are you aware of any triggers which may have caused the symptoms\n\nto kick on? So for example, things like takeaway\n\nfoods or eating out or beating around other people who had similar symptoms.\n\nYeah. So I had takeaway about four days ago.\n\nBut other than that, I've, yeah, been eating normally.\n\nI think unusual. Yeah. Do you remember what you ate?\n\nYeah. I I ate at a Chinese restaurant with friends.\n\nOkay.\n\nAnyone else unwell with similar symptoms?\n\nSo no one else in the family. So I have a wife and two kids and one child was vomiting, but they haven't got diarrhea. It's no one with the\n\nsame\n\nsymptoms.\n\nOkay. Okay. Fine.\n\nRight. And in terms of your overall health, are you normally fitting well?\n\nOr\n\nYeah. I mean, other than\n\nasthma, like using inhaler, everything else is fine.\n\nOkay. And is your asthma well controlled?\n\nYeah. That's fine. Just, yeah, use an inhaler, and that's something\n\ncontrol.\n\nFine. And you don't have any other tummy problem, bowel problem that should be aware of?\n\nNo. No. Okay. And apart from inhalers, do you take any other medication\n\nNo. No other medications.\n\nOkay. Fine.\n\nIn terms of just your your day to day life, you said it's been affecting your life.\n\nYeah. In what way has it been affecting your life?\n\nSorry. I need to stay close to the toilet because I go\n\nquite frequently during the these past three days. Okay.\n\nYeah. Other than that, it's Yeah. Yeah, the main concern.\n\nAnd have you are you currently working at the moment?\n\nYeah. I I work. You work? I'm an accountant.\n\nOkay. Have you been going to work the last three days, or you've been at home?\n\nYeah. I've been going to work. Okay.\n\nThat must be difficult for you then.\n\nYeah. It's been\n\nquite difficult.\n\nRight. And you say you mentioned you live with a wife and\n\ntwo children. Is that right?\n\nYes.\n\nYep. Alright.\n\nJust a couple of other question we need to ask. Do you smoke at all?\n\nNo. I don't smoke.\n\nAnd do you drink much in the way of alcohol?\n\nNo. I I don't drink alcohol. No. Okay.\n\nYeah. So\n\nnormally, at this stage, I like to\n\nexamine you if that's okay. But Yeah. But but having listened to your stories,\n\nI think you just to recap the the last\n\ndays, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side.\n\nAnd vomiting and being generally quite weak and lethargic.\n\nYeah. You mentioned you had this Chinese takeaway as well three days ago, and I wonder whether that might be\n\ncause of your problems.\n\nOkay. It\n\nseems like you may have something\n\ncalled gastroenteritis. Okay.\n\nWhich essentially just a tummy bug or infection of your tummy.\n\nYep. Mainly caused by viruses, but they can be\n\npossibility of bacteria causing your symptoms. Yeah.\n\nAt this stage, what we'd recommend is just\n\nwhat we say conservative management. So I don't think you need anything like antibiotics. It's really just\n\nmaking sure you're well hydrated, so drinking Mhmm. Fluids.\n\nThere are things like\n\nDairolite you can get from the pharmacy, which it's\n\nhelps replenish some of your minerals and vitamins.\n\nOkay. And if you are having vomiting and diarrhea, would say recommend that at first.\n\nYou know, first couple of days. Yeah. If you are feeling\n\nfeverish and weak, taking some paracetamol two tablets up to four times a day for the first few days can also help.\n\nI'll certainly advise you to take some time at work. Actually, I know you're quite keen to work. I would say next\n\ntwo two to three days Yeah. Action clears from your system.\n\nTake some time off and rest.\n\nIf your symptoms\n\nhaven't\n\ngot better, you know, in in three to days, I'd like you to come back and see me again.\n\nOkay.\n\nSure.\n\nIf it is ongoing, then we have to wonder whether there's something else causing symptoms.\n\nYep. And we may need to do further tests like\n\ntaking a sample of your stool so we can test that.\n\nEtcetera, etcetera.\n\nYep. Sure.\n\nYep. How's that sound?\n\nThat sounds great. Yeah.\n\nYeah. Do you have any questions for me?\n\nNo. No further questions. Nope.\n\nOkay. Is the is the treatment plan clear?\n\nYeah.\n\nYeah. That's that's very clear. Thank you.\n\nGreat. Well, I wish you all the best.\n\nOkay. Thank you.\n\nThank you. Bye. 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It does not require or invent bilious vomiting.","yes","Initial vomiting now stopped, no blood."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt hot at onset, no measured temp, no current fever; weak/shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite, tolerating fluids, soups/smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway and one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma, inhaler, well controlled; inhaler the only medication listed."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","Needs to stay near toilet; affects activities; working with difficulty."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely acute gastroenteritis (viral > bacterial)\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Oral rehydration (Dioralyte) captured, but no statement of conservative management or that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"paracetamol 2 tablets up to 4x/day for first few days\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest and take 2-3 days off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","partial","Stool sample captured but review interval stated as \"3-5 days\" rather than the spoken 3-4 days."]],"claims":[["Return if no improvement in 3-5 days","Transcript states review if not better \"in three to four days\"; 3-5 days is not said."]],"note":"Presenting Condition\n\nOnset 3–4 days ago after eating Chinese takeaway\n\nLoose, watery stools 6–7x/day\n\nCramping pain in lower abdomen, left-sided, intermittent\n\nInitial vomiting at symptom onset; now resolved\n\nFelt hot at onset without measured temp; currently no fever\n\nFeels weak/shaky; loss of appetite; tolerating fluids; eating soups/smoothies\n\nNeeds to stay near toilet; affects day-to-day activities\n\n\n\n\nRadiology\n\nNone discussed\n\n\n\n\nPast Medical History\n\nAsthma, uses inhaler; well controlled\n\nDenies prior tummy/bowel problems\n\n\n\n\nMedications\n\nInhaler for asthma\n\nAdvised: paracetamol 2 tablets up to 4x/day for first few days if feverish/weak\n\n\n\n\nRed Flag/Screening Questions\n\nBlood in stool: denies\n\nVomiting: present at start, now stopped; no blood\n\nFever: felt hot at onset, no measured temp; no current fever\n\nPain radiation to back: denies\n\nSweats/night symptoms: denies\n\n\n\n\nSocial History\n\nLives with wife and two children\n\nOne child vomited; no family members with diarrhoea\n\nNon-smoker\n\nNo alcohol\n\nOccupation: accountant; has continued working despite symptoms; difficult\n\n\n\n\nSport & Exercise History\n\nNot discussed\n\n\n\n\nGoals\n\nSymptom relief and return to normal activities/work\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nLikely acute gastroenteritis (viral > bacterial) post takeaway\n\nPrognosis: expect improvement within 2–3 days; reassess if persistent\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nOral rehydration (e.g., Dioralyte) to replace fluids/electrolytes\n\nLight diet as tolerated\n\nParacetamol for feverishness/weakness\n\nRest and take 2–3 days off work\n\nReturn if no improvement in 3–5 days for further tests (e.g., stool sample)\n\n\n\n\nPlan\n\nExpect recovery within several days\n\nOff work next 2–3 days, rest and hydrate\n\nReview if symptoms persist beyond 3–5 days or worsen; consider stool testing and further work-up\n","review":133.71052631578948,"saved":249.28947368421052,"clean":false,"effort":15.384615384615385,"sig":[["partial","The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","Review interval recorded as 3-5 days instead of the stated 3-4 days, altering follow-up timing."]],"mb":13.092217,"signable":160.24452631578947},{"label":"Run 3","wer":20.648343904157855,"text":"Hello? Hello. Hi. Hi. Should we stop?\n\nYep. Okay. Hello. Good morning, sir. How can I help you this morning?\n\nHi. I've just had some diarrhea for the last\n\nthree days, and it's been affecting me. I need to\n\nstay close to the toilet. And, yeah, it's been affecting my day to day activities.\n\nYeah. I'm sorry to hear that. And and when you say diarrhea, what do you mean by\n\ndiarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\nYeah. So it's like loose and watery stool going to the toilet quite often.\n\nAnd, like, some pain in my, like, lower stomach.\n\nOkay. And how many times a day are you going, let's say, for the last couple of days?\n\nProbably, like, six, seven times a\n\nday. Six, seven times a day.\n\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\n\nNo. No blood. Yeah. Just watery and loose stool.\n\nOkay. And you mentioned you've had some pain in your tummy as well.\n\nYep. Whereabouts is the\n\npain exactly? So it's like in my lower abdomen.\n\nSo, like, yeah, just to one side.\n\nOne side. And what side is that?\n\nOn the left side.\n\nLeft side. Okay. And\n\nyou describe the pain to me?\n\nYeah. It feels like a cramp.\n\nLike a muscular cramp. And\n\nyeah, I feel a bit weak and shaky.\n\nOkay.\n\nAnd does the pain is that is it there all the time, or does it come and go?\n\nIt comes and goes.\n\nDoes it go? Does the pain move anywhere else? For example, towards your back?\n\nNo. Just mainly my stomach.\n\nOkay. Fine. And you mentioned you'd feeling quite weak and shaky as well. What do mean by\n\nshaky? Do you mean you've been having have you been feeling feverish, for example?\n\nYeah. It doesn't feel like yeah. I just think\n\nfor the week. I haven't had a fever at the moment, but I did notice\n\nsome temperature when the symptoms started. So\n\nyeah, around about three or four days ago.\n\nYou measure your temperature then?\n\nYeah. I I didn't measure my temperature.\n\nNo. But I felt just a bit hot. Okay. Okay.\n\nOther symptoms like sweating or No. No.\n\nAnd any vomiting at all?\n\nYeah. So\n\nI vomited at the start of the symptoms, but now I've stopped vomiting.\n\nYou stopped vomiting. Okay. And was your vomit I know it's not nice. We've talked\n\nabout, but was it just normal food color\n\nYeah. Yeah. Just normal vomit.\n\nYeah. And there was no blood in your vomit?\n\nThat right?\n\nNo blood. No.\n\nRight. Okay. Yeah.\n\nAnd any other symptoms at all? So you mentioned tummy pain. You\n\ndiarrhea. You mentioned your vomiting. Yep. Anything else that comes to mind?\n\nI had a loss of appetite, so I haven't been eating as much.\n\nBut I've been able to hold down fluids\n\nOkay. So you're drinking fluids. Yeah. What kind of foods have you managed to eat if anything?\n\nJust soups and, yeah, light foods.\n\nLike smoothies and, yeah, liquid foods mainly. Okay.\n\nFine. And so the start is\n\ndays ago with symptoms. Are you aware of any triggers which may have caused the symptoms\n\nto kick on? So for example, thinking I take away\n\nfoods or eating out or beating around other people who would see the symptoms.\n\nYeah. So I had takeaway about four days ago.\n\nBut other than that, I've, yeah, been eating normally.\n\nI think unusual. Yeah. Do you remember what you ate?\n\nYeah. I I ate at a Chinese restaurant with friends.\n\nOkay.\n\nAnyone else unwell with similar symptoms?\n\nSo no one else in the family. So I have a wife and two kids and one child was vomiting, but they haven't got diarrhea. There's no one with the\n\nsame symptoms.\n\nOkay. Okay. Fine.\n\nRight. And in terms of your overall health,\n\nare you normally feeling well?\n\nOr\n\nYeah. I mean, other than\n\nlike, using inhaler, everything else is fine.\n\nOkay. And is your asthma well controlled?\n\nYeah. That's fine. Just yeah. You send inhaler.\n\nAnd that's under control.\n\nFine. And you don't have any other\n\ntummy problem, bowel problem that should be aware of?\n\nNo.\n\nNo. Okay.\n\nAnd apart from the inhalers, do you take any other medications?\n\nNo. No other medications.\n\nOkay. Fine.\n\nIn terms of just your your day to day life, you said it's been affecting your life.\n\nYeah. In what way has it been affecting your life?\n\nSorry. I need to stay close to the toilet because I go\n\nquite frequently during the these past three days. Okay.\n\nYeah. Other than that, it's Yeah. Yeah, the main concern.\n\nAnd have you are you currently working at the moment?\n\nYeah. I I work. You work? I'm an accountant.\n\nOkay. Have you been going to work the last three days, or you've been at home?\n\nYeah. I've been going to work. Okay.\n\nThat must be difficult for you then.\n\nYeah. It's\n\nbeen quite difficult.\n\nRight. And you say you mentioned you live with a wife and\n\ntwo children. Is that right?\n\nYes. Yep. Alright.\n\nJust a couple of other question we need to ask. Do you smoke at all?\n\nNo. I don't smoke.\n\nAnd do you drink much in the way of alcohol?\n\nNo. I I don't drink alcohol. No. Okay.\n\nYeah. So\n\nnormally, at this stage, I like to\n\nexamine you if that's okay. But\n\nYeah.\n\nBut but having listened to your stories, I think\n\njust to recap, the last three days you've been having loose stool, diarrhea, bit of\n\ntummy pain mainly on the left hand side, vomiting and being generally quite weak and lethargic.\n\nYeah. You mentioned you had this Chinese takeaway as well three days ago, I wonder whether that might be\n\nthe cause of your problems.\n\nOkay.\n\nIt seems like you may have something\n\ncalled gastroenteritis. Okay.\n\nWhich essentially just a tummy bug or infection of your tummy.\n\nYep. Mainly caused by viruses, they can be\n\na possibility of bacteria causing your symptoms. Yeah.\n\nAt this stage, what we'd recommend is just\n\nwhat we say conservative management. So I don't think you need anything like\n\nantibiotics. It's really just making sure you're well hydrated.\n\nSo drinking Mhmm. Fluids.\n\nThere are things like Dairolite. You\n\nget from the pharmacy, which it's, it helps\n\nreplenish some of your minerals and vitamins.\n\nOkay.\n\nAnd if you are having vomiting and diarrhea, I would say recommend that in the first, you know, first couple of days.\n\nYeah. If you are\n\nfeeling\n\nfeverish and weak, taking some paracetamol two tablets up to four times a day for the first few days can also help.\n\nI'll certainly advise you to take some time at work. Actually, I know you're quite\n\nkeen to work. I would say next two two to three days,\n\naction clears from your system. Take some time off and rest.\n\nIf your symptoms haven't got better, you know, in in\n\nthree to four days, I'd like you to come back and see me again. Okay.\n\nSure.\n\nBecause if it is ongoing, then we have to wonder whether there's something else causing symptoms.\n\nYep. And we may need to do further tests like\n\ntaking a sample of your stool so we can test that, etcetera,\n\nYep. Sure. Yep.\n\nHow's that sound?\n\nThat sounds great. Yeah.\n\nYeah. Do you have any questions for me?\n\nNo. No further questions.\n\nNope. Okay. Is the is the treatment plan clear?\n\nYeah. Yeah. That's that's very clear. Thank\n\nyou. Great. Well, I wish you all the best.\n\nOkay. Thank\n\nyou. Thank you. Bye. 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It does not require or invent bilious vomiting.","yes","Initial vomiting now resolved; blood in vomit denied."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt feverish at onset, no measured temp, no current fever, weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, soups/smoothies."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway with friends; one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma controlled with inhaler; inhaler listed as sole regular medication."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"must stay close to toilet; work attendance difficult but ongoing\"."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely acute gastroenteritis (viral or bacterial)\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Conservative management with fluids and ORS (Dioralyte), but no statement that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Paracetamol captured but as \"up to 1 g QID\" rather than the spoken two tablets; no strength was stated."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest; take 2-3 days off work\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return if no improvement in 3-4 days for stool tests."]],"claims":[["paracetamol up to 1 g QID","Only \"two tablets up to four times a day\" was said; 1 g strength is not in the transcript."],["Prognosis: expected improvement within 2-4 days with conservative care","No prognosis or expected recovery timeframe was stated; clinician only said to take 2-3 days off and review if not better in 3-4 days."]],"note":"Presenting Condition\n\nOnset 3–4 days ago after eating Chinese takeaway with friends\n\nLoose, watery stools 6–7x/day for 3 days\n\nLower abdominal pain, left‑sided, cramping, intermittent; non-radiating\n\nInitial vomiting at symptom start; now resolved\n\nFelt feverish at onset; no measured temp; currently no fever\n\nFeels weak and shaky; reduced appetite; tolerating fluids; eating soups/smoothies\n\nImpact: must stay close to toilet; work attendance difficult but ongoing (accountant)\n\n\n\n\nRed Flag/Screening Questions\n\nBlood in stool: denies\n\nBlood in vomit: denies\n\nFever: felt hot at onset; none currently; no sweats\n\nVomiting: present initially; resolved\n\nOther bowel/abdominal history: denies\n\n\n\n\nPast Medical History\n\nAsthma, controlled with inhaler\n\n\n\n\nMedications\n\nInhaler for asthma\n\nAdvised: paracetamol up to 1 g QID PRN for fever/aches\n\n\n\n\nSocial History\n\nLives with wife and two children; one child vomited but no diarrhoea\n\nOccupation: accountant; has been attending work despite symptoms\n\nTobacco: non-smoker\n\nAlcohol: does not drink\n\n\n\n\nDiagnosis\n\nLikely acute gastroenteritis (viral or bacterial)\n\nPrognosis: expected improvement within 2–4 days with conservative care\n\n\n\n\nTreatment\n\nEd:\n\nHydration emphasis; oral rehydration salts (e.g., Dioralyte)\n\nRest; take 2–3 days off work\n\nParacetamol up to 1 g QID for fever/aches\n\nReturn if no improvement in 3–4 days for further tests (e.g., stool sample)\n\n\n\n\nPlan\n\nConservative management with fluids, ORS, rest, paracetamol PRN\n\nReview if symptoms persist beyond 3–4 days or worsen\n\nPossible investigations at review: stool studies\n","review":141.21052631578948,"saved":241.78947368421052,"clean":false,"effort":26.923076923076923,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Paracetamol recorded as up to 1 g QID; spoken instruction was two tablets with no strength stated."]],"mb":13.095532,"signable":161.26452631578948},{"label":"Run 4","wer":20.29598308668076,"text":"Hello? Hello. Hi. Hi. Should we stop?\n\nYep. Okay. Hello. Good morning, sir. How can I help you this morning?\n\nHi. I've just had some diarrhea for the last\n\nthree days, and it's been affecting me. I need to\n\nstay close to the toilet. And, yeah, it's been affecting my day to day activities.\n\nYeah. I'm sorry to hear that. And and when you say diarrhea,\n\ndo you mean by diarrhea? Do you mean you're going to the toilet more often, or are your stools more loose?\n\nYeah. So it's like loose and watery stool going to the toilet quite\n\nand, like, some pain in my\n\nlike, lower stomach. Okay. And how many times a day are you going, let's say, for the last\n\ncouple of days?\n\nProbably, like, six, seven times a day.\n\nSix, seven times a day.\n\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\n\nNo. No blood. Yeah. Just watery and loose stool.\n\nOkay. And you mentioned you've had some pain in your tummy as well.\n\nYep. Whereabouts is the pain exactly? So it's\n\nlike in my lower abdomen.\n\nSo, like, yeah, just to one side.\n\nOne side. And what side is that?\n\nOn the left side.\n\nLeft side. Okay. And can you describe the pain to me?\n\nYeah. It feels like a cramp, like a muscle.\n\nCramp. And, yeah, I feel a bit weak and shaky.\n\nOkay. And does the pain is that is it there all the time, or does it come and go?\n\nIt comes and goes.\n\nDoes it go? Does the pain move anywhere else? For example, towards your back?\n\nNo. Just mainly my stomach.\n\nOkay. Fine. And you mentioned you'd feeling quite weak and shaky as well. What do mean by\n\nshaky? Do you mean you've been having have you been feeling feverish, for example?\n\nYeah. It doesn't feel like yeah. I just make feel weak. I haven't had\n\na fever at the moment, but I did notice a temperature\n\nwhen the symptoms started. So\n\nyeah, around about three or four days ago.\n\nYou measure your temperature then?\n\nYeah. I I didn't measure my temperature. No. But I felt just a bit hot.\n\nOkay.\n\nOkay. Any\n\nother symptoms like sweating or\n\nnight? No. No. And any vomiting at all?\n\nYeah. So I vomited at the start of the symptoms, but\n\nnow I've stopped vomiting.\n\nVomiting. Okay. And was your vomit I know it's not nice to talk about, but was it just normal\n\nfood color?\n\nYeah. Yeah. Just normal vomit.\n\nYeah.\n\nAnd there was no blood in your vomit. Is that right?\n\nNo blood.\n\nNo. Right. Okay.\n\nYeah. And any other symptoms\n\nall? You mentioned tummy pain. You mentioned diarrhea. You mentioned your vomiting.\n\nYep. Anything else that comes to mind?\n\nI had a loss of appetite.\n\nSo I haven't been eating as much. Okay. But I've been able to\n\nhold down fluids.\n\nOkay. So you're drinking fluids.\n\nYeah. What kind of foods have you managed to eat and anything?\n\nJust soups and, yeah, light foods.\n\nLike smoothies and, yeah, liquid foods mainly. Okay.\n\nFine. And so\n\nyou started three days ago with symptoms. Are you aware of any triggers which may have caused the symptoms\n\nto kick on? So for example, things like takeaway\n\nfoods or eating out or beating around other people who had similar symptoms.\n\nYeah. So I had takeaway about four days ago.\n\nBut other than that, I've, yeah, been eating normally.\n\nI think unusual. Yeah. Do you remember what you ate?\n\nYeah. I I ate at a Chinese restaurant with friends.\n\nOkay.\n\nAnyone else unwell with similar symptoms?\n\nSo no one else in the family. So I have a wife and two kids and one child was vomiting, but they haven't got diarrhea. It's no one with the\n\nsame\n\nsymptoms.\n\nOkay. Okay. Fine.\n\nRight. And in terms of your overall health, are you normally fitting well?\n\nOr\n\nYeah. I mean, other than\n\nasthma, like, using inhaler, everything else is fine.\n\nOkay. And is your asthma well controlled?\n\nYeah. That's fine. Just, yeah, use an inhaler, and that's something\n\ncontrol.\n\nFine. And you don't have any other tummy problem, bowel problem that should be aware of?\n\nNo. No. Okay. And apart from inhalers, do you take any other medication\n\nNo. No other medications.\n\nOkay. Fine.\n\nIn terms of just your your day to day life, you said it's been affecting your life.\n\nYeah. In what way has it been affecting your life?\n\nSorry. I need to stay close to the toilet because I go\n\nquite frequently during the these past three days. Okay.\n\nYeah. Other than that, it's Yeah. Yeah, the main concern.\n\nAnd have you are you currently working at the moment?\n\nYeah. I I work. You work? I'm an accountant.\n\nOkay. Have you been going to work the last three days, or you've been at home?\n\nYeah. I've been going to work. Okay.\n\nThat must be difficult for you then.\n\nYeah. It's been\n\nquite difficult.\n\nRight. And you say you mentioned you live with a wife and\n\ntwo children. Is that right?\n\nYes.\n\nYep. Alright.\n\nJust a couple of other question we need to ask. Do you smoke at all?\n\nNo. I don't smoke.\n\nAnd do you drink much in the way of alcohol?\n\nNo. I I don't drink alcohol. No. Okay.\n\nYeah. So\n\nnormally, at this stage, I like to\n\nexamine you if that's okay. But Yeah. But but having listened to your stories,\n\nI think you just to recap the the last\n\ndays, you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side.\n\nAnd vomiting and being generally quite weak and lethargic.\n\nYeah. You mentioned you had this Chinese takeaway as well three days ago, and I wonder whether that might be\n\ncause of your problems.\n\nOkay. It\n\nseems like you may have something\n\ncalled gastroenteritis. Okay.\n\nWhich essentially just a tummy bug or infection of your tummy.\n\nYep. Mainly caused by viruses, but they can be\n\npossibility of bacteria causing your symptoms. Yeah.\n\nAt this stage, what we'd recommend is just\n\nwhat we say conservative management. So I don't think you need anything like antibiotics. It's really just\n\nmaking sure you're well hydrated, so drinking Mhmm. Fluids.\n\nThere are things like\n\nDairolite you can get from the pharmacy, which it's\n\nhelps replenish some of your minerals and vitamins.\n\nOkay. And if you are having vomiting and diarrhea, would say recommend that at first.\n\nYou know, first couple of days. Yeah. If you are feeling\n\nfeverish and weak, taking some paracetamol two tablets up to four times a day for the first few days can also help.\n\nI'll certainly advise you to take some time at work. Actually, I know you're quite keen to work. I would say next\n\ntwo two to three days Yeah. Action clears from your system.\n\nTake some time off and rest.\n\nIf your symptoms\n\nhaven't\n\ngot better, you know, in in three to days, I'd like you to come back and see me again.\n\nOkay.\n\nSure.\n\nIf it is ongoing, then we have to wonder whether there's something else causing symptoms.\n\nYep. And we may need to do further tests like\n\ntaking a sample of your stool so we can test that.\n\nEtcetera, etcetera.\n\nYep. Sure.\n\nYep. How's that sound?\n\nThat sounds great. Yeah.\n\nYeah. Do you have any questions for me?\n\nNo. No further questions. Nope.\n\nOkay. Is the is the treatment plan clear?\n\nYeah.\n\nYeah. That's that's very clear. Thank you.\n\nGreat. Well, I wish you all the best.\n\nOkay. Thank you.\n\nThank you. Bye. 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Um I'll admit","significant":false},{"start":6449,"end":6449,"said":"four","significant":false},{"start":6477,"end":6481,"said":"","significant":false},{"start":6490,"end":6492,"said":"you","significant":false},{"start":6513,"end":6513,"said":"Because","significant":false},{"start":6564,"end":6571,"said":"","significant":false},{"start":6587,"end":6594,"said":"caused your","significant":false},{"start":6855,"end":6860,"said":"no.","significant":false},{"start":7011,"end":7011,"said":"Bye.","significant":false},{"start":7033,"end":7037,"said":"","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","yes","Onset 3-4 days, loose watery stools 6-7x/day, denies blood in stools."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","yes","\"Intermittent crampy pain in left lower abdomen.\""],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","yes","Vomited at start, now stopped; denies blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","Felt hot at onset, no measured temp, no current fever; weak and shaky."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Reduced appetite, tolerating fluids, light foods (soups, smoothies)."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese restaurant takeaway and one child vomited without diarrhoea."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","yes","Asthma, inhaler, well controlled; no other regular medications."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","yes","\"Needs to stay close to a toilet; affecting day-to-day activities\" and work difficulty."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Suspected acute gastroenteritis, likely viral; bacterial a possibility.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Hydration and Dioralyte captured, but no statement that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","\"Paracetamol 2 tablets up to 4 times/day.\""],["The plan captures rest and approximately two to three days off work.","yes","\"Rest and take 2-3 days off work.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Review if not improving in 3-4 days; consider stool testing."]],"claims":[],"note":"Presenting Condition\n\nOnset 3–4 days ago after eating takeaway at a Chinese restaurant\n\nLoose, watery stools 6–7x/day\n\nIntermittent crampy pain in left lower abdomen\n\nFelt hot at onset; no measured temp; currently no fever\n\nVomited at start of illness; vomiting has now stopped\n\nFeels weak and shaky; reduced appetite; tolerating fluids; eating light foods (soups, smoothies)\n\nNeeds to stay close to a toilet; affecting day‑to‑day activities\n\nContinues to attend work; difficult to manage symptoms at work\n\n\n\n\nPast Medical History\n\nAsthma; uses inhaler; well controlled\n\nDenies other gastrointestinal or bowel conditions\n\nNo known blood in stool or vomit reported\n\n\n\n\nMedications\n\nInhaler for asthma\n\nNo other regular medications\n\n\n\n\nRed Flag/Screening Questions\n\nBlood in stools: denies\n\nBlood in vomit: denies\n\nFever: felt hot initially; no current fever; did not measure temperature\n\nNight sweats: denies\n\nVomiting: present initially; now resolved\n\n\n\n\nSocial History\n\nLives with wife and two children\n\nOne child vomited but no diarrhoea in family\n\nAccountant; has been attending work despite symptoms\n\nTobacco: does not smoke\n\nAlcohol: does not drink\n\n\n\n\nSport & Exercise History\n\nNot discussed\n\n\n\n\nGoals\n\nSymptom relief and return to normal daily activities/work\n\n\n\n\nObjective\n\n(Consent obtained)\n\nExamination planned; not performed within transcript\n\n\n\n\nDiagnosis\n\nSuspected acute gastroenteritis, likely viral; bacterial a possibility\n\nPrognosis: expected improvement within 2–3 days with conservative care\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nMaintain hydration; consider oral rehydration solution (e.g., Dioralyte)\n\nParacetamol 2 tablets up to 4 times/day for fever/aches in first few days\n\nRest and take 2–3 days off work\n\n\n\n\nPlan\n\nExpect improvement in 2–3 days\n\nIf not improving in 3–4 days, review; consider stool testing and further investigations\n\nReturn sooner if worsening symptoms or new red flags appear\n\n\n\n\nHome Exercise Program\n\nNone prescribed for this condition\n","review":109.64473684210527,"saved":273.35526315789474,"clean":false,"effort":3.8461538461538463,"sig":[],"mb":13.165512,"signable":131.14273684210528}],"patientnotes":[{"label":"Run 1","wer":21.42353770260747,"text":"Hello. Hello. Hi.\nHi.\nShould\nwe stop? Yeah. Okay. Hello, how can I help you this morning?\nHi. I've just had some diarrhea for the last three days and it's been affecting me. I need to stay close to the toilet and yeah it's been affecting my day to day activities.\nSorry to hear that. And when you say diarrhea what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\nYeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my like lower stomach.\nOkay. And how many times a day are you going? Let's say\nthe last couple of days probably like six, seven times a day. Six, seven times a day.\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\nNo, no blood. Yeah, just watery and.\nLoose stall.\nOkay. And you mentioned you've had some pain in your tummy as well.\nYeah.\nWhereabouts is the pain?\nSo it's like in my lower abdomen. So, like. Yeah, just to one side. What side is that on the left side. Left side. Okay.\nAnd can you describe the pain to me?\nYeah, it feels like a cramp, like a muscular cramp. And yeah, I feel a bit weak and shaky.\nOkay. And does the pain. Is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\nNo, just mainly my stomach. Okay, fine.\nAnd you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having been feeling feverish, for example?\nYeah, it doesn't feel like. Yeah, it just makes me feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so.\nYeah, around about three or four days ago.\nDid you measure your temperature then?\nYeah, I didn't measure my temperature, no, But I felt just a bit hot. Okay.\nAny other symptoms, like sweating or night? No. And any vomiting at all?\nYeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\nYou stopped vomiting. Okay. And was your vomit. I know it's not nice to talk about, but was it just normal food color?\nYeah. Yeah, just normal vomit. There was no blood in your vomit? No blood? No. Okay.\nAnd any other symptoms at all? You mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Anything else that comes to mind?\nI had a loss of appetite. I haven't been eating as much, but I've been able to hold down fluids.\nOkay, so you're drinking fluids. What kind of foods have you managed to eat?\nAnything?\nJust soups and. Yeah, light foods, like smoothies and. Yeah, liquid foods, mainly. Okay,\nfine. And so we started three days ago. Symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So, for example, things like takeaway foods or eating out or being around other people who would. Similar symptoms?\nYeah, So I had takeaway about four days ago, but other than that, I've been eating normally, I think. Unusual. Yeah.\nDo you remember what you ate?\nYeah, I ate at a Chinese restaurant with friends. Okay,\nanyone else unwell with similar symptoms?\nSo no one else in the family? So I have a wife and two kids, and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\nOkay, fine.\nRight. And in terms of your overall health, are you normally fitting? Well,\nyeah. I mean, other than asthma, use an inhaler, everything else is fine.\nOkay. And is your asthma well controlled?\nYeah, that's fine. Just, yeah, use an inhaler and that's under control. And\nyou don't have any other tummy problem, bowel problems I should be aware of?\nNo.\nOkay. Apart from the inhalers, do you take any other medications?\nNo. No other medications.\nIn terms of just your, your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\nSo I need to stay close to the toilet because I go quite frequently during the, these past three days. Yeah, other than that, it's, yeah, the main concern.\nAnd are you currently working at the moment?\nYeah, I work.\nI'm an accountant. Okay. Have you been going to work the last three days or have you been at home? Yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. All right, just a couple of other questions we need to ask. Do you smoke at all? No, I don't smoke. Do you drink much in the way of alcohol? No, I don't drink alcohol, no. Okay. So normally at this stage I like to examine you, if that's okay. But having listened to your story, sir, I think just to recap, for the last three days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left hand side, and vomiting and being generally quite weak and lethargic. You mentioned you're having this Chinese takeaway as well, three days ago. And I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug.\nOr infection of your tummy, mainly caused by viruses, but they can be possibility of bacteria causing your symptoms. At this stage, what we'd recommend is just what we say, conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Diurelite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that first couple of days, if you are feeling feverish and weak, taking some Paracetamol, a few tablets, up to four times a day for the first few days can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work. I would say next two to three days. Players in your system.\nTake some time off and rest. If your symptoms haven't got better, you know, in three to four days, I'd like you to come back and see me again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etc. Etc. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me? No. No further questions. Okay. Is the treatment plan clear? Yeah, yeah, that's. That's very clear. Thank you. Great. Well, I wish you all the best. Okay. Thank you. Thank you. Bye.","marks":[{"start":0,"end":6,"said":"","significant":false},{"start":18,"end":21,"said":"Um","significant":false},{"start":32,"end":36,"said":"start","significant":false},{"start":55,"end":55,"said":"how um. Good morning sir","significant":false},{"start":90,"end":93,"said":"Hello how are you Oh hey um","significant":false},{"start":310,"end":317,"said":"what'd","significant":false},{"start":637,"end":637,"said":"or","significant":false},{"start":690,"end":699,"said":"mention","significant":false},{"start":824,"end":830,"said":"stool.","significant":false},{"start":928,"end":928,"said":"exactly Yep.","significant":false},{"start":933,"end":942,"said":"","significant":false},{"start":974,"end":978,"said":"um...yeah","significant":false},{"start":997,"end":997,"said":"One side. 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Yep","significant":false},{"start":6316,"end":6321,"said":"yep.","significant":false},{"start":6430,"end":6430,"said":"no.","significant":false},{"start":6570,"end":6570,"said":"Bye.","significant":false},{"start":6586,"end":6586,"said":"bye.","significant":false}],"facts":[["The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","partial","Captures \"Loose, watery stools 6-7 times/day, onset 3 days ago\" but omits absence of blood in stool."],["The note captures intermittent cramping left lower abdominal pain, without clear radiation.","partial","\"Lower left abdominal cramp-like pain, intermittent\" captured; absence of radiation not documented."],["The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","partial","\"Vomited at symptom onset, now resolved\" captured; no mention of absence of blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","yes","\"Weakness, shakiness, brief feverish feeling, no measured temperature\" conveys past subjective fever, weakness and no measured temp."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Loss of appetite, tolerating fluids (soups, smoothies, light foods)\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","partial","Chinese takeaway captured but the household child with vomiting is not mentioned."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","no","Asthma, inhaler use and absence of other medications are not documented."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","\"affecting daily activities\" noted, but need to stay close to toilet and work disruption omitted."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Likely acute gastroenteritis.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Hydration and oral rehydration solution recommended, but no statement that antibiotics are not needed."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","\"Paracetamol up to four times daily\" given without the two-tablet dose."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest; take 2-3 days off work.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Return if no improvement in 3-4 days for review and possible stool testing.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nDiarrhoea for three days affecting daily activities.\n\nHistory of Presenting Complaint::\n\nLoose, watery stools 6–7 times/day, onset 3 days ago.\n\nLower left abdominal cramp-like pain, intermittent.\n\nWeakness, shakiness, brief feverish feeling, no measured temperature.\n\nVomited at symptom onset, now resolved.\n\nLoss of appetite, tolerating fluids (soups, smoothies, light foods).\n\nPossible trigger: Chinese takeaway 4 days ago.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely acute gastroenteritis.\n\nPlan\n\nMedications::\n\nDiurelite oral rehydration solution recommended.\n\nParacetamol up to four times daily for fever/weakness.\n\nIncrease fluid intake; use oral rehydration solution.\n\nTake Paracetamol if feverish or feeling weak.\n\nRest; take 2–3 days off work.\n\nReturn if no improvement in 3–4 days for review and possible stool testing.\n\nContinue light diet as tolerated.","review":197.85526315789474,"saved":185.14473684210526,"clean":false,"effort":34.61538461538461,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Omits the negative screen for blood in stool, a pertinent red-flag negative that bears on invasive/bacterial cause."],["partial","The note captures initial vomiting which has now stopped, and no blood in vomit. It does not require or invent bilious vomiting.","Omits the negative screen for blood in vomit, a pertinent red-flag negative."],["missing","The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","Asthma, inhaler use and medication list entirely absent; relevant to prescribing."]],"mb":22.694467,"latency":27.111,"signable":224.96626315789473},{"label":"Run 2","wer":21.141649048625794,"text":"Hello. Hello? Hi. Should we stop? Yeah. Okay.\nHello? Good morning sir, how can I help you this morning?\nHi. I've just had some diarrhea for the last three days and it's been affecting me. I need to stay close to the toilet and yeah it's been affecting my day to day activities.\nSorry to hear that. And when you say diarrhea what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\nYeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my like lower stomach.\nOkay. And how many times a day are you going? Let's say\nover the last couple of days probably like six, seven times a day. Six, seven times a day\nand you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\nNo blood. Yeah, just watery and loose stool.\nOkay and you mentioned.\nYou've had some pain in your tummy as well?\nYeah.\nWhereabouts is the pain?\nSo it's like in my lower abdomen. So, like. Yeah, just to one side.\nOne side. And\nwhat side is that on the left side. Left\nside. Okay. And can you describe the pain to me?\nYeah, it feels like a cramp, like a muscular cramp. And, yeah, I feel a bit weak and shaky.\nOkay. And does the pain. Is that. Is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\nNo, just mainly my stomach. Okay, fine.\nAnd you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having been feeling feverish, for example?\nYeah, it doesn't feel like. Yeah, I just make me feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so, yeah, around about three or four days ago.\nYour temperature then?\nYeah, I didn't measure my temperature, no, But I felt just a bit hot. Okay. Okay.\nAny other symptoms like sweating or night? No. And any vomiting at all?\nYeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\nYou stopped vomiting. Okay. And was your vomit. I know it's not nice things to talk about, but was it just normal food color?\nYeah. Yeah, just normal vomit. There was no blood in your vomit? No blood? No. Okay.\nAnd any other symptoms at all? You mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Anything else that comes to mind?\nI had a loss of appetite. I haven't been eating as much, but I've been able to hold down fluids.\nOkay, so you're drinking fluids. What kind of foods have you managed to eat? Anything,\nJust soups and.\nYeah, light foods like smoothies and. Yeah, liquid foods mainly.\nOkay, fine. And so we started three days ago. Symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So, for example, things like take away foods or eating out or being around other people who would. Similar symptoms?\nYeah, so I had takeaway about four days ago, but other than that I've, yeah, been eating normally, I think. Unusual. Yeah.\nDo you remember what you ate?\nYeah, I ate at a Chinese restaurant with friends.\nOkay. Anyone else unwell with similar symptoms?\nSo no one else in the family? So I have a wife and two kids and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\nOkay. Okay, fine. Right. And in terms of your overall health, are you normally fitting well.\nYeah, I mean other than asthma, use an inhaler, everything else is fine.\nOkay. And is your asthma well controlled?\nYeah, that's fine. Just yeah, use an inhaler and that's under control. And\nyou don't have any other tummy problem, bowel problems I should be aware of?\nNo. No. Okay.\nApart from inhalers, do you take any other medications?\nNo, no other medications.\nOkay, fine. In terms of just your day to day life, you said it's been affecting your life. In what way has it been affecting your life?\nSo I need to stay close to the toilet because I go quite frequently during these past three days. Yeah, other than that it's the main concern.\nAnd are you currently working at the moment?\nYeah, I work. Work. I'm an accountant. Okay. Have you been going into work the last three days or you've been at home? Yeah, I've been going to work.\nThat must be difficult for you then. Yeah, it's been quite difficult. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. Just a couple of other questions we need to ask. Do you smoke at all? No, I don't smoke. Do you drink much in the way of alcohol? No, I don't drink alcohol, no. Okay. So normally at this stage I like to examine you. That's okay. But. But having listened to your stories, I think just to recap, for the last three days you've been having loose stool, diarrhea, a bit of tummy pain mainly on the left hand side and vomiting and being generally quite weak and lethargic. You mentioned you're having this Chinese takeaway as well three days ago. And I wonder whether that might be the cause of your problems. It seems like you may have something called gastroenteritis, which is essentially a tummy bug or infection of your tummy mainly caused by viruses, but they can be possibly.\nOf bacteria causing your symptoms. At this stage, what we'd recommend is just what we say, conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Diurelite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. Okay. And if you are having vomiting and diarrhea, I would say recommend that first couple of days. Yeah. If you are feeling feverish and weak, taking some Paracetamol, two tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work. I would say next two to three days clears from your system, take some time off and rest. If your symptoms haven't got better in three to four days, I'd like to come back and see you again.\nOkay, sure. Because if it is ongoing, then we have to wonder whether something else causing symptoms. And we may need to do further tests like taking a sample of your stool so we can test that, etc. Etc.\nYeah, sure. Yeah.\nHow's that sound?\nThat sounds great. Yeah. Yeah. Do\nyou have any questions for me?\nNo, no further questions.\nOkay. Is the treatment plan clear?\nYeah, yeah, that's very clear. Thank you.\nGreat. Well, I wish you all the best.\nOkay, thank you. Thank you. 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It does not require or invent bilious vomiting.","partial","Vomiting resolved captured, but states \"One episode\" (count not given) and omits no blood in vomit."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","partial","\"Weakness... mild temperature at onset, no measured fever\" but does not clearly state no current fever."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","\"Reduced appetite, tolerating soups, smoothies, fluids\"."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","partial","\"Chinese takeaway 4 days ago\" captured, but the vomiting household child is omitted."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","no","Asthma, inhaler use and no other medications are not recorded."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","\"affecting daily activities\" and \"limited by symptoms\" at work, but need to stay close to a toilet omitted."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute gastroenteritis, likely viral or bacterial\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Oral rehydration solution recorded, but no statement that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","\"two tablets up to four times daily\" correct, but adds unstated strength \"500 mg\"."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest from work for 2-3 days\"."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"Review if no improvement in 3-4 days; consider stool testing\"."]],"claims":[["One episode of vomiting resolved.","Transcript says only \"I vomited at the start of the symptoms\"; the number of episodes was never given."],["Paracetamol 500 mg, two tablets","No tablet strength was stated in the transcript."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with three days of diarrhoea affecting daily activities.\n\nHistory of Presenting Complaint::\n\nSubjective:\n\n3‑day history of watery diarrhoea, 6‑7 motions/day.\n\nLeft lower abdominal cramp‑like pain, intermittent.\n\nWeakness, shakiness, mild temperature at onset, no measured fever.\n\nOne episode of vomiting resolved.\n\nReduced appetite, tolerating soups, smoothies, fluids.\n\nPossible trigger: Chinese takeaway 4 days ago.\n\nWorks as accountant, continues to attend work but limited by symptoms.\n\nObjective\n\nObjective:\n\nNo physical examination performed during telehealth.\n\nNo vital signs recorded.\n\nNot discussed\n\nAssessment\n\nAssessment:\n\nAcute gastroenteritis, likely viral or bacterial.\n\nPlan\n\nMedications::\n\nOral rehydration solution (e.g., Diurelite) recommended for hydration and electrolyte replacement.\n\nParacetamol 500 mg, two tablets up to four times daily for fever and discomfort advised.\n\nPlan:\n\nMaintain fluid intake with oral rehydration solutions.\n\nParacetamol as needed for fever/pain.\n\nRest from work for 2‑3 days.\n\nReview if no improvement in 3‑4 days; consider stool testing.\n\nFollow‑up as needed.","review":251.5263157894737,"saved":131.4736842105263,"clean":false,"effort":53.84615384615385,"sig":[["missing","The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","Asthma and inhaler use are absent, so the record has no comorbidity or current medication."],["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Invented a paracetamol tablet strength that was never stated."]],"mb":25.296679,"latency":92.371,"signable":343.8973157894737},{"label":"Run 3","wer":21.21212121212121,"text":"Hello. Hello. Hi.\nHi. Should we stop? Yeah. Okay. Hello. Good morning sir, how can I help you this morning?\nHi. I've just had some diarrhea for the last three days and it's been affecting me. I need to stay close to the toilet and yeah it's been affecting my day to day activities.\nSorry to hear that. And when you say diarrhea what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\nYeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my like lower stomach.\nOkay. And how many times a day are you going? Let's say\nthe last couple of days probably like six, seven times a day. Six, seven times a day\nand you may mention it, mainly watery. Have you noticed any other things like blood in your stools?\nNo, no blood. Yeah, just watery and.\nLoose stall.\nOkay. And you mentioned you've had some pain in your tummy as well.\nYep.\nWhereabouts is the pain?\nSo it's like in my lower abdomen. So, like. Yeah, just to one side. What side is that on the left side.\nLeft side. Okay. And can you describe the pain to me?\nYeah, it feels like a cramp, like a muscular cramp. And yeah, I feel a bit weak and shaky.\nOkay. And does the pain. Is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\nNo, just mainly my stomach. Okay.\nAnd you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having been feeling feverish, for example?\nYeah, it doesn't feel like. Yeah, it just makes me feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so.\nYeah, around about three or four days ago.\nDid you measure your temperature then?\nYeah, I didn't measure my temperature, no. But I felt just a bit hot. Okay. Okay.\nAny other symptoms, like sweating or night? No. And any vomiting at all?\nYeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\nYou stopped vomiting. Okay. And was your vomit. I know it's not nice to talk about, but was it just normal food color?\nYeah. Yeah, just normal vomit. And there was no blood in your vomit, is that right? No blood? No, no. Okay.\nAnd any other symptoms at all? You mentioned tummy pain, you mentioned diarrhea, you mentioned vomiting. Anything else that comes to mind?\nI had a loss of appetite. I haven't been eating as much, but I've been able to hold down fluids.\nOkay, so you're drinking fluids. What kind of foods have you managed to eat?\nJust soups and. Yeah, light foods, like smoothies and. Yeah, liquid foods, mainly. Okay, fine.\nAnd so we started three days ago. Symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So, for example, things like takeaway foods or eating out or being around other people who would. Similar symptoms?\nYeah, So I had takeaway about four days ago, but other than that, I've been eating normally, I think. Unusual. Yeah.\nDo you remember what you ate?\nYeah, I ate at a Chinese restaurant with friends. Okay.\nAnyone else unwell with similar symptoms?\nSo no one else in the family? So I have a wife and two kids, and one child was vomiting, but they haven't got diarrhea. No one with the same symptoms.\nOkay, fine.\nRight. And in terms of your, your overall health, are you normally fitting well or.\nYeah, I mean, other than asthma, Use an inhaler, everything else is fine.\nOkay. And is your asthma well controlled?\nYeah, that's fine. Just. Yeah, use an inhaler and that's\nunder control. And you don't have any other tummy problem, bowel problems I should be aware of?\nNo.\nOkay. Apart from the inhalers, do you take any other medications?\nNo, no other medications.\nIn terms of just your, your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\nSo I need to stay close to the toilet because I go quite frequently during the, these past three days. Yeah, other than that, it's, yeah, the main concern.\nAnd are you currently working at the moment?\nYeah, I work.\nI'm an accountant. Okay. Have you been going to work the last three days or you've been at home? Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. Alright, just a couple of other questions we need to ask. Do you smoke at all? No, I don't smoke. Do you drink much in the way of alcohol? No, I don't drink alcohol, no. Okay. So normally at this stage I like to examine you, if that's okay. But having listened to your stories, I think just to recap, for the last three days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left hand side, and vomiting and being quite weak and lethargic. You mentioned you're having this Chinese takeaway as well, three days ago. And I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy.\nOr infection of your tummy, mainly caused by viruses, but they can be possibility of bacteria causing your symptoms. At this stage, what we'd recommend is just what we say, conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Diurelite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that first couple of days, if you are feeling feverish and weak, taking some Paracetamol, a few tablets up to four times a day for the first few days can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work. I would say next two to three days clears in your system.\nTake some time off and rest. If your symptoms haven't got better, you know, in three to four days, I'd like you to come back and see me again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etc. Etc. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me? No. No further questions. Okay. Is the treatment plan clear? Yeah, yeah, that's. That's very clear. Thank you. Great. 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It does not require or invent bilious vomiting.","partial","Vomiting at onset now resolved captured; no blood in vomit omitted."],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","partial","\"mild feeling of fever without measured temperature\" and weakness, but timing at onset and no current fever not stated."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite with tolerance of fluids, soups, smoothies, light liquids."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","partial","Chinese takeaway captured; household child vomiting omitted."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","\"Inhaler for asthma as usual\" but control status and no other medications not stated."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","partial","\"affecting daily activities\" noted, but need to stay near a toilet and work disruption not captured."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"likely acute gastroenteritis\"."],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Fluids and Diurelite ORS captured; no mention of conservative approach or no antibiotics."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","yes","Paracetamol up to four times a day for fever/discomfort; no conflicting dose."],["The plan captures rest and approximately two to three days off work.","yes","Time off work for next two to three days to rest."],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","Return for review if not improved in three to four days, possible stool testing."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nPatient reports three days of diarrhea affecting daily activities.\n\nHistory of Presenting Complaint::\n\nThe patient began experiencing loose, watery stools about three days ago, occurring six to seven times per day. He also reports lower left abdominal cramp-like pain, weakness, shakiness, a mild feeling of fever without measured temperature, an episode of vomiting at symptom onset that has since resolved, loss of appetite, and ability to tolerate fluids such as soups, smoothies, and other light liquids. He notes a possible trigger from a Chinese takeaway meal consumed four days ago. No relieving factors were identified.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: likely acute gastroenteritis.\n\nPlan\n\nMedications::\n\nParacetamol up to four times a day for fever and weakness.\n\nDiurelite oral rehydration solution to replenish minerals and vitamins.\n\nInhaler for asthma as usual.\n\nRecommend liberal fluid intake and oral rehydration (Diurelite) to stay hydrated.\n\nAdvise taking Paracetamol as needed for fever or discomfort, up to four times daily.\n\nSuggest taking time off work for the next two to three days to rest.\n\nIf symptoms do not improve within three to four days, return for review and possible stool testing.\n\nEncourage continued light diet as tolerated.","review":205.27631578947367,"saved":177.72368421052633,"clean":false,"effort":30.76923076923077,"sig":[["partial","The note captures three days of watery/loose diarrhoea, approximately six to seven bowel movements daily, with no blood in stool.","Absence of blood in stool is a key pertinent negative for infective diarrhoea management."]],"mb":27.351045,"latency":33.28,"signable":238.55631578947367},{"label":"Run 4","wer":22.05778717406624,"text":"Hello. Hello. Hi. Hi. Should\nwe stop? Yeah. Okay. Hello, how can I help you this morning?\nHi. I've just had some diarrhea for the last three days and it's been affecting me. I need to stay close to the toilet and yeah it's been affecting my day to day activities.\nSorry to hear that. And when you say diarrhea what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\nYeah, so it's like loose and watery stool going to the toilet quite often and like some pain in my like lower stomach.\nOkay. And how many times a day are you going? Let's say\nthe last couple of days probably like six, seven times a day. Six, seven times a day.\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\nNo, no blood. Yeah, just watery and.\nLoose stall.\nOkay. And you mentioned you've had some pain in your tummy as well.\nYep.\nWhereabouts is the pain?\nSo it's like in my lower abdomen. So, like. Yeah, just to one side.\nOne side?\nWhat side is that on the left side.\nLeft side. Okay. And can you describe the pain to me?\nYeah, it feels like a cramp, like a muscular cramp. And, yeah, I feel a bit weak and shaky.\nOkay. And does the pain. Is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\nNo, just mainly my stomach. Okay, fine.\nAnd you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having been feeling feverish, for example?\nYeah, it doesn't feel like. Yeah, it just makes me feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so.\nYeah, around about three or four days ago.\nDid you measure your temperature then?\nYeah, I didn't measure my temperature, no, But I felt just a bit hot. Okay.\nAny other symptoms, like sweating or night? No. And any vomiting at all?\nYeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\nYou stopped vomiting. Okay. And was your vomit. I know it's not nice to talk about, but was it just normal food color?\nYeah. Yeah, just normal vomit. There was no blood in your vomit? No blood? No. Okay.\nAnd any other symptoms at all? You mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Anything else that comes to mind?\nI had a loss of appetite. I haven't been eating as much, but I've been able to hold down fluids.\nOkay, so you're drinking fluids. What kind of foods have you managed to eat?\nAnything?\nJust soups and. Yeah, light foods like smoothies and. Yeah, liquid foods, mainly. Okay,\nfine. And so you start three days ago. Symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So, for example, things like takeaway foods or eating out or being around other people who would. Similar symptoms?\nYeah, So I had takeaway about four days ago, but other than that, I've been eating normally, I think. Unusual. Yeah.\nDo you remember what you ate?\nYeah, I ate at a Chinese restaurant with friends. Okay.\nAnyone else unwell with similar symptoms?\nSo no one else in the family? So I have a wife and two kids, and one child was vomiting, but they haven't got diarrhea. No one would do. Same symptoms.\nOkay,\nfine.\nRight. And in terms of your overall health, are you normally fitting? Well,\nyeah. I mean, other than asthma, use an inhaler, everything else is fine.\nOkay. And is your asthma well controlled?\nYeah, that's fine. Just, yeah, use an inhaler and that's under control.\nAnd you don't have any other tummy problem, bowel problems I should be aware of?\nNo.\nOkay. Apart from the inhalers, do you take any other medications?\nNo. No other medications.\nIn terms of just your, your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\nSo I need to stay close to the toilet because I go quite frequently during the, these past three days. Yeah, other than that, it's, yeah, the main concern.\nAnd are you currently working at the moment?\nYeah, I work.\nI'm an accountant. Okay. Have you been going to work the last three days or you've been at home? Yeah, I've been going to work. Okay, that must be difficult for you then. Yeah, it's been quite difficult. And you say you mentioned you live with a wife and two children, is that right? Yes. Yeah. Alright, just a couple of other questions we need to ask. Do you smoke at all? No, I don't smoke. Do you drink much in the way of alcohol? No, I don't drink alcohol, no. Okay. So normally at this stage I like to examine you, if that's okay. But having listened to your stories, I think just to recap, for the last three days you've been having loose stools, diarrhea, a bit of stomach pain, mainly on the left hand side, and vomiting and being generally quite weak and lethargic. You mentioned you're having this Chinese takeaway as well, three days ago. And I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a stomach.\nOr infection of your tummy, mainly caused by viruses, but they can be a possibility of bacteria causing your symptoms. At this stage, what we'd recommend is just what we say, conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Diurelite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that first couple of days, if you are feeling feverish and weak, taking some Paracetamol, a few tablets, up to four times a day for the first few days can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work. I would say next two to three days in your system.\nTake some time off and rest. If your symptoms haven't got better, you know, in three to four days, I'd like you to come back and see me again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. Yeah. And we may need to do further tests, like taking a sample of your stool so we can test that, etc. Etc. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah. Yeah. Do you have any questions for me? No, no further questions. Okay. Is the treatment plan clear? Yeah. Yeah, that's very clear. Thank you. Great. Well, I wish you all the best. Okay. 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It does not require or invent bilious vomiting.","yes","\"Initial vomiting resolved, no blood in vomit or stool.\""],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","partial","Weakness and feeling hot without measured fever captured, but not that fever was at onset and absent now."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite; tolerates fluids, soups, smoothies, light foods."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. 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Hello. Hi. Hi. Should we stop? Yeah. Okay.\nHello. Good morning, sir. How can I help you this morning?\nHi. I've just had some diarrhea for the last three days and it's been affecting me. I need to stay close to the toilet and yeah, it's been affecting my day to day activities.\nSorry to hear that. And when you say diarrhea, what do you mean by diarrhea? Do you mean you're going to the toilet more often or are your stools more loose?\nYeah, so it's like loose and watery stool, going to the toilet quite often and like some pain in my like lower stomach.\nOkay. And how many times a day are you going? Let's say the last couple of days.\nProbably like six, seven times a day. Six, seven times a day.\nAnd you mentioned it's mainly watery. Have you noticed any other things like blood in your stools?\nNo, no blood. Yeah, just watery and loose.\nOkay. And you mentioned you've had some pain in your tummy as well.\nYeah.\nWhereabouts is the pain?\nIn my lower abdomen. So, like. Yeah, just to one side.\nOne side?\nWhat side is that on the left side. Left\nside. Okay. And can you describe the pain to me?\nYeah, it feels like a cramp, like a muscular cramp. And yeah, yeah, I feel a bit weak and shaky.\nOkay. And does the pain. Is it there all the time or does it come and go? It comes and goes. Does the pain move anywhere else, for example, towards your back?\nNo, just mainly my stomach. Okay, fine.\nAnd you mentioned you've been feeling quite weak and shaky as well. What do you mean by shaky? Do you mean you've been having been feeling feverish, for example?\nYeah, it doesn't feel like. Yeah, it just makes me feel weak. I haven't had a fever at the moment, but I did notice a temperature when the symptoms started, so.\nYeah, around about three or four days ago.\nYou measure your temperature then?\nYeah, I didn't measure my temperature, no, But I felt just a bit hot. Okay. Okay.\nAny other symptoms like sweating or. No. And any vomiting at all?\nYeah, so I vomited at the start of the symptoms, but now I've stopped vomiting.\nYou stopped vomiting. Okay. And was your vomit. I know it's not nice to talk about, but was it just normal food color?\nYeah. Yeah, just normal vomit. And there was no blood in your vomit, is that right? No blood? No. Okay.\nAnd any other symptoms at all? You mentioned tummy pain, you mentioned diarrhea, you mentioned the vomiting. Anything else that comes to mind?\nI had a loss of appetite. I haven't been eating as much, but I've been able to hold down fluids.\nOkay, so you're drinking fluids. What kind of foods have you managed to eat? Anything?\nJust soups and. Yeah, light foods, like smoothies and. Yeah, liquid foods, mainly. Okay, fine.\nAnd so we started three days ago with symptoms. Are you aware of any triggers which may have caused the symptoms to kick on? So, for example, things like takeaway foods or eating out or being around other people who would. Similar symptoms?\nYeah, So I had takeaway about four days ago, but other than that, I've been eating normally, I think. Unusual. Yeah.\nDo you remember what you\nate? Yeah, I ate at a Chinese restaurant with friends. Okay,\nanyone else unwell with similar symptoms?\nSo no one else in the family? So I have a wife and two kids, and one child was vomiting, but they haven't got diarrhea. There's no one with the same symptoms.\nOkay, fine. Right.\nAnd in terms of your overall health, are you normally fitting? Well,\nyeah. I mean, other than asthma, use an inhaler, everything else is fine.\nOkay. And is your asthma well controlled?\nYeah, that's fine. Just use an inhaler and that's under control.\nAnd you don't have any other tummy problem, bowel problems I should be aware of?\nNo. Okay.\nApart from inhalers, do you take any other medications?\nNo. No other medications.\nIn terms of just your, your day to day life, you said it's been affecting your life. Yeah. In what way has it been affecting your life?\nSo I need to stay close to the toilet because I go quite frequently during the. These past three days. Yeah. Other than that, it's, yeah, the main concern.\nAnd are you currently working at the moment?\nYeah, I work.\nI'm an accountant. Okay. Have you been going into work the last three days or you've been at home? Yeah, I've been going to work. Okay. That must be difficult for you then. Yeah, it's been quite difficult. And you say you mentioned you live with a wife and two children, is that right? Yes. All right, just a couple of other questions we need to ask. Do you smoke at all? No, I don't smoke. Do you drink much in the way of alcohol? No, I don't drink alcohol, no. Okay. So normally at this stage, I like to examine you, if that's okay. But having listened to your stories, I think just to recap, for the last three days you've been having loose stool, diarrhea, a bit of tummy pain, mainly on the left hand side, and vomiting and being quite weak and lethargic. You mentioned you're having this Chinese takeaway as well, three days ago. And I wonder whether that might be the cause of your problems. Okay. It seems like you may have something called gastroenteritis, which is essentially just a tummy bug or.\nInfection of your. Of your tummy, mainly caused by viruses, but they can be possibility of bacteria causing symptoms. At this stage, what we'd recommend is just what we say, conservative management. So I don't think you need anything like antibiotics. It's really just making sure you're well hydrated. So drinking fluids. There are things like Diurelite you can get from the pharmacy, which helps replenish some of your minerals and vitamins. And if you are having vomiting and diarrhea, I would say recommend that first couple of days, if you are feeling feverish and weak, taking some Paracetamol, two tablets, up to four times a day for the first few days, can also help. I would certainly advise you to take some time at work, actually. I know you're quite keen to work. I would say next two to three days, clears from your system, takes a.\nSome time off and rest. If your symptoms haven't got better, you know, in three to four days, I'd like you to come back and see you again. Okay, sure. Because if it is ongoing, then we have to wonder whether there's something else causing symptoms. And we may need to do further tests, like taking a sample of your stool so we can test that, etc. Etc. Yeah, sure. Yeah. How's that sound? That sounds great. Yeah? Yeah. Do you have any questions for me? No. No further questions. Okay. Is the treatment plan clear? Yeah. Yeah, that's very clear. Thank you. Great. Well, I wish you all the best. 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It does not require or invent bilious vomiting.","yes","\"Vomited at symptom onset, now ceased; no blood in stool or vomit.\""],["The note captures feeling feverish at onset but no current fever, along with weakness/lethargy. It does not assert a measured temperature.","partial","Weakness and unmeasured feeling hot captured, but chief complaint lists \"low-grade fever\" and no current fever is not stated."],["The note captures reduced appetite but ability to retain fluids and tolerate light/liquid foods.","yes","Loss of appetite but tolerating fluids, soups and smoothies documented."],["The note captures recent Chinese takeaway/restaurant exposure and vomiting in a household child or household contact. Do not require an exact exposure day or insist that every family member was ill.","yes","Chinese takeaway and one child vomiting without diarrhoea documented."],["The note captures controlled asthma treated with inhaler(s) and no other regular medications reported.","partial","\"Continue regular asthma inhaler; no other meds\" but asthma control is not captured."],["The note captures the need to stay close to a toilet and disruption to work/daily activities.","no","Need to stay close to the toilet and disruption to work/daily activities are not documented."],["The assessment identifies suspected gastroenteritis or an acute gastrointestinal infection.","yes","\"Acute gastroenteritis, likely viral aetiology with possible bacterial contribution.\""],["The plan captures conservative management with hydration/oral rehydration solution (e.g. Dioralyte) and no antibiotics recommended at this stage.","partial","Fluids and oral rehydration solution captured, but no mention that antibiotics are not recommended."],["The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","partial","Two tablets up to four times daily is correct, but an unstated strength \"500 mg\" is added."],["The plan captures rest and approximately two to three days off work.","yes","\"Rest and take 2-3 days off work.\""],["The plan captures review if not improving in approximately three to four days and possible stool testing if symptoms persist.","yes","\"If no improvement in 3-4 days, return for review and consider stool testing.\""]],"claims":[["Paracetamol 500 mg","Transcript only says \"two tablets up to four times a day\"; no strength was stated."],["low-grade fever","Patient only \"felt just a bit hot\" at onset, temperature not measured and no current fever; a low-grade fever was never described."]],"note":"Subjective\n\nChief Complaint::\n\n3‑day history of watery diarrhoea, 6‑7 motions/day, left lower abdominal cramp, vomiting (resolved), weakness, low‑grade fever.\n\nHistory of Presenting Complaint::\n\nOnset 3 days ago after Chinese takeaway; symptoms include loose watery stools, crampy left lower abdominal pain (intermittent), loss of appetite but tolerates fluids (soups, smoothies).\n\nVomited at symptom onset, now ceased; no blood in stool or vomit; no fever measured but feels hot.\n\nNo recent sick contacts; family members only one child vomited, no diarrhoea.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAcute gastroenteritis, likely viral aetiology with possible bacterial contribution from recent food exposure.\n\nPlan\n\nMedications::\n\nParacetamol 500 mg, 2 tablets up to 4 times daily for fever/pain.\n\nDiurelite oral rehydration solution for fluid/electrolyte replacement.\n\nContinue regular asthma inhaler; no other meds.\n\nIncrease oral fluid intake; use Diurelite as needed.\n\nTake Paracetamol as above for fever or discomfort.\n\nRest and take 2‑3 days off work.\n\nIf no improvement in 3‑4 days, return for review and consider stool testing.","review":179.93421052631578,"saved":203.06578947368422,"clean":false,"effort":38.46153846153847,"sig":[["partial","The plan captures paracetamol for fever/discomfort, with the spoken instruction of two tablets up to four times daily if a dose is included; strength in mg was not stated.","Adds a 500 mg strength that was never stated."]],"mb":22.700484,"latency":31.227,"signable":211.16121052631578}]}},{"id":"day1_consultation02","name":"Eczema","dictation":false,"language":false,"stress":false,"reference":"Hello?\n\n Hello. Can you hear me well?\n\n Uh uh yes. I think. It's a bit better. It's a bit, it's a bit, it's not very clear. But let's continue anyway.\n\n OK.\n\n Uh, OK. Let's start again. So how can I help you sir?\n\n Yes. So, it's been a few days now. I have like a sore, and a red skin. It's kind of, it's really itchy, and it's like super annoying. So I'd like to find something quick to solve it.\n\n OK.\n\n No, no problem. I'm happy to help. Um whereabouts in your skin is it affected?\n\n Uh, mostly like my chest, my, my hands, my arms. Like, like really, it's it's super annoying. Like it's itching a lot, like all the time. And\n\n I can't even sleep at night. I really need something quickly to, to solve it. Because even at work I, I can, when I'm in a meeting and I have to, like uh think about my work, I can't focus, I can't actually focus on my work. It's really annoying because I can't actually think about, uh, what I have to say. I'm always like, uh, disturbed by this disease.\n\n Yeah.\n\n No no, OK. I'm certain this is obviously affecting you. And uh we'll try our very best to get get this sorted out for you. Um, have you had anything like this before in the past?\n\n Um so yes. Uh earlier I was like prescribed for my eczema.\n\n OK.\n\n And they gave me like some cream, and something to, uh when I like shower, when I was in the shower, had to put something. But um\n\n OK.\n\n Did it help?\n\n Um I mean, at that time yes. That's, those symptoms, like these symptoms appear like, when the symptoms appeared again, I tried those and it didn't work.\n\n I've tried a few things. Like I bought a, a steroid cream at the pharmacy last night. But it apparently didn't help, because it's still itching a lot today. Uh, yeah.\n\n OK.\n\n OK.\n\n Do you remember the name of the cream you bought?\n\n A steroid cream.\n\n OK, steroid, OK. um would you say these symptoms are very similar to your eczema symptoms, or different?\n\n Um\n\n it's much more like itchy. And my eczema was more like only in the arm. But now it's also on the chest. And in the on the, on the hands as well.\n\n OK.\n\n Like pretty, yeah when, like I like, for instance hiking, during the weekend. And\n\n I am, I can't really do it anymore, because it's like very like I wanted to do that last weekend. And because super painful, and I I have to take like showers every day to be able to, cannot uh ease this itching part, which is very very annoying.\n\n Yes.\n\n No. Well OK. That's so you mentioned the itchiness. Um you also mentioned it's been quite sore.\n\n Yeah.\n\n Um have you, have you noticed any uh bleeding or discharge from your skins?\n\n . OK.\n\n No. Um so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. But uh, yeah.\n\n OK.\n\n You've not, haven't uh seen any other uh pus or blood, coming out of your skin.\n\n No.\n\n No. And you mentioned it all started three days ago.\n\n Are you, four days ago. Are you aware of any triggers, or anything that you may have done, that may have caused your symptoms to start?\n\n Four days ago.\n\n So for example, have you changed your uh shower gel, any clothing?\n\n Have you been around anyone else?\n\n No I . It's actually like, it's really annoying, because I'm thinking about, maybe I should change something. Because I I haven't, and I don't understand I cannot, um afraid of asking people around me because it's cannot you know um, I don't feel really comfortable asking about these questions. It's kind of intimate that. So I your help now.\n\n Mm.\n\n Mm. No no, OK. That's OK. Um\n\n Fine, so just to resummarize. For the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well?\n\n Yeah.\n\n Uh, no. Just the chest, hands and like, like inside the elbows. Yeah.\n\n OK. anything on your face at all?\n\n Am I what?\n\n On your face?\n\n On my face? No.\n\n No, OK. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n No. just very itchy. Nothing else.\n\n Itchy. OK. So your, your bowels are working OK?\n\n Your chest is OK? No cough, no breathing difficulties?\n\n No.\n\n You're passing urine OK.\n\n I I think so.\n\n OK, alright. Um\n\n It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n Any what?\n\n Any ideas, as to what could be causing your symptoms?\n\n Um so I had eczema before. So maybe it's disease, but it seems like more uh, like uh my eczema was only on the arms. So, I'm I'm not sure. I I really have no idea.\n\n OK. That's OK. So um, normally at this stage I like to examine you. Um\n\n To see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's, you've got some dry skin and some, uh cracked skin as well.\n\n Uh and has been very itchy. And so would your um\n\n Yeah.\n\n Uh your your background of eczema. Um\n\n So\n\n Sorry to say, there's a couple of questions I wanted to ask you, which I completely forgot, my apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n Uh, no. I just had asthma in the past. But not anymore.\n\n OK. Not anymore, OK. And do you take any regular medications at the moment?\n\n Uh no.\n\n No, OK. Do you have any allergies to anything?\n\n I like some , sorry? Yeah?\n\n sorry I said do you have any allergies to anything?\n\n Hello?\n\n Hello? Yes.\n\n can you hear me? That's alright I think it . Uh do you have any allergies at all?\n\n Ohh, allergies. Uh, no.\n\n No, OK. Um and tell me about your um uh your situation at home. Who do you live with?\n\n Uh so, I live with a few flatmates. I'm a, so you know I'm thirty one. Uh I, yeah I'm I have a full time job. And so I'm living with a few people to save money.\n\n OK. And what do you do for work?\n\n Uh I work uh at a pharmaceutical company.\n\n So it's been a, it's been a few years now. Uh it's uh, it's kind of interesting. We're working I'm a, like a kind of project manager. Uh I mean, do you want to, to know more about it?\n\n OK. Uh no no no that's , that's absolutely fine. Um just a couple of questions I want to ask you, which can sometimes affect your symptoms, is, do you smoke at all?\n\n No.\n\n No. And do you drink much in the way of alcohol?\n\n Uh you know, once in a while I can, I like hanging out with people once in a while. So yeah I'd say a few, a few beers per week. Something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger. But it's been, it's been a while.\n\n OK. OK. OK I've got to say, at this stage I've got to say this sound quality is not uh great. But I will continue because we've come this far. Um\n\n So um, based on everything you mentioned Sarah , I do wonder whether this is a flare-up of your eczema. Um\n\n The reason being that you said it was quite itchy. Um it's mainly affecting your chest and your back.\n\n Um and uh, having looked at your skin, uh the the the rash does appear quite familiar. Um you mentioned using steroid creams, yesterday.\n\n Um from the pharmacy. I wonder whether giving you a stronger prescription of a of a steroid may be beneficial.\n\n Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something, some emollients, which helps to moisturize the skin.\n\n OK.\n\n OK.\n\n Um which use in the bath and shower. And it's definitely worth um using that for the first seven to ten days.\n\n OK.\n\n Uh before we make the decision on whether it's working or not.\n\n OK.\n\n Um it's also worth um using antihistamines, which you can sometimes buy over counter.\n\n Things like Loratadine or Piriton, which can help the itchiness of your skin.\n\n OK.\n\n And uh, um it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use, in terms of shower gels or soap.\n\n Because if that's causing your symptoms, then we need to have a discussion about an eczema CU.\n\n OK. Yes, I have tried antihistamines, uh lately, but it didn't really help.\n\n Ohh, could you say that again, sorry?\n\n I have tried uh antihistamines, but uh but it didn't really help.\n\n OK.\n\n OK. So it's something for you to think about. you can get different types of antihistamines. I can give you something a little bit stronger today as well.\n\n Um, something like Fexofenadine, which I can give to you today. It's definitely worth trying, and it's not going to do you any harm.\n\n OK.\n\n Um but I think using the steroids and the emollients, um on a regular basis\n\n Uh over the next week to ten days, should hopefully control your symptoms. But do come back and see me next week, if things don't get better.\n\n That sounds good.\n\n OK? Um do you have any questions for me?\n\n Uh, no that's it. Thank you very much. Bye. Thank you as well. Bye.\n\n OK. Well I wish you all the best.\n\n Thank you. Have a good 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1","wer":14.302812687013763,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So, how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like, really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying, because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get us sorted out for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to— when I, like, was shower— when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms are— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— in the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying.\n\n  No. Well, okay. That's okay. So you mentioned the itchiness.\n\n  Yeah.\n\n  Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. So, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  I'm noticing any other, uh, pus or blood coming out of your skin?\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start?\n\n  No.\n\n  So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No. I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something, because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly?\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay?\n\n  Yeah.\n\n  Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I— like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So, it's been a— it's been a few years now. Uh, it's a— it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I want to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so, um, based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Um.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritan, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, I— I\n\n  have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully cure— control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[{"start":767,"end":775,"said":"I can","significant":false},{"start":840,"end":843,"said":"I can't","significant":false},{"start":851,"end":855,"said":"I can't","significant":false},{"start":1032,"end":1051,"said":"OK. I'm certain","significant":false},{"start":1125,"end":1127,"said":"this","significant":false},{"start":1473,"end":1480,"said":"That's those","significant":false},{"start":1512,"end":1515,"said":"appear","significant":false},{"start":1528,"end":1533,"said":"the","significant":false},{"start":1869,"end":1887,"said":"OK.","significant":false},{"start":1892,"end":1898,"said":"","significant":false},{"start":2063,"end":2072,"said":"arm. 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Yes","significant":false},{"start":8258,"end":8266,"said":"tried","significant":false},{"start":8325,"end":8327,"said":"Ohh","significant":false},{"start":8444,"end":8460,"said":"OK. OK.","significant":false},{"start":8766,"end":8775,"said":"","significant":false},{"start":8897,"end":8901,"said":"","significant":false},{"start":9088,"end":9093,"said":"Thank you very much. Bye. Thank you as well. Bye. OK.","significant":false},{"start":9138,"end":9162,"said":"","significant":false},{"start":9183,"end":9211,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day hx\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"sore, erythematous, intensely pruritic skin affecting chest, hands and antecubital fossae\", dry/cracked; no legs asserted."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding, pus or other discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupting sleep, work concentration and weekend hiking\"."],["The note captures: Known eczema and past asthma.","yes","\"PMH: eczema; past asthma, no longer active\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior treatment \"previously effective, but not with current sx\"; \"OTC steroid cream used last night without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Antihistamines tried recently without relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified trigger; no change in shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Discussed stronger Rx topical steroid for current flare\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"regular emollient use, including as bath/shower substitute, for 7–10 days\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"stronger option of fexofenadine discussed\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of possible triggers, including clothing, soaps and shower gels\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Advised review next week if not improving after 7–10 days of treatment\"."]],"claims":[],"note":"Subjective\n4-day hx sore, erythematous, intensely pruritic skin affecting chest, hands and antecubital fossae; no facial involvement.\nSkin dry/cracked in places; no bleeding, pus or other discharge.\nPruritus constant, disrupting sleep, work concentration and weekend hiking; showering daily to ease itch/pain.\nPrevious eczema, previously limited to arms; current episode more pruritic and more widespread than prior flares.\nPrior eczema cream/shower treatment previously effective, but not with current sx. OTC steroid cream used last night without benefit. Antihistamines tried recently without relief.\nNo identified trigger; no change in shower gel or clothing. Worried about cause and uncomfortable discussing possible exposures with others.\nDenies fever, cough or dyspnoea. Bowels normal; thinks urination normal.\nPMH: eczema; past asthma, no longer active. No regular meds. No known allergies.\nNon-smoker. Alcohol: few beers/week. Lives with flatmates; works full-time.\nObjective\nSkin visually reviewed during consultation; clinician described rash appearance as familiar.\nAssessment\nSuspected eczema flare: intensely pruritic, dry/cracked erythematous rash with prior eczema history.\nPt notes atypical flare pattern, with greater itch and involvement of chest/hands in addition to previous arm involvement.\nNo reported bleeding, purulent discharge, fever or respiratory sx.\nPlan\nDiscussed stronger Rx topical steroid for current flare.\nDiscussed regular emollient use, including as bath/shower substitute, for 7–10 days.\nDiscussed antihistamines for itch: OTC loratadine or Piritan; stronger option of fexofenadine discussed given inadequate response to previous antihistamine.\nKeep diary of possible triggers, including clothing, soaps and shower gels.\nAdvised review next week if not improving after 7–10 days of treatment.\nPt agreed with plan; no further questions.","review":84.0,"saved":232.5,"clean":true,"effort":0.0,"sig":[]},{"label":"Run 2","wer":14.542190305206462,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Uh, earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— in the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm not seeing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly.\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay.\n\n  And.\n\n  Your chest is okay. No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well. Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I was going to say, at this stage, I was going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, uh, I\n\n  have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[{"start":765,"end":773,"said":"I can","significant":false},{"start":838,"end":841,"said":"I can't","significant":false},{"start":849,"end":853,"said":"I can't","significant":false},{"start":1029,"end":1048,"said":"OK. I'm certain","significant":false},{"start":1122,"end":1138,"said":"this sorted out","significant":false},{"start":1485,"end":1492,"said":"That's those","significant":false},{"start":1523,"end":1523,"said":"appear","significant":false},{"start":1536,"end":1541,"said":"the","significant":false},{"start":1877,"end":1899,"said":"OK.","significant":false},{"start":1904,"end":1910,"said":"","significant":false},{"start":2074,"end":2083,"said":"arm. 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Yes","significant":false},{"start":8262,"end":8270,"said":"tried","significant":false},{"start":8329,"end":8331,"said":"Ohh","significant":false},{"start":8448,"end":8464,"said":"OK. OK.","significant":false},{"start":8770,"end":8779,"said":"","significant":false},{"start":9086,"end":9091,"said":"Thank you very much. Bye. Thank you as well. Bye. OK.","significant":false},{"start":9136,"end":9160,"said":"","significant":false},{"start":9181,"end":9209,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","4-day history recorded."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on chest, hands and inner elbows; legs not listed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies bleeding/discharge."],["The note captures: Itching disturbs sleep.","yes","Sleep disturbance recorded."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration and hiking impact recorded."],["The note captures: Known eczema and past asthma.","yes","Eczema and past asthma recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema treatments and OTC steroid last night not relieving current flare."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines tried without benefit."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identified trigger; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Suspected eczema flare."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","Stronger topical steroid prescribed."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollient including bath/shower use."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Fexofenadine for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Trigger diary covering clothing, soaps, shower products."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Review next week if not improving; 7–10 day trial."]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx pruritic, erythematous, sore skin rash.\nDistribution: chest, hands and antecubital areas. Denies facial involvement.\nReports marked itch, sleep disturbance, impaired concentration at work and unable to hike due to pain/itch.\nSkin reportedly dry and cracked in places. Denies bleeding, discharge or pus.\nDenies fever, cough, SOB. Reports bowel function normal; thinks urination normal.\nSimilar to prior eczema but itchier and more extensive; previous eczema mainly affected arms.\nNo identified trigger; denies changes to shower gel or clothing.\nPrior eczema treated with cream and a shower product, previously effective but not during current flare.\nUsed OTC steroid cream last night without benefit. Has tried antihistamines without benefit.\nPMH: eczema; past asthma, no longer active per pt.\nRegular meds: none. Allergies: none known.\nSocial: lives with flatmates; works as project manager in pharmaceutical company. Non-smoker. Drinks a few beers/week.\nObjective\nClinician reports visual review of rash; appearance described as familiar/consistent with eczema.\nNo detailed rash morphology or examination findings documented.\nAssessment\nSuspected eczema flare.\nSupported by pruritic, dry/cracked, erythematous and sore skin with prior eczema history; current distribution includes chest, hands and antecubital fossae.\nNo reported fever, purulent discharge or bleeding.\nPlan\nPrescribe stronger topical steroid; strength, regimen and duration not documented.\nProvide emollient/moisturiser for skin and use in bath/shower.\nUse topical steroid and emollient regularly for 7–10 days before assessing response.\nPrescribe fexofenadine for pruritus; pt reports previous antihistamine trial was ineffective.\nKeep diary of possible triggers, including clothing, shower gels and soaps.\nReview next week if symptoms do not improve.","review":84.0,"saved":232.5,"clean":true,"effort":0.0,"sig":[],"mb":11.857361,"latency":23.487,"signable":107.487},{"label":"Run 3","wer":14.362657091561939,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get— get us sorted out for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Earlier I was, like, prescribed for my eczema. And they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did it help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— My eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I— I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly?\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. And anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay?\n\n  Yeah.\n\n  Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  You're passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you some— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Um.\n\n  Okay.\n\n  Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just, uh, I\n\n — I have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay.\n\n  Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[{"start":765,"end":773,"said":"I can","significant":false},{"start":838,"end":841,"said":"I can't","significant":false},{"start":849,"end":853,"said":"I can't","significant":false},{"start":1029,"end":1048,"said":"OK. I'm certain","significant":false},{"start":1122,"end":1124,"said":"this","significant":false},{"start":1476,"end":1483,"said":"That's those","significant":false},{"start":1514,"end":1514,"said":"appear","significant":false},{"start":1527,"end":1532,"said":"the","significant":false},{"start":1868,"end":1886,"said":"OK.","significant":false},{"start":1891,"end":1897,"said":"","significant":false},{"start":2062,"end":2071,"said":"arm. 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OK.","significant":false},{"start":9139,"end":9163,"said":"","significant":false},{"start":9184,"end":9212,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day hx\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, erythematous, pruritic, cracked skin on \"chest, hands and antecubital areas\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies bleeding, pus or other discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"Pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration and hiking\"."],["The note captures: Known eczema and past asthma.","yes","\"PMH: eczema; remote asthma\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","\"Tried previous eczema treatments and OTC steroid cream last night without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"recent antihistamine trial without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified trigger; denies changes in shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Probable eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"trial of stronger prescription topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollient/moisturiser, including use in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"stronger antihistamine, e.g. fexofenadine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers, including clothing, soaps and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if symptoms not improving\"."]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx sore, erythematous, intensely pruritic rash.\nDistribution: chest, hands and antecubital areas. Denies facial involvement.\nSkin cracked in some areas; denies bleeding, pus or other discharge.\nPruritus disrupting sleep, work concentration and hiking.\nHx eczema, previously mainly affecting arms; prior prescribed cream and shower product had helped. Current episode more extensive and more pruritic.\nTried previous eczema treatments and OTC steroid cream last night without benefit.\nReports recent antihistamine trial without benefit.\nNo identified trigger; denies changes in shower gel or clothing.\nDenies fever, cough or SOB. Bowels normal. Reports passing urine, no concerns stated.\nPMH: eczema; remote asthma, no longer active per pt.\nRegular meds: none. Allergies: none reported.\nNon-smoker. Drinks a few beers/week.\nObjective\nClinician reported visual review of rash; described appearance as familiar, without documented morphology or further examination findings.\nAssessment\nProbable eczema flare.\nSupported by prior eczema, acute pruritic/sore erythematous skin with dryness/cracking, and distribution involving hands/antecubital areas/chest.\nNo reported fever, discharge, bleeding or respiratory symptoms.\nPlan\nDiscussed trial of stronger prescription topical steroid; clinician stated this would be prescribed.\nDiscussed emollient/moisturiser, including use in bath/shower.\nUse steroid treatment and emollients regularly for 7–10 days before assessing response.\nDiscussed stronger antihistamine, e.g. fexofenadine, for pruritus; clinician stated this could be provided.\nKeep diary of potential triggers, including clothing, soaps and shower products.\nReview next week if symptoms not improving.","review":75.78947368421052,"saved":240.71052631578948,"clean":true,"effort":0.0,"sig":[],"mb":11.812573,"latency":26.551,"signable":102.34047368421052},{"label":"Run 4","wer":14.063435068821065,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\n\n  Okay.\n\n  So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, uh, think about my work and focus, like, actually focus on my work, it's—\n\n  Yeah.\n\n  Really annoying because I can't actually think about, uh, what I have to say. I'm always, like, uh, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so, yes. Uh, earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did that help?\n\n  Um, I mean, at that time, yes, but the symptoms, like, these symptoms are, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream.\n\n  Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying.\n\n  No. Well, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago. Are you—\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else—\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest, hands, and, like, like, inside the elbows.\n\n  Okay. And anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your, your bowels are working okay? Your chest is okay? No cough, no breathing difficulties?\n\n  No.\n\n  You're passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I usually, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything? Hello?\n\n  Hello? Yes?\n\n  Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I've— yeah, I'm— I have a full-time job and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I want to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in the way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, th-this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you something— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh, before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay. Just I— I have tri\n\n ed antihistamines, uh, lately, but it didn't really help. Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um, something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\n\n  That sounds good.\n\n  Okay. Um, do you have any questions for me?\n\n  Uh, no, that's it.\n\n  Okay. Well, I wish you all the best.\n\n  Thank you very much.\n\n  Thank you. Have a good day.\n\n  Bye. Thank you, doctor. Bye.","marks":[{"start":765,"end":773,"said":"I can","significant":false},{"start":842,"end":845,"said":"I can't","significant":false},{"start":853,"end":857,"said":"I can't","significant":false},{"start":1042,"end":1061,"said":"OK. I'm certain","significant":false},{"start":1140,"end":1156,"said":"this sorted out","significant":false},{"start":1504,"end":1511,"said":"That's those","significant":false},{"start":1543,"end":1546,"said":"appear","significant":false},{"start":1559,"end":1564,"said":"the","significant":false},{"start":1900,"end":1922,"said":"OK.","significant":false},{"start":1927,"end":1933,"said":"","significant":false},{"start":2098,"end":2107,"said":"arm. 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No facial involvement.\nPruritus persistent; disrupting sleep, concentration at work and hiking.\nSkin cracked in places. Denies bleeding, discharge or pus.\nDenies fever, cough, SOB, bowel concerns or urinary concerns.\nSimilar to prior eczema but more pruritic and more widespread; previous eczema mainly affected arms.\nNo identified trigger or recent change in shower gel/clothing reported.\nPrevious eczema treatments included cream and shower product; initially effective but not with current flare.\nTried pharmacy-purchased topical steroid cream last night without relief.\nTried antihistamines recently without benefit.\nPMH: eczema; past asthma, no longer active per pt.\nNo regular meds. NKDA.\nNon-smoker. Drinks a few beers/week.\nObjective\nRemote consultation; audio quality intermittently poor.\nClinician reports visual assessment of rash; appearance described as familiar/consistent with eczema.\nNo objective examination details documented.\nAssessment\nProbable eczema flare.\nSupported by prior eczema, marked pruritus, dry/cracked skin and affected flexural areas/chest.\nNo reported fever, purulent discharge or bleeding to suggest infective complication from history.\nPlan\nPrescribe stronger topical steroid cream; strength/directions not documented.\nPrescribe emollient/moisturiser for regular use, including as bath/shower substitute.\nAdvise consistent steroid and emollient use for 7–10 days before assessing response.\nPrescribe fexofenadine for pruritus; discussed that alternative antihistamines may be more effective despite recent unsuccessful antihistamine trial.\nAdvise keeping a diary of potential triggers, including clothing, shower gels and soaps.\nReview next week if symptoms do not improve.","review":80.21052631578947,"saved":236.28947368421052,"clean":true,"effort":0.0,"sig":[],"mb":11.82695,"latency":22.234,"signable":102.44452631578946},{"label":"Run 5","wer":14.422501496110113,"text":"Hello.\n\n  Hello.\n\n  Uh—\n\n  Can you hear me well?\n\n  Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\n\n  Okay.\n\n  Okay. Let's start again. So how can I help you, sir?\n\n  Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it.\n\n  No, no problem. I'm happy to help. Um, whereabouts in your skin is it affected?\n\n  Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always— like, disturbed by this disease.\n\n  No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get a source of that for you. Um, have you had anything like this before in the past?\n\n  Um, so yes. Earlier I was, like, prescribed for my eczema, and they gave me, like, some cream and something to— when I, like, was shower— when I was in the shower I had to put something.\n\n  Okay.\n\n  But, um, yeah.\n\n  Did it help?\n\n  Um, I mean, at that time yes, but the symptoms, like, these symptoms are— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n\n  Okay.\n\n  Uh, yeah.\n\n  Do you remember the name of the cream you bought?\n\n  Uh, steroid cream?\n\n  Okay, steroid. Okay. That's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\n\n  Um, it's much more, like, itchy and— my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well.\n\n  Okay.\n\n  Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I wanted to do that last weekend and it was super painful, and I think I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying.\n\n  No. Well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you— have you noticed any, uh, bleeding or discharge from your skin?\n\n  No. Um, my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean.\n\n  Okay.\n\n  But, uh, yeah.\n\n  No, I'm noticing any other, uh, pus or blood coming out of your skin.\n\n  No.\n\n  No. And you mentioned it all started three days ago.\n\n  Four days ago.\n\n  Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else?\n\n  No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something, because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfortable asking about these questions. It's kind of intimate, and so I really need your help now.\n\n  Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\n\n  Uh, no. Just the chest.\n\n  Mainly.\n\n  Hands and, like, like, inside the elbows.\n\n  Okay. Any— anything on your face at all?\n\n  In my what?\n\n  On your face.\n\n  Oh, on my face? No.\n\n  No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n\n  No, no. Just the itching.\n\n  Itching.\n\n  Nothing else.\n\n  Okay. So your— your bowels are working okay.\n\n  And.\n\n  Your chest is okay. No cough, no breathing difficulties?\n\n  No.\n\n  Your passing urine okay?\n\n  Uh, I think so.\n\n  Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\n\n  Any what?\n\n  Any ideas as to what could be causing your symptoms?\n\n  Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure. I— I really have no idea.\n\n  Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\n\n  Yeah.\n\n  Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\n\n  Uh, no. I just had asthma, in the past, but.\n\n  Okay.\n\n  Not anymore.\n\n  Not anymore. Okay. And do you take any regular medications at the moment?\n\n  Uh, no.\n\n  No. Okay. Do you have any allergies to anything?\n\n  I use, like, something— sorry, yeah.\n\n  Just— sorry, I was going to say, do you have any allergies to anything?\n\n  Okay.\n\n  Hello?\n\n  Hello? Yes.\n\n  Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all?\n\n  Oh, allergies? Uh, no.\n\n  No. Okay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\n\n  Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job, and so I'm living with a few people to save money.\n\n  Okay. And what do you do for work?\n\n  Uh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it?\n\n  Okay. Uh, no, no, no, that's absolutely— that's absolutely fine. Um, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\n\n  No.\n\n  No. And do you drink much in a way of alcohol?\n\n  Uh, you know, o-once in a while, I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been— it's been a while.\n\n  Okay. Okay. Okay. I'm going to say, at this stage, I'm going to say, this sound quality is not, uh, great, but I will continue because we've come this far. Um, so based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema. Um, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the— the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial?\n\n  Okay.\n\n  Uh, which I'm happy to prescribe to you today. As well as, I'm going to give you some— some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh, before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritan, which can help with the itchiness of your.\n\n  Okay.\n\n  Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\n  Okay.\n\n  Just— I— I have to write antihistamines, uh, lately, but it didn't really help.\n\n  Oh, could you say that again? Sorry?\n\n  I have tried the antihistamines.\n\n  Okay.\n\n  Uh, but it didn't really help.\n\n  It didn't? Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um.\n\n  Okay.\n\n  Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis. Um, over the next week to 10 days, should hopefully cure— control your symptoms. 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Yes","significant":false},{"start":8207,"end":8215,"said":"tried","significant":false},{"start":8274,"end":8276,"said":"Ohh","significant":false},{"start":8393,"end":8409,"said":"OK. OK.","significant":false},{"start":8715,"end":8727,"said":"think","significant":false},{"start":8843,"end":8847,"said":"","significant":false},{"start":9034,"end":9039,"said":"Thank you very much. Bye. Thank you as well. Bye. OK.","significant":false},{"start":9084,"end":9108,"said":"","significant":false},{"start":9129,"end":9157,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'4-day hx sore, erythematous, intensely pruritic skin rash.'"],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, erythematous, cracked skin on chest, hands, arms/antecubital fossae; no legs invented."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Denies bleeding, pus or other discharge.'"],["The note captures: Itching disturbs sleep.","yes","'disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'disrupting... work concentration and hiking.'"],["The note captures: Known eczema and past asthma.","yes","'PMH: eczema; past asthma, no longer active.'"],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previous eczema cream/shower product not helping current flare; OTC steroid cream without benefit."],["The note captures: Antihistamines already tried have not helped.","yes","'Reports antihistamines recently tried without relief.'"],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified trigger; denies changes to shower gel or clothing.'"],["The note captures: Assessment is a likely eczema flare.","yes","'Suspected eczema flare.'"],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid cream.'"],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Provide emollients/moisturisers, including for use in bath/shower.'"],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Offer fexofenadine for pruritus.'"],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Keep diary of potential triggers, including clothing, soap and shower products.'"],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review next week if symptoms do not improve.'"]],"claims":[],"note":"Subjective\n31-year-old with 4-day hx sore, erythematous, intensely pruritic skin rash.\nDistribution: chest, hands, arms/antecubital fossae. No facial involvement.\nPruritus constant; disrupting sleep, work concentration and hiking.\nSkin cracked in places. Denies bleeding, pus or other discharge.\nDenies fever, cough or SOB. Bowels normal; reports passing urine adequately.\nHx eczema, previously limited to arms; current episode more widespread and more pruritic.\nPrevious eczema cream and shower product helped historically but not with current flare.\nTried OTC steroid cream since previous night without benefit. Reports antihistamines recently tried without relief.\nNo identified trigger; denies changes to shower gel or clothing.\nPMH: eczema; past asthma, no longer active.\nNo regular meds. No known allergies.\nNon-smoker. Drinks a few beers/week.\nLives with flatmates; works full-time as a project manager at a pharmaceutical company.\nObjective\nRash reportedly viewed during consultation; detailed morphology not documented.\nNo objective observations/vitals documented.\nAssessment\nSuspected eczema flare.\nSupported by prior eczema and current pruritic, sore, erythematous, cracked rash affecting chest, hands and flexural elbows.\nSymptoms are more extensive and itchier than previous eczema episodes.\nNo reported fever, bleeding, purulent discharge, cough or SOB.\nPlan\nPrescribe stronger topical steroid cream; strength, regimen and duration not documented.\nProvide emollients/moisturisers, including for use in bath/shower.\nUse topical steroid and emollients regularly for 7–10 days before assessing response.\nOffer fexofenadine for pruritus despite limited response to previous antihistamine trial.\nKeep diary of potential triggers, including clothing, soap and shower products.\nReview next week if symptoms do not improve.","review":80.84210526315789,"saved":235.6578947368421,"clean":true,"effort":0.0,"sig":[],"mb":11.815073,"latency":26.268,"signable":107.11010526315789}],"heidi":[{"label":"Run 1","wer":17.41472172351885,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's al- also on the chest and in the, in the, on the hands as well. Okay. Yeah, when- like, I like, for instance, hiking- Yeah... during the weekend, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um- Yeah. Have you, have you noticed any, uh, bleeding or discharge from your skins?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I have now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well? No. Just the chest Mains and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itchy. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it correct do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. There's a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm gonna give you something some emollients, which helps to moisturize the skin, which you use in a bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritone, which can help with the itchiness of your Okay. Skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the Imolements on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nNo. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you later. Bye.","marks":[{"start":130,"end":135,"said":"","significant":false},{"start":724,"end":728,"said":"I can","significant":false},{"start":794,"end":797,"said":"I can't","significant":false},{"start":804,"end":808,"said":"I can't","significant":false},{"start":974,"end":994,"said":"OK. I'm certain","significant":false},{"start":1383,"end":1390,"said":"That's those","significant":false},{"start":1420,"end":1420,"said":"appear","significant":false},{"start":1433,"end":1438,"said":"the","significant":false},{"start":1752,"end":1773,"said":"OK. um","significant":false},{"start":1926,"end":1935,"said":"arm. But","significant":false},{"start":1945,"end":1948,"said":"","significant":false},{"start":2009,"end":2014,"said":"OK. 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OK.","significant":false},{"start":8373,"end":8394,"said":"","significant":false},{"start":8412,"end":8438,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"itchy, sore, red skin\"; \"chest, hands, inner elbows\"; cracked skin."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"impacting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema..., asthma (resolved)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior Rx \"helped at the time but current flare unresponsive\"; OTC steroid \"no improvement\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines recently - no relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers; no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected eczema flare-up\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Stronger topical steroid cream prescribed\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for moisturising, to be used in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine prescribed for itchiness\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Follow-up in one week if symptoms do not improve\"."]],"claims":[],"note":"Subjective:\n\n- 4-day history of very itchy, sore, red skin\n\n- Widespread, primarily chest, hands, inner elbows\n\n- Cracked skin in some areas\n\n- Constant, severe itchiness impacting sleep and concentration at work\n\n- Denies bleeding or discharge\n\n- No known triggers; no recent changes to shower gel or clothing\n\n- Denies fever, cough, breathing difficulties, bowel/urinary issues\n\n- PMHx: eczema (previously managed with cream and shower product), asthma (resolved)\n\n- Meds: OTC steroid cream last night - no improvement; previously prescribed eczema cream/shower product - helped at the time but current flare unresponsive; antihistamines recently - no relief\n\n- Allergies: NKDA\n\n- Social: lives with flatmates, full-time project manager at pharmaceutical company, non-smoker, few beers/week\n\n\n\n\nObjective:\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment:\n\n- Suspected eczema flare-up; more widespread and itchier than previous episodes\n\n\n\n\nPlan:\n\n- Stronger topical steroid cream prescribed\n\n- Emollients for moisturising, to be used in bath/shower\n\n- Use steroid cream and emollients regularly for 7-10 days, then review effectiveness\n\n- Fexofenadine prescribed for itchiness\n\n- Keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Follow-up in one week if symptoms do not improve","review":56.21052631578947,"saved":260.2894736842105,"clean":true,"effort":0.0,"sig":[],"mb":37.781067,"latency":27.283,"signable":83.49352631578947},{"label":"Run 2","wer":16.63674446439258,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problems. I'm happy to help. Whereabouts on your skin, is it affected?\n\nMostly like my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And\n\nThey gave me, like, some cream and something to when I, like, was shower when I was in the shower, had to put something. Okay. But Did it help? I mean, at that time, yes. But the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Like, itchy, yeah, when, like, I like, for instance, hiking- Yeah... during the weekends, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No. Well, well, okay, that's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have you, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I'm help now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest Maine. Hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nUh, your background of eczema. Um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of? Uh, no, I just had asthma in the past, but not anymore. Not anymore, okay. And do you take any regular medications at the moment? Uh, no. No. Okay. Do you have any allergies to anything? I like something. Sorry. Yeah. Sorry, I was gonna say, do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Oh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No. Okay. Um, and tell me about your, um-\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm gonna give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritone, which can help with the itchiness of your Okay. Skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. 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OK.","significant":false},{"start":8419,"end":8440,"said":"","significant":false},{"start":8458,"end":8486,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Sore, red, intensely itchy skin rash x4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin \"Affecting chest, hands, inner elbows\" with legs correctly not included."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"interfering with sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"interfering with... concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema...; asthma (resolved)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no relief\" captured, but prior eczema treatments are noted only as effective at the time, not as failing now."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines recently - ineffective\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers identified (no change in shower gel, clothing, or contacts)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Stronger topical steroid cream to affected areas\" with no invented name/dose."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for use during bathing/showering; use 7-10 days\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine for itch relief\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep trigger diary (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Follow-up in 1 week if no improvement\"."]],"claims":[],"note":"Subjective\n\n- Sore, red, intensely itchy skin rash x4 days\n\n- Affecting chest, hands, inner elbows\n\n- Constant, severe itch; interfering with sleep and concentration at work\n\n- Skin cracked in some areas; denies bleeding or discharge\n\n- No fever or other systemic symptoms\n\n- Bowels and urinary function normal; respiratory system clear\n\n- No known triggers identified (no change in shower gel, clothing, or contacts)\n\n- PMHx: eczema (previously treated with cream and bath emollients, effective at the time; current symptoms more widespread and itchy than prior flares confined to arms); asthma (resolved)\n\n- Meds: nil regular; OTC steroid cream from pharmacy yesterday - no relief; antihistamines recently - ineffective\n\n- Allergies: NKDA\n\n- Social: lives with flatmates; works full-time as project manager at pharmaceutical company; non-smoker; occasional alcohol (few beers/week)\n\n\n\n\nObjective\n\n- Rash appears familiar on examination\n\n\n\n\nAssessment\n\n- Suspected flare-up of eczema\n\n\n\n\nPlan\n\n- Stronger topical steroid cream to affected areas\n\n- Emollients for use during bathing/showering; use 7-10 days then review effectiveness\n\n- Fexofenadine for itch relief\n\n- Keep trigger diary (clothing, shower gels, soaps) to discuss next visit\n\n- Follow-up in 1 week if no improvement","review":75.46052631578948,"saved":241.03947368421052,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":37.712102,"latency":27.984,"signable":103.44452631578949},{"label":"Run 3","wer":16.39736684619988,"text":"Hello? Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problems. I'm happy to help. Whereabouts with your skin is it affected?\n\nMostly like my chest, my my hands, my arms, like, like really it's it's super annoying. Like it's itching a lot, like all the time. And I can't even sleep at night. Like I really need something quickly to to solve it. Because even at work, I like, um, when I'm in the meeting and I have to, like, think about my work, I focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no, okay, I understand this is obviously affecting you, and, uh, we'll try our very best to get get it sorted out for you. Um, have you had anything like this before in the past? Um, so yes. Uh, earlier I was like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something to, when I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms, like, these symptoms app like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more, like, only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Like, itchy, yeah, when-- Like, I like, for instance, hiking- Yeah... during the weekend, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um- Yeah. Have, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower drill, any clothing? Have you been around anyone else? No, I, I haven't... It's actually, like, it's very annoying because I'm thinking about may- maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I don't have now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers? No. Just the itching. Itching? Nothing else. Okay. So your your bowels are working okay?\n\nYour chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? Uh, I think so. Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arm, so I'm not sure. I, I really have no idea. Okay. No, that's okay. So, um, normally at this stage, I like to examine you, um, to see the rash itself, to see exactly what type of rash it is. But from what you've told me, you mentioned it's- you've got some dry skin and some, uh, cracked skin as well, uh, and it's been very itchy. And so with your, um-\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like sorry. Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it corrected Do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. There's a couple of questions I want to ask you, which can sometimes affect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I'll continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's medicating your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you use in a bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You you can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. 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OK.","significant":false},{"start":8473,"end":8494,"said":"","significant":false},{"start":8512,"end":8540,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"itchy skin rash x4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on \"chest, hands, arms (including inside elbows)\"; no legs claimed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe itch, disturbing sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disturbing sleep and concentration at work\"."],["The note captures: Known eczema and past asthma.","yes","\"PMHx: eczema...; asthma (currently asymptomatic)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no improvement\" captured, but failure of previously helpful eczema treatments this time is not stated."],["The note captures: Antihistamines already tried have not helped.","yes","\"OTC antihistamines recently - no relief\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No known triggers identified\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Suspected flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for itch\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"keep diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"."]],"claims":[],"note":"Subjective:\n\n- 31yo male, sore, red, intensely itchy skin rash x4 days\n\n- Rash on chest, hands, arms (including inside elbows)\n\n- Severe itch, disturbing sleep and concentration at work\n\n- Skin cracked in some areas\n\n- Denies bleeding, discharge, pus\n\n- No fevers or systemic symptoms\n\n- Bowels, chest, urine output normal\n\n- No known triggers identified\n\n- PMHx: eczema (previously managed with cream + shower treatment); asthma (currently asymptomatic)\n\n- Meds: nil regular; OTC steroid cream last night - no improvement; OTC antihistamines recently - no relief\n\n- Allergies: nil known\n\n- Social: lives with flatmates; full-time project manager at pharmaceutical company; non-smoker; few beers/week\n\n\n\n\nObjective:\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment:\n\n- Suspected flare-up of eczema - intensely itchy, sore, cracked skin on chest, hands, arms\n\n- More widespread and itchier than previous eczema episodes\n\n\n\n\nPlan:\n\n- Prescribe stronger topical steroid\n\n- Prescribe emollients for bath/shower, use for 7-10 days\n\n- Prescribe fexofenadine for itch\n\n- Advised to keep diary of potential triggers (clothing, shower gels, soaps)\n\n- Review in 1 week if no improvement","review":70.40789473684211,"saved":246.0921052631579,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":42.599253,"latency":27.942,"signable":98.34989473684212},{"label":"Run 4","wer":16.935966487133452,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and in the and the on the hands as well. Okay. Yeah. When like I like, for instance, hiking during the weekends and I am I can't really do it anymore because it's like very like like I wanted to do that last weekend and it was super painful. And I have to take like showers every day to be able to kind of ease this itching part, which is very, very annoying. No. Well okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Um have you noticed any, uh, bleeding or discharge from your skins?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers, so anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel, any clothing? Have you been around anyone else? No, I, I haven't... It's actually, like, it's really annoying because I'm thinking about may- maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I'll help now. No. No. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest Maine. Hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it crack do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your your situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, again, I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You you can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay, well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you later. 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Thank you as well. Bye. 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Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway. Okay. Okay, so let's start again. So how can I help you, sir?\n\nYes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts in your skin is it affected? Mostly, like, my chest, my my hands, my arms, like\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get us sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I like was shower when I was in the shower, I had to put something. Okay. But did it help? I mean, at that time, yes, but the symptoms, like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's al- also on the chest and in the, and the, on the hands as well. Okay. Yeah, when- like, I like, for instance, hiking- Yeah... during the weekends, and I, um, I can't really do it anymore because it's, like, very, like, like I wanted to do that last weekend, and it was super painful, and- Yeah... I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No, well, well, okay, that's good. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um, have, have you noticed any, uh, bleeding or discharge from your skin?\n\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You have noticed any other pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you Four days ago? Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone? No. I I haven't it's actually, like, it's really annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I refer your help now. No, no. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and like, like inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers? No. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay?\n\nYour chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? Uh, I think so. Okay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arm, so I'm not sure. I I really have no idea. Okay. No, that's okay. So, um, normally at this stage, I like to examine you, um, to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well, uh, and it's been very itchy. And so with your, um-\n\nYour your background of eczema. Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment? No. No. Okay. Do you have any allergies to anything? Like, something sorry? Yeah. Sorry. I was gonna say do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think it cracked. Do you have any allergies at all? Oh, allergies? No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We are working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've gotta say at this stage, I've gotta say that the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you have to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or piritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay, well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[{"start":130,"end":135,"said":"","significant":false},{"start":724,"end":728,"said":"I can","significant":false},{"start":795,"end":798,"said":"I can't","significant":false},{"start":805,"end":809,"said":"I can't","significant":false},{"start":975,"end":993,"said":"OK. I'm certain","significant":false},{"start":1066,"end":1068,"said":"this","significant":false},{"start":1380,"end":1387,"said":"That's those","significant":false},{"start":1418,"end":1418,"said":"appear","significant":false},{"start":1431,"end":1436,"said":"the","significant":false},{"start":1750,"end":1758,"said":"OK. um","significant":false},{"start":1911,"end":1920,"said":"arm. But","significant":false},{"start":1930,"end":1933,"said":"","significant":false},{"start":1995,"end":2000,"said":"OK. 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Hello. Can you hear me well? Uh, yes, I think it's a bit better. It's a bit, it's a bit... It's not very clear, but let's, let's continue anyway.\n\nOkay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. So I'd like to find something quick to solve it. No. No problem. I'm happy to help. Whereabouts on your skin is it affected? Mostly, like, my chest, my my hands, my arms, like,\n\nLike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus like, actually focus on my work, it's Yeah. Really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No. No. Okay. I'm saying this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes. Earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to\n\nWhen I, like, was shower when I was in the shower, I had to put something. Okay. But Did it help? I mean, at that time, yes. But the symptoms like, these symptoms, like, when these symptoms appeared again, I tried those, and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more like itchy, and my eczema was more like only in the arms, and now it's also on the chest and in the and the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And I have to take, like, showers every day to be able to kind of ease this itching part, which is very, very annoying. No. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have have you noticed any bleeding or discharge from your skins?\n\nNo. Um, so my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But, uh, yeah. You don't have noticing any other, uh, pus or blood coming out of your skin? No. No. And you mentioned it all started three days ago. Are you- Four days ago. Four days ago. Are you aware of any triggers, so anything that you may have done that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel, any clothing? Have you been around anyone at all? No, I, I haven't. It's actually, like, it's really annoying because I'm thinking about maybe I should change something because I, I haven't, and I don't understand, and I'm kind of-\n\nAfraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I refer your head now. No, no. Okay. That's okay. Fine. So just to re summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest hands and, like like, inside the elbows. Okay. Any anything on your face at all? In my what? On your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Itching. Nothing else. Okay. So your your bowels are working okay? Your chest is okay. No cough, no breathing difficulties? No. You're passing urine okay? I think so. Okay. Alright. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like, my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. No. That's okay. So, normally, at this stage, I'd like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your\n\nUh, your background of eczema. Um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of? Uh, no, I just had asthma in the past, but not anymore. Not anymore, okay. And do you take any regular medications at the moment? Uh, no. No. Okay. Do you have any allergies to anything? I like something. Sorry. Yeah. Sorry, I was gonna say, do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Oh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No. Okay. Um, and tell me about your, um-\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm thirty one. I yeah. I have a full time job, and so I'm living with a few people to save money. Okay. And what do you do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a like a kind of project manager. I mean, do you want to to know more about it? Okay. No. No. No. That's absolute that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while. So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the the sound quality is not great, but I'll I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the the the rash does appear quite familiar. You mentioned you using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial, which I'm happy to prescribe to you today. As well as I'm going to give you something some emollients, which helps to moisturize the skin, which you want to use in the bath and shower. And it's definitely worth using that for the first seven to ten days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter, things like loratadine or pyritin, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you.\n\nOkay. Just I I have tried antihistamines lately, but it didn't really help. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I certainly think using the steroids and the emollients on a regular basis over the next week to ten days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me?\n\nUh, no, that's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[{"start":130,"end":135,"said":"","significant":false},{"start":725,"end":729,"said":"I can","significant":false},{"start":796,"end":799,"said":"I can't","significant":false},{"start":806,"end":810,"said":"I can't","significant":false},{"start":986,"end":992,"said":"certain","significant":false},{"start":1381,"end":1388,"said":"That's those","significant":false},{"start":1418,"end":1418,"said":"appear","significant":false},{"start":1431,"end":1436,"said":"the","significant":false},{"start":1750,"end":1771,"said":"OK. um","significant":false},{"start":1924,"end":1933,"said":"arm. But","significant":false},{"start":2002,"end":2007,"said":"OK. Like pretty","significant":false},{"start":2065,"end":2073,"said":"weekend.","significant":false},{"start":2187,"end":2193,"said":"because","significant":false},{"start":2267,"end":2274,"said":"cannot uh","significant":false},{"start":2494,"end":2494,"said":". OK.","significant":false},{"start":2616,"end":2639,"said":"OK. 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Thank you as well. Bye. OK.","significant":false},{"start":8400,"end":8421,"said":"","significant":false},{"start":8439,"end":8467,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","4-day history recorded."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on chest, hands and inner elbows; legs not listed."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies bleeding/discharge."],["The note captures: Itching disturbs sleep.","yes","Sleep disturbance recorded."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration and hiking impact recorded."],["The note captures: Known eczema and past asthma.","yes","Eczema and past asthma recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid last night no improvement recorded; prior eczema treatments listed but their current failure not stated."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines tried without benefit."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identified trigger; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Suspected eczema flare."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","Stronger topical steroid prescribed."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollient including bath/shower use."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Fexofenadine for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Trigger diary covering clothing, soaps, shower products."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Review next week if not improving; 7–10 day trial."]],"claims":[],"note":"Subjective\n\n- 4-day history of sore, red, intensely itchy skin rash\n\n- Affecting chest, hands, inner elbows\n\n- Constant itch, disturbing sleep and work concentration\n\n- Denies facial involvement\n\n- Cracked skin in some areas; denies bleeding, discharge, pus\n\n- No obvious triggers identified (no change in shower gel, clothing, contacts)\n\n- Difficulty hiking due to pain; requires daily showers for relief\n\n- Current symptoms more extensive and itchier than previous eczema episodes\n\n- PMHx: eczema (previously managed with topical cream and shower treatment); asthma (resolved)\n\n- Meds: OTC steroid cream last night - no improvement; previously tried antihistamines - no relief\n\n- Allergies: NKDA\n\n- Social: lives with flatmates; full-time project manager at pharmaceutical company; non-smoker; few beers/week\n\n- ROS: denies fever, cough, breathing difficulty; bowel function normal; urine output normal\n\n\n\n\nObjective\n\n- Rash appears consistent with eczema flare\n\n\n\n\nAssessment\n\n- Suspected flare-up of eczema\n\n\n\n\nPlan\n\n- Prescribe stronger topical steroid cream to affected areas\n\n- Prescribe emollients for use during baths/showers\n\n- Recommend fexofenadine for itch relief\n\n- Use steroid and emollients regularly for 7-10 days\n\n- Keep diary of potential triggers (clothing, shower gels, soap)\n\n- Follow-up in one week if no improvement","review":76.40789473684211,"saved":240.0921052631579,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":38.326817,"latency":33.439,"signable":109.8468947368421}],"freed":[{"label":"Run 1","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[{"start":74,"end":74,"said":"a bit it's a bit it's","significant":false},{"start":463,"end":463,"said":"my","significant":false},{"start":491,"end":491,"said":"it's","significant":false},{"start":660,"end":664,"said":"I I can","significant":false},{"start":726,"end":729,"said":"I can't","significant":false},{"start":737,"end":741,"said":"I can't","significant":false},{"start":904,"end":916,"said":"OK. 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Bye.","significant":false},{"start":7816,"end":7839,"said":"","significant":false},{"start":7857,"end":7889,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked/dry skin on chest, hands and inner elbows; \"denies involvement of the face or legs\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies any bleeding, discharge, or pus\"."],["The note captures: Itching disturbs sleep.","yes","Itching \"significantly disrupts his sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work focus and hiking both captured."],["The note captures: Known eczema and past asthma.","yes","\"Eczema\" and \"Asthma, resolved\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previous treatments tried without improvement and OTC steroid cream from the night prior not helping."],["The note captures: Antihistamines already tried have not helped.","yes","\"tried antihistamines without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"unable to identify any specific triggers, including changes in shower gel, clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema Flare-up\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients in bath and shower, used regularly."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for itch control\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return for follow-up next week if symptoms do not improve\"."]],"claims":[],"note":"Subjective\nCliniTech Benchmark ea24bd0b, a 31-year-old male with a history of eczema and resolved asthma, presents with a 4-day history of itchy, sore, red skin affecting the chest, hands, and inner elbows. He describes the rash as intensely pruritic, with cracked skin in some areas, and reports that the itching is constant and significantly disrupts his sleep and ability to focus at work. He denies any bleeding, discharge, or pus from the affected skin. He denies involvement of the face or legs. He denies fever, cough, breathing difficulties, or urinary symptoms.\n\nThe patient reports a prior history of eczema, which previously affected only his arms and was treated with a prescribed cream and a shower product. He states that when the current symptoms recurred, he tried those previous treatments without improvement. He also purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines without benefit. He is unable to identify any specific triggers, including changes in shower gel, clothing, or environmental exposures. He notes that the current presentation is more widespread and more intensely itchy than his prior eczema episodes. He reports that outdoor activities such as hiking have become difficult due to the symptoms, and he has been taking daily showers in an attempt to ease the itching.\n\nMedical History  \n- Eczema  \n- Asthma, resolved\n\nMedications and Supplements  \n- Over-the-counter steroid cream  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema  \n- Antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: A few beers per week socially  \n- Exercise: Enjoys hiking on weekends  \n- Occupation: Works as a project manager at a pharmaceutical company\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties  \n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin rash affecting chest, hands, and inner elbows, disrupting sleep and work.\n\nEczema Flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy and sore skin rash affecting the chest, hands, and inner elbows, consistent with an eczema flare-up given his past medical history of eczema. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, now involving chest and hands. The rash is characterized by dryness, cracking, and intense pruritus that significantly impacts his sleep and work concentration. Previous over-the-counter steroid cream purchased yesterday has been ineffective. The patient has tried antihistamines recently without relief. No systemic symptoms, fever, or secondary infection signs such as bleeding or discharge are present.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients and steroids regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine for itch control  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up next week if symptoms do not improve\n","review":156.3157894736842,"saved":160.1842105263158,"clean":true,"effort":0.0,"sig":[],"mb":16.153109,"latency":44.892,"signable":189.11578947368417},{"label":"Run 2","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[{"start":74,"end":74,"said":"a bit it's a bit it's","significant":false},{"start":463,"end":463,"said":"my","significant":false},{"start":491,"end":491,"said":"it's","significant":false},{"start":660,"end":664,"said":"I I can","significant":false},{"start":726,"end":729,"said":"I can't","significant":false},{"start":737,"end":741,"said":"I can't","significant":false},{"start":904,"end":916,"said":"OK. 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Bye.","significant":false},{"start":7816,"end":7839,"said":"","significant":false},{"start":7857,"end":7889,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Return for follow-up next week if symptoms do not improve'."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 1540ec38, a 31-year-old male with a history of eczema and resolved asthma, presents with a 4-day history of sore, red, itchy skin affecting the chest, hands, and inside the elbows. He reports the rash is severely pruritic, causing significant sleep disturbance and impaired ability to focus at work during meetings. He describes the skin as cracked in some areas but denies any bleeding, discharge, or pus. He notes the distribution is more widespread than his prior eczema, which was limited to the arms.\n\nThe patient reports that previous eczema treatments, including a prescribed cream and a shower product, were helpful at the time but have not been effective for the current episode. He purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines without improvement. He denies any identifiable triggers, including changes in shower gel or clothing.\n\nMedical History\n- Eczema\n- Asthma, resolved\n\nMedications and Supplements\n- Over-the-counter steroid cream, applied topically\n- Antihistamines\n- Previously prescribed eczema cream\n- Previously prescribed shower product for eczema\n\nAllergies\n- No known allergies\n\nSocial History\n- Tobacco: Non-smoker\n- Alcohol: A few beers per week socially\n- Occupation: Works as a project manager at a pharmaceutical company, full-time\n- Living Situation: Lives with several flatmates\n- Hobbies: Enjoys hiking on weekends\n\nReview of Systems\n- General: Denies fever\n- Respiratory: Denies cough, breathing difficulties\n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin rash affecting chest, hands, and arms, disrupting sleep and work.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows, consistent with an eczema flare-up given his past medical history of eczema. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, and the symptoms are more severely pruritic than his prior episodes. The rash is characterized by dry, cracked skin without bleeding or discharge. Previous over-the-counter steroid cream purchased yesterday provided no relief. The patient has tried antihistamines without improvement. No fever, systemic symptoms, or other concerning features are present. The clinical presentation is most consistent with an eczema exacerbation requiring prescription-strength treatment.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up next week if symptoms do not improve\n","review":139.26315789473682,"saved":177.23684210526318,"clean":true,"effort":0.0,"sig":[],"mb":16.226082,"latency":62.151,"signable":188.15215789473683},{"label":"Run 3","wer":20.047875523638538,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but the symptoms, like these symptoms, like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay.\n  Yeah.\n  Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay, steroid, okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, that's okay. So you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  Have you noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties? No. You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to ask, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So I live with a few flatmates. So you know I'm 31. I have a full-time job and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye.\n  Thank you, Victor.\n  Bye.","marks":[{"start":74,"end":74,"said":"a bit it's a bit it's","significant":false},{"start":463,"end":463,"said":"my","significant":false},{"start":491,"end":491,"said":"it's","significant":false},{"start":660,"end":664,"said":"I I can","significant":false},{"start":726,"end":729,"said":"I can't","significant":false},{"start":737,"end":741,"said":"I can't","significant":false},{"start":904,"end":916,"said":"OK. 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Bye.","significant":false},{"start":7816,"end":7839,"said":"","significant":false},{"start":7857,"end":7889,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 093c4fb7, a 31-year-old male with a history of eczema, presents with a 4-day history of sore, red, itchy skin affecting the chest, hands, and inside the elbows. He describes the rash as intensely pruritic, with cracked skin in some areas, but denies any bleeding, discharge, or pus from the affected areas. He reports the itching is constant and severe enough to disrupt his sleep and significantly impair his ability to focus at work during meetings. He also notes that outdoor activities such as hiking have become painful and difficult due to the symptoms. He has been taking daily showers in an attempt to ease the itching.\n\nThe patient has a history of eczema, which previously affected only his arms. He reports that the current symptoms are similar but more pruritic and more widespread than his prior eczema episodes. He was previously prescribed a cream and a shower product for eczema, which helped at that time. However, when the current symptoms appeared, he tried those same treatments without improvement. He also purchased an over-the-counter steroid cream from the pharmacy the night prior, which has not provided relief. He has also tried antihistamines, which did not help. He denies any known triggers, including changes in shower gel, clothing, or exposure to anyone with similar symptoms. He denies fever, cough, breathing difficulties, or urinary symptoms. He denies any involvement of the face.\n\nMedical History  \n- Eczema  \n- Asthma in the past, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream, applied topically  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema  \n- Over-the-counter antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: Occasional, a few beers per week  \n- Occupation: Works as a project manager at a pharmaceutical company, full-time  \n- Living Situation: Lives with several flatmates in a shared accommodation  \n- Hobbies: Enjoys hiking on weekends, though currently unable to participate due to symptoms\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with a 4-day history of itchy, sore skin rash affecting chest, hands, and arms.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows. The rash is characterized by dry, cracked skin without bleeding or discharge. Patient has a history of eczema that previously affected only the arms, but current presentation shows similar characteristics with expanded distribution. Previous eczema treatments and over-the-counter steroid cream purchased yesterday have been ineffective. The distribution pattern, itching severity, and skin appearance are consistent with an eczema flare-up, though the expanded distribution beyond previous patterns warrants monitoring.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for moisturizing skin, to be used in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":161.3684210526316,"saved":155.1315789473684,"clean":true,"effort":0.0,"sig":[],"mb":15.979855,"latency":54.773,"signable":202.0604210526316},{"label":"Run 4","wer":20.586475164572114,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, okay, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay. Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, so you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  You haven't noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties?\n  No.\n  You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to say, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So, I live with a few flatmates. So, you know, I'm 31. I have a full-time job, and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned you were using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":74,"end":74,"said":"a bit it's a bit it's","significant":false},{"start":463,"end":463,"said":"my","significant":false},{"start":491,"end":491,"said":"it's","significant":false},{"start":660,"end":664,"said":"I I can","significant":false},{"start":726,"end":729,"said":"I can't","significant":false},{"start":737,"end":741,"said":"I can't","significant":false},{"start":904,"end":922,"said":"OK. 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Bye.","significant":false},{"start":7762,"end":7785,"said":"","significant":false},{"start":7803,"end":7831,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","No identifiable triggers; no change in shower gel or clothing."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[["He went hiking last weekend and the symptoms were 'super painful'.","Transcript says he 'wanted to do that last weekend' and 'can't really do it anymore'; it does not say he went hiking."]],"note":"Subjective\nCliniTech Benchmark 95def2c6, a 31-year-old male with a history of eczema and asthma (no longer active), presents with a 4-day history of itchy, sore, red skin affecting the chest, hands, and inside the elbows. He describes the rash as \"super annoying\" and reports constant itching that is significantly impacting his daily functioning, including difficulty sleeping at night and inability to focus at work during meetings. He also notes that the rash has interfered with his recreational activities, reporting that he went hiking last weekend and the symptoms were \"super painful,\" requiring daily showers to ease the itching.\n\nHe reports the skin appears cracked in some areas but denies any bleeding, discharge, or pus. He has a history of eczema, which previously affected only his arms, and notes that the current symptoms are similar but more itchy and more widespread than his prior eczema episodes. He was previously prescribed a cream and a shower product for his eczema, which helped at that time, but when he tried those same treatments for the current symptoms, they were ineffective. He purchased an over-the-counter steroid cream from the pharmacy the night prior to presentation, which also did not help. He has also tried antihistamines recently without relief. He is unaware of any specific triggers and has not changed his shower gel, clothing, or been around anyone new.\n\nMedical History  \n- Eczema  \n- Asthma, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream applied topically  \n- Previously prescribed eczema cream applied topically  \n- Previously prescribed shower product for eczema  \n- Over-the-counter antihistamines\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Denies smoking  \n- Alcohol: Occasional, a few beers per week  \n- Occupation: Works as a project manager at a pharmaceutical company, full-time  \n- Living Situation: Lives with several flatmates in a shared accommodation  \n- Hobbies: Enjoys hiking on weekends, though currently limited by symptoms\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties  \n- Genitourinary: Denies urinary symptoms\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with a 4-day history of itchy, sore skin rash affecting chest, hands, and inner elbows.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy, sore skin rash affecting the chest, hands, and inner elbows. The rash is characterized by dry, cracked skin without bleeding or discharge. Current symptoms are more widespread and severe than previous eczema episodes, with significant impact on sleep and daily functioning. Patient has tried over-the-counter steroid cream without improvement and has also tried antihistamines without relief. No fever, respiratory symptoms, or other systemic complaints. Physical examination findings appear consistent with eczema flare-up given the clinical presentation and patient's history.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for use in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch relief  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":170.5263157894737,"saved":145.9736842105263,"clean":false,"effort":10.0,"sig":[],"mb":16.014195,"latency":49.007,"signable":207.3103157894737},{"label":"Run 5","wer":20.586475164572114,"text":"Hello. Hello. Can you hear me well?\n  Yes, I think it's a bit better. It's not very clear, but let's continue anyway. Okay. Okay. Let's start again. So how can I help you, sir?\n  Yes, so it's been a few days now. I have like a sore and a red skin. It's kind of, it's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\n  No, no problem. I'm happy to help. Whereabouts in your skin is it affected?\n  Mostly like my chest, my hands, my arms, like really it's super annoying, like it's itching a lot, like all the time and I can't even sleep at night, like I really need something quickly to solve it because even at work, like when I'm in a meeting and I have to like think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say, I'm always... Like, disturbed by this disease.\n  No, no, okay, I understand this is obviously affecting you and we'll try our very best to get it sorted out for you. Have you had anything like this before in the past?\n  So, yes, earlier I was prescribed for my eczema. Okay. They gave me some cream and something to when I was in the shower I had to put something.\n  Okay. Did it help?\n  I mean, at that time, yes, but when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\n  Okay. Do you remember the name of the cream you bought?\n  Steroid cream.\n  Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\n  It's much more like itchy and my eczema was more like only in the arms and now it's also on the chest and on the hands as well. Like I like for instance hiking during the weekends and I can't really do it anymore because it's like very like I went into that last weekend and it was... super painful and I have to take like showers every day to be able to kind of ease this itching part which is very very annoying.\n  Okay, so you mentioned the itchiness, you also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\n  No, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But yeah.\n  You haven't noticed any other pus or blood coming out of your skin? No. And you mentioned it all started 3 days ago. 4 days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone?\n  No, it's actually, like, it's very annoying because I'm thinking about... Maybe I should change something because I haven't and I don't understand and I'm kind of afraid of asking people around me because it's kind of, you know, I don't feel really comfortable asking about these questions, it's kind of intimate and so I read your head now.\n  No, no, okay, that's okay. Fine, so just to re-summarize, for the last 4 days you've had very itchy skin, very sore skin all over your body, mainly your chest. Did you also mention your arms and legs as well?\n  No, just the chest, hands and like inside the elbows.\n  Okay, anything on your face at all?\n  On my what?\n  On your face?\n  Oh, on my face, no.\n  No, okay. And apart from this, any other symptoms have you noticed, for example, have you noticed any temperature or fevers?\n  No, just itching.\n  Itching?\n  Nothing else.\n  Okay, so your bowels are working okay? Your chest is okay, no cough, no breathing difficulties?\n  No.\n  You're passing urine okay?\n  I think so.\n  Okay, all right. It's always good to know, so I mean, do you have any ideas as to what could be causing your symptoms?\n  Any what?\n  Any ideas as to what could be causing your symptoms?\n  So I had eczema before, so maybe it's this, but it seems like more... Like my eczema was only on the arms, so I'm not sure, I really have no idea.\n  Okay, that's okay. So normally at this stage I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your... Your background of eczema, sorry there's a couple of questions I wanted to ask you which I completely forgot, my apologies. Apart from eczema, do you have any other medical problems I should be aware of?\n  No, I just had asthma in the past but not anymore.\n  Not anymore, okay. And do you take any regular medications at the moment?\n  No.\n  No, okay. Do you have any allergies to anything? Sorry, I was going to say, do you have any allergies to anything? Hello. Hello, yes. Can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\n  Oh, allergies, no.\n  No, okay. And tell me about your situation at home. Who do you live with?\n  So, I live with a few flatmates. So, you know, I'm 31. I have a full-time job, and so I'm living with a few people to save money.\n  Okay, and what do you do for work?\n  I work at a pharmaceutical company, so it's been a few years now. It's kind of interesting, I'm like a project manager. Do you want to know more about it?\n  Okay. No, no, no, that's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect your symptoms, is do you smoke at all? No. No. And do you drink much, in a way, of alcohol?\n  You know, once in a while, I like hanging out with people once in a while. So, yeah, I'd say a few beers per week, something like this. Nothing crazy. I used to drink a lot more when I was younger, but it's been a while.\n  Okay, I've got to say, at this stage, I've got to say, the sound quality is not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare-up of your eczema, the reason being that you said it's quite itchy, it's mainly affecting your chest and your back, and having looked at your skin, the rash does appear quite familiar. You mentioned you were using steroid creams yesterday. from the pharmacy, I wonder whether giving you a stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today, as well as I'm going to give you some emollients which helps moisturize the skin, which you can use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piriton, which can help with the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap, because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\n  I have tried antihistamines lately but it didn't really help.\n  Could you say that again, sorry?\n  I have tried the antihistamines, but it didn't really help.\n  Okay, so something for you to think about, you can get different type of antihistamines, I can give you something a little bit stronger today as well, something like fexofenadine which I can give to you today, it's definitely worth trying it, it's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better.\n  That sounds good. OK.\n  Do you have any questions for me?\n  No, that's it.\n  OK. Well, I wish you all the best.\n  Thank you very much.\n  Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":74,"end":74,"said":"a bit it's a bit it's","significant":false},{"start":463,"end":463,"said":"my","significant":false},{"start":491,"end":491,"said":"it's","significant":false},{"start":660,"end":664,"said":"I I can","significant":false},{"start":726,"end":729,"said":"I can't","significant":false},{"start":737,"end":741,"said":"I can't","significant":false},{"start":904,"end":922,"said":"OK. 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Uh I yeah I'm","significant":false},{"start":5162,"end":5162,"said":"it's been a","significant":false},{"start":5177,"end":5177,"said":"Uh it's uh","significant":false},{"start":5202,"end":5202,"said":"We're working","significant":false},{"start":5214,"end":5214,"said":"kind of","significant":false},{"start":5231,"end":5231,"said":"Uh I mean","significant":false},{"start":5293,"end":5293,"said":"that's","significant":false},{"start":5340,"end":5346,"said":"want","significant":false},{"start":5505,"end":5505,"said":"I can","significant":false},{"start":5578,"end":5578,"said":"a few","significant":false},{"start":5615,"end":5615,"said":"Nothing","significant":false},{"start":5691,"end":5691,"said":"it's been","significant":false},{"start":5874,"end":5877,"said":"Sarah","significant":false},{"start":5965,"end":5969,"said":"it was","significant":false},{"start":6114,"end":6122,"said":"","significant":false},{"start":6333,"end":6333,"said":"something","significant":false},{"start":6389,"end":6396,"said":"","significant":false},{"start":6617,"end":6633,"said":"over counter.","significant":false},{"start":6902,"end":6905,"said":"your","significant":false},{"start":6956,"end":6979,"said":"an eczema CU. OK. Yes","significant":false},{"start":7043,"end":7043,"said":"Ohh","significant":false},{"start":7151,"end":7151,"said":"it's","significant":false},{"start":7208,"end":7212,"said":"types","significant":false},{"start":7427,"end":7436,"said":"","significant":false},{"start":7712,"end":7712,"said":"Thank you very much. Bye. Thank you as well. Bye.","significant":false},{"start":7762,"end":7785,"said":"","significant":false},{"start":7803,"end":7831,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Eczema and asthma no longer active/resolved documented."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'no identifiable triggers and has not changed any personal care products or clothing'."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for use in bath and shower, regularly for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine antihistamine for itch'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Reassess after 7-10 days and return if symptoms do not improve."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 88acd250, a 31-year-old male with a history of eczema and asthma (no longer active), presents with a 4-day history of intensely itchy, sore, red skin affecting the chest, hands, and inner elbows. He describes the rash as severely pruritic, with cracked skin in some areas, and reports the itching is constant and disrupts his sleep and ability to focus at work. He notes that the current symptoms are more widespread than his prior eczema, which was limited to the arms, and are significantly more itchy. He denies any bleeding, pus, or discharge from the skin. He denies fever, cough, breathing difficulties, or urinary symptoms.\n\nThe patient reports no identifiable triggers and has not changed any personal care products or clothing. He has tried an over-the-counter steroid cream purchased from the pharmacy the previous night without improvement. He has also tried antihistamines without relief. He previously used a prescribed eczema cream and a shower product during a prior eczema episode, which helped at that time but are no longer effective for the current symptoms. The rash has significantly impacted his daily functioning, including his ability to sleep, concentrate at work during meetings, and engage in outdoor activities such as hiking on weekends. He reports having to take daily showers in an attempt to ease the itching.\n\nMedical History  \n- Eczema  \n- Asthma, no longer active\n\nMedications and Supplements  \n- Over-the-counter steroid cream, applied topically  \n- Antihistamines  \n- Previously prescribed eczema cream  \n- Previously prescribed shower product for eczema\n\nAllergies  \n- No known allergies\n\nSocial History  \n- Tobacco: Non-smoker  \n- Alcohol: A few beers per week socially  \n- Exercise: Enjoys hiking on weekends  \n- Occupation: Project manager at a pharmaceutical company\n\nReview of Systems  \n- General: Denies fever  \n- Respiratory: Denies cough, breathing difficulties\n\nObjective\nN/A\n\nAssessment & Plan\n31-year-old male with history of eczema, presenting with 4-day onset of intensely itchy, sore skin affecting chest, hands, and inner elbows, disrupting sleep and work.\n\nEczema flare-up  \nAssessment: Patient presents with a 4-day history of intensely itchy and sore skin affecting the chest, hands, and inner elbows, consistent with an eczema flare-up. The distribution has expanded beyond his previous eczema pattern, which was limited to arms, now involving chest and hands. The rash is characterized by dryness, cracking, and intense pruritus that significantly impacts sleep and work performance. Previous over-the-counter steroid cream purchased from pharmacy has been ineffective. No systemic symptoms, fever, or other concerning features. The clinical presentation is most consistent with an eczema exacerbation requiring stronger prescription therapy.  \nPlan:  \n- Prescribe stronger prescription steroid cream  \n- Prescribe emollients for use in bath and shower  \n- Use emollients regularly for 7-10 days before reassessing effectiveness  \n- Prescribe fexofenadine antihistamine for itch control  \n- Keep diary of potential triggers including clothing, shower gels, and soaps  \n- Return for follow-up if symptoms do not improve\n","review":149.3684210526316,"saved":167.1315789473684,"clean":true,"effort":0.0,"sig":[],"mb":15.99375,"latency":53.402,"signable":190.56742105263157}],"cliniscripts":[{"label":"Run 1","wer":14.90125673249551,"text":"Hello.\nHello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So, it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying. Okay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like all the time, and I can't even sleep at night.\nLike, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No, no. Okay, I understand. This is obviously affecting you, and we'll try our very best to get a source of that for you. Um, have you had anything like this before in the past?\nUm, so, yes. Uh, earlier I was, like, prescribed for my eczema. Okay.\nAnd they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time, yes, but the symptoms, like, these symptoms are, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like, really, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so, my skin is a bit cracked in some parts. Like, kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers, anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I, I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate, and so I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest, hands, and, like, like, inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, no. Just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. Your passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI, I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nUh, and it's been very itchy. And so, with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma.\nIn the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just, uh, sorry, I was going to say, do you have any allergies to anything?\nHello?\nHello? Yes? Oh, can you hear me? Sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\nUh, so, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So, it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute— that's absolute fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms. Is— do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay.\nI'm going to say, at this stage, I'm going to say, th-this sound quality is not, uh, great, but I'll, I'll continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, th-th-the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday. Um, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be beneficial. Okay.\nUh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin.\nUm, which I'm going to use in the bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh. Okay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter. Things like loratadine or piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower\ngels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Okay. Just, I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again, sorry? I have tried the antihistamines. Okay.\nUh, but it didn't really help.\nIt didn't. Okay. So it's something for you to think about. You can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it.\nOkay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[{"start":727,"end":735,"said":"I can","significant":false},{"start":800,"end":803,"said":"I can't","significant":false},{"start":811,"end":815,"said":"I can't","significant":false},{"start":975,"end":994,"said":"OK. I'm certain","significant":false},{"start":1063,"end":1079,"said":"get this sorted out","significant":false},{"start":1418,"end":1425,"said":"That's those","significant":false},{"start":1457,"end":1460,"said":"appear","significant":false},{"start":1473,"end":1478,"said":"the","significant":false},{"start":1799,"end":1821,"said":"OK.","significant":false},{"start":1826,"end":1832,"said":"","significant":false},{"start":1993,"end":2002,"said":"arm. 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OK.","significant":false},{"start":8840,"end":8861,"said":"","significant":false},{"start":8879,"end":8907,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Sore, red, itchy, cracked skin on chest, hands and inside elbows captured, but the patient correcting that legs are not affected is omitted."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"causing sleep disturbance\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"difficulty concentrating at work\"."],["The note captures: Known eczema and past asthma.","yes","History of eczema and \"asthma (not currently active)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior treatment \"ineffective for current symptoms\" and OTC steroid cream last night did not help."],["The note captures: Antihistamines already tried have not helped.","yes","\"patient reported previous antihistamine use was unhelpful\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"Unable to identify specific triggers\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"suspects a flare-up of the patient's eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe a stronger prescription steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients \"to be used in the bath and shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine fexofenadine offered."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels or soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Follow-up in one week if not improving."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 4-day history of sore, red, and intensely itchy skin, primarily affecting their chest, hands, and arms (specifically inside the elbows).\n- Symptoms are significantly bothersome, causing sleep disturbance and difficulty concentrating at work.\n- Patient has a history of eczema, previously treated with a cream and a shower product, which helped at the time but is ineffective for current symptoms.\n- Self-treated with an over-the-counter steroid cream last night, which did not alleviate the itching.\n- Describes current symptoms as much more itchy and widespread compared to previous eczema, which was confined to the arms.\n- Reports cracked skin in some areas, but no bleeding, discharge, pus, fever, cough, breathing difficulties, or issues with bowel movements or urination.\n- Unable to identify specific triggers for the current flare-up and expresses discomfort discussing their condition with others.\n- Patient has a history of asthma (not currently active) and no known allergies. They are 31 years old, live with flatmates, and work as a project manager at a pharmaceutical company. They do not smoke and consume a few beers per week.\n\nO (Objective):\n- The doctor noted poor sound quality during the consultation.\n- Patient appeared cooperative during the interaction.\n- The doctor inferred the rash appears familiar, suggesting a possible flare-up of eczema.\n\nA (Assessment):\n- The doctor suspects a flare-up of the patient's eczema, given the itchiness, distribution on the chest, hands, and arms (inside elbows), and previous history.\n- The previous steroid cream used by the patient was ineffective, suggesting a need for a stronger prescription.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream for the affected areas.\n- Prescribe emollients for moisturizing the skin, to be used in the bath and shower for 7-10 days.\n- Recommend over-the-counter antihistamines (e.g., loratadine or piritin) for itch relief, or prescribe a stronger antihistamine (fexofenadine) as patient reported previous antihistamine use was unhelpful.\n- Advise the patient to keep a diary of potential triggers, including clothing, shower gels, or soaps.\n- Schedule a follow-up appointment in one week to reassess symptoms if they do not improve.\n","review":132.14473684210526,"saved":184.35526315789474,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":27.781054,"latency":24.492,"signable":142.11973684210525},{"label":"Run 2","wer":15.140634350688211,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like, it's itching a lot, like all the time, and I can't even sleep at night.\nLike, I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you, and we'll try our very best to get a source that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was, like, prescribed for my eczema. Okay.\nAnd they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like, these symptoms app— like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms or different?\nUm, it's much more, like, itchy and my eczema was more, like, only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like, yeah, when— like, I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like, I want it to— that last weekend and it was super painful and I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts. Like, kind of cracked if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I— I haven't. It's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and, like, like, inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay. And. Your chest is okay. No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Oh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute— that's absolute fine.\nUm, just a couple of questions I want to ask you, which can sometimes affect your symptoms.\nIs— do you smoke at all?\nNo. No. And do you drink much in the way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while, so yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, the having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial.\nOkay. Uh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just, I, I have to write antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines. I can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully c-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. 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OK.","significant":false},{"start":8852,"end":8873,"said":"","significant":false},{"start":8891,"end":8919,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","partial","Eczema captured but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream from previous night failed, but not stated that previously helpful eczema treatments failed this time."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients used regularly and in baths/showers for 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","partial","Follow-up next week is stated unconditionally; the 'if not improving' condition is missing."]],"claims":[],"note":"S (Subjective):\n- Patient presents with a 4-day history of sore, red, and intensely itchy skin, primarily affecting the chest, hands, and inner elbows.\n- Symptoms are described as \"super annoying,\" causing sleep disturbance and difficulty concentrating at work.\n- Patient has a past medical history of eczema, for which they were previously prescribed cream and a shower additive that helped at the time.\n- Current symptoms are more intensely itchy and widespread compared to previous eczema flare-ups, which were primarily limited to the arms.\n- Patient attempted self-treatment with a steroid cream purchased from a pharmacy the previous night, which provided no relief. They also tried antihistamines previously, which did not help.\n- Patient reports skin is cracked in some areas, but denies bleeding, discharge, pus, or fever. Hiking during weekends is now painful due to the skin condition.\n\nO (Objective):\n- Patient's speech was affected by poor sound quality during the consultation.\n- Patient is 31 years old, lives with flatmates, and works full-time as a project manager at a pharmaceutical company.\n- Patient denies smoking.\n- Patient reports occasional alcohol consumption, \"a few beers per week.\"\n- Patient denies any known allergies.\n\nA (Assessment):\n- Suspected flare-up of eczema, given the patient's history and current symptoms of intense itchiness, redness, and cracked skin.\n- The widespread nature of the rash, affecting the chest and hands in addition to previously affected areas, suggests a more severe presentation than prior episodes.\n- Previous self-treatment with over-the-counter steroid cream and antihistamines was ineffective.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream to be applied to affected areas.\n- Prescribe emollients for skin moisturization, to be used regularly and potentially in baths/showers for 7-10 days.\n- Prescribe a stronger antihistamine (fexofenadine) to help manage the itchiness.\n- Advise patient to keep a diary of potential triggers, including clothing, shower gels, or soaps, to identify factors exacerbating symptoms.\n- Schedule a follow-up appointment for next week to reassess symptoms and treatment effectiveness.\n","review":163.13157894736844,"saved":153.36842105263156,"clean":false,"effort":16.666666666666664,"sig":[["partial","Review next week or after roughly 7–10 days if not improving.","Records a scheduled follow-up next week when the doctor said to return only if not improving, misstating the follow-up plan."]],"mb":27.582752,"latency":24.628,"signable":173.14257894736843},{"label":"Run 3","wer":14.961101137043686,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was like prescribed for my eczema. Okay. And they gave me like some cream and something to, uh, when I like was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms are like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the on the hands as well. Okay. Like really, yeah, when like I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's like very like— like I want it to— that last weekend and it was super painful and I think I have to take like showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No. I— it's actually like it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest, hands, and like, like inside the elbows. Okay.\nAny— anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay. And. Your chest is okay. No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like my eczema was only on the arms, so I'm, I'm not sure.\nI, I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your, your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I usually like something sorry, yeah. Just sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so I live with a few flatmates. I'm a so you know I'm 31. Uh, I yeah, I'm I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working I'm a like a kind of project manager. Uh, I'm in do you want to, to know more about it? Okay. Uh, no, no, no. That's absolutely that's absolutely fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms.\nIs do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can I like hanging out with people once in a while. So yeah, I'd say a few a few beers per week, something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger, but it's been. Mm-hmm. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial.\nOkay. Uh, which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You, you can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully cu-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[{"start":724,"end":732,"said":"I can","significant":false},{"start":797,"end":800,"said":"I can't","significant":false},{"start":808,"end":812,"said":"I can't","significant":false},{"start":974,"end":993,"said":"OK. I'm certain","significant":false},{"start":1071,"end":1087,"said":"this sorted out","significant":false},{"start":1418,"end":1425,"said":"That's those","significant":false},{"start":1456,"end":1459,"said":"appear","significant":false},{"start":1470,"end":1475,"said":"the","significant":false},{"start":1793,"end":1815,"said":"OK.","significant":false},{"start":1820,"end":1826,"said":"","significant":false},{"start":1983,"end":1992,"said":"arm. 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OK.","significant":false},{"start":8800,"end":8821,"said":"","significant":false},{"start":8839,"end":8867,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States a 4-day history of the current rash."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Sore, red, itchy, cracked skin on 'the chest, hands, and inside the elbows'; no leg involvement stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","Denies any bleeding, discharge, or pus."],["The note captures: Itching disturbs sleep.","yes","Itching disrupts sleep."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Impaired focus at work during meetings and hiking limited."],["The note captures: Known eczema and past asthma.","yes","Past medical history of eczema and past history of asthma."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously helpful prescribed cream/shower product ineffective now; OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'unable to identify any specific triggers'."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe a stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for moisturising, used in baths and showers."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'follow-up appointment in one week to reassess symptoms if they do not improve'."]],"claims":[],"note":"S (Subjective):\n- The patient reports a 4-day history of sore, red, and intensely itchy skin, primarily affecting the chest, hands, and inside the elbows.\n- Symptoms are described as \"super annoying\" and disruptive, causing difficulty sleeping at night and impacting focus at work during meetings.\n- The patient has a past medical history of eczema, for which they were previously prescribed cream and a shower product, which helped at the time.\n- Current symptoms are noted to be \"much more itchy\" and more widespread than previous eczema flare-ups, which were confined to the arms.\n- Self-treatment attempts include trying previously prescribed eczema creams (which did not work) and a steroid cream bought from a pharmacy last night (which also did not help).\n- The patient reports some cracked skin in affected areas but no bleeding or discharge, pus, or blood. They deny any associated fever or temperature, cough, breathing difficulties, or issues with bowel movements or urination.\n- The patient is unable to identify any specific triggers for the current symptoms. They mention being 31 years old, living with flatmates, and working as a project manager at a pharmaceutical company.\n- The patient denies smoking and reports occasional alcohol consumption (a few beers per week). They also have a past history of asthma but are not currently on any regular medications and report no known allergies.\n\nO (Objective):\n- The patient's voice quality was noted to be unclear at times during the conversation.\n- The patient was cooperative and engaged during the interaction, providing detailed descriptions of their symptoms and medical history.\n- The patient reported the inability to hike during weekends due to pain and the need for daily showers to ease itching.\n\nA (Assessment):\n- The doctor suspects a flare-up of the patient's eczema, given the intensely itchy nature of the rash, its distribution primarily on the chest, hands, and elbows, and the patient's history of eczema.\n- The current symptoms are more severe and widespread than previous eczema episodes.\n- Previous at-home treatments with over-the-counter steroid cream and antihistamines have not provided relief.\n\nP (Plan):\n- Prescribe a stronger prescription steroid cream to be used for 7-10 days.\n- Prescribe emollients for moisturizing the skin, which can also be used in baths and showers.\n- Prescribe a stronger antihistamine (fexofenadine) to help with the itchiness, as previous over-the-counter antihistamines were ineffective.\n- Advise the patient to keep a diary of potential triggers, such as clothing, shower gels, or soaps, to identify factors that may be exacerbating symptoms.\n- Schedule a follow-up appointment in one week to reassess symptoms if they do not improve.\n","review":136.42105263157896,"saved":180.07894736842104,"clean":true,"effort":0.0,"sig":[],"mb":27.624344,"latency":22.998,"signable":147.44705263157897},{"label":"Run 4","wer":15.020945541591862,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts on your skin is it affected? Uh, mostly like my chest, my— my hands, my arms. Like, like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always like, uh, disturbed by this disease. No, no.\nOkay. I understand. This is obviously affecting you and, uh, we'll try our very best to get— get a source of that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was like prescribed for my eczema. Okay. And they gave me like some cream and something to, uh, when I like was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did that help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms are like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay. Steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the on the hands as well. Okay. Like really, yeah, when like I like for instance hiking during the weekends and I— I can't really do it anymore because it's like very like— like I want it to that last weekend and it was super painful and I think I have to take like showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Yeah. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No. I— it's actually like it's very annoying because I'm thinking about maybe I should change something because I— I haven't and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and like— like inside the elbows. Okay. And anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo.\nN just the itching. Itching. Nothing else. Okay. So your— your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I so I had eczema before, so maybe it's this, but it seems like more, uh, like my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's you've got some dry skin and some, uh, cracked skin as well.\nMm-hmm. Uh, and it's been very itchy. And so with your, um, uh, your— your background of eczema, um, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I usually like something sorry, yeah. Just sorry, I was going to say do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with?\nUh, so I live with a few flatmates. I'm a so you know I'm 31. Uh, I yeah, I'm I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been a it's been a few years now. Uh, it's a it's kind of interesting. We are working I'm a like a kind of project manager. Uh, I'm in do you want to, to know more about it? Okay. Uh, no, no, no. That's absolute that's absolute fine.\nUm, just a couple of questions I want to ask you, which can sometimes affect your symptoms.\nIs do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while I can I like hanging out with people once in a while. So yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I— I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, the having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st of a steroid may be beneficial. Okay. Uh, which I'm happy to prescribe to you today.\nAs well as I'm going to give you something some emollients, which helps to moisturize the skin.\nUm, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh. Okay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter. Things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower\ngels or soap. Because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Okay. Just I— I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I certainly think using the steroids and the emollients, um, on a regular basis, um, over the next week to 10 days, should hopefully cure control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it.\nOkay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. Bye.","marks":[{"start":724,"end":732,"said":"I can","significant":false},{"start":797,"end":800,"said":"I can't","significant":false},{"start":808,"end":812,"said":"I can't","significant":false},{"start":974,"end":993,"said":"OK. I'm certain","significant":false},{"start":1071,"end":1087,"said":"this sorted out","significant":false},{"start":1418,"end":1425,"said":"That's those","significant":false},{"start":1456,"end":1459,"said":"appear","significant":false},{"start":1470,"end":1475,"said":"the","significant":false},{"start":1793,"end":1815,"said":"OK.","significant":false},{"start":1820,"end":1826,"said":"","significant":false},{"start":1983,"end":1992,"said":"arm. 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OTC steroid cream from last night gave no relief."],["The note captures: Antihistamines already tried have not helped.","yes","Has tried antihistamines without relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","Assessment: eczema flare-up."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger prescription steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients to moisturise skin, used in bath or shower, for 7 to 10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","Stronger antihistamine (fexofenadine) prescribed for itch."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers including clothing, shower gels, and soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'return for a follow-up next week if symptoms do not improve'."]],"claims":[],"note":"S (Subjective):\n- The Patient reports a several-day history (four days) of sore, red, and intensely itchy skin, which is \"super annoying\" and is interfering with sleep and work concentration.\n- Symptoms primarily affect the chest, hands, and arms, and are more widespread and itchy than previous eczema flare-ups, which were confined to the arms.\n- The Patient notes their skin is \"a bit cracked in some parts\" but denies bleeding, discharge, pus, or blood.\n- They have a history of eczema, for which they were previously prescribed a cream and a shower product, which initially helped, but current symptoms did not respond to these old medications.\n- The Patient attempted self-treatment with an over-the-counter steroid cream purchased last night, which did not alleviate the itching; they also tried antihistamines recently without success.\n\nO (Objective):\n- The Patient's voice quality was noted to be \"not very clear\" and \"cracked\" at times during the conversation.\n- The Patient appears cooperative and provides detailed responses regarding their symptoms and medical history.\n- The Patient is 31 years old and lives with flatmates.\n- They work full-time as a project manager at a pharmaceutical company.\n- The Patient denies smoking and reports occasional alcohol consumption (a few beers per week).\n\nA (Assessment):\n- The Doctor suspects a flare-up of eczema, given the Patient's history and the reported symptoms of itchiness and affected areas.\n- The current symptoms are more severe and widespread compared to previous eczema episodes.\n- Previous treatments, including a prescribed cream and shower product for eczema, and an over-the-counter steroid cream, have been ineffective for the current presentation.\n\nP (Plan):\n- The Doctor plans to prescribe a stronger steroid cream and emollients to moisturize the skin, to be used for 7 to 10 days.\n- The Patient is advised to use emollients in the bath or shower.\n- The Doctor will prescribe a stronger antihistamine (fexofenadine) for the itchiness, as over-the-counter options were ineffective.\n- The Patient is advised to keep a diary of potential triggers, such as clothing, shower gels, or soaps, to discuss at a follow-up appointment.\n- The Patient is instructed to return for a follow-up next week if symptoms do not improve.\n","review":164.1315789473684,"saved":152.3684210526316,"clean":false,"effort":13.333333333333334,"sig":[],"mb":27.871156,"latency":24.424,"signable":174.11457894736841},{"label":"Run 5","wer":14.602034709754639,"text":"Hello. Hello.\nCan you hear me well? Uh, yes, I think. It's a bit better. It's a bit— it's a bit— it's not very clear, but let's continue anyway.\nOkay. Okay. Let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of— it's really itchy, and it's, like, super annoying.\nOkay. So I'd like to find something quick to solve it. No, no problem. I'm happy to help. Um, whereabouts in your skin is it affected? Uh, mostly like my chest, my— my hands, my arms, like— like really it's— it's super annoying. Like it's itching a lot, like all the time, and I can't even sleep at night.\nLike I really need something quickly to— to solve it, because even at work I— like, um, when I'm in a meeting and I have to, like, think about my work and focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always— like, uh, disturbed by this disease. No, no.\nOkay, I understand. This is obviously affecting you, and we'll try our very best to get a source that for you. Um, have you had anything like this before in the past?\nUm, so yes. Uh, earlier I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to, uh, when I, like, was shower— uh, when I was in the shower I had to put something. Okay. But, um, yeah. Did it help?\nUm, I mean, at that time yes, but the symptoms, like these symptoms, like, when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today. Okay. Uh, yeah. Do you remember the name of the cream you bought? Uh, steroid cream. Okay, steroid. Okay. Uh, that's okay. Um, do you— would you say these symptoms are very similar to your eczema symptoms, or different?\nUm, it's much more like itchy and my eczema was more like only in the arms, and now it's also on the chest and in the— and the— on the hands as well. Okay. Like really, yeah, when— like I like, for instance, hiking during the weekends and I— I can't really do it anymore because it's, like, very— like, like I wanted to do that last weekend and it was super painful and. Yes. I think I have to take, like, showers every day to be able to kind of, uh, ease this itching part, which is very, very annoying. No.\nWell, well, okay. That's okay. So you mentioned the itchiness. Um, you also mentioned it's been quite sore. Um. Yeah. Have you— have you noticed any, uh, bleeding or discharge from your skin?\nNo. Um, so my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But, uh, yeah.\nNo, I'm noticing any other, uh, pus or blood coming out of your skin.\nNo. No.\nAnd you mentioned it all started three days ago.\nAre you. Four days ago. Four days ago. Are you aware of any triggers? So anything that you may have done, that may have caused your symptoms to start? So, for example, have you changed your, uh, shower gel? Any clothing? Have you been around anyone else? No, I— it's actually, like, it's very annoying because I'm thinking about maybe I should change something because I— I haven't, and I don't understand, and I'm kind of, um, afraid of asking people around me because it's kind of, you know, um, I don't feel really comfor\ntable asking about these questions. It's kind of intimate and. Mm-hmm. So I really need your help now. Hmm. No, no. Okay. That's okay. Um, fine. So just to re-summarize, for the last four days you've had very itchy skin, very sore skin all over your body, mainly your chest, and did you also mention your arms and legs as well?\nUh, no. Just the chest and hands and, like, like inside the elbows. Okay.\nAnd anything on your face at all?\nIn my what? On your face. Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, no. Just the itching. Itching. Nothing else. Okay. So your, your bowels are working okay? And. Your chest is okay? No cough, no breathing difficulties?\nNo. You're passing urine okay?\nUh, I think so.\nOkay. All right. Um, it's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms? Um, I— so I had eczema before, so maybe it's this, but it seems like more, uh, like, uh, my eczema was only on the arms, so I'm— I'm not sure.\nI— I really have no idea. Okay. No, that's okay. So, um, normally at this stage I'd like to examine you. Um, to see the rash itself and see exactly what type of rash it is.\nBut from what you've told me, you mentioned it's— you've got some dry skin and some, uh, cracked skin as well.\nUh. Mm-hmm. And it's been very itchy. And so with your, um, uh, your, your background of eczema, um, sorry, so there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Um, apart from the eczema, do you have any other medical problems I should be aware of?\nUh, no. I just had asthma, in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\nUh, no.\nNo. Okay. Do you have any allergies to anything? I use, like, something— sorry, yeah. Just— sorry, I was going to say, do you have any allergies to anything?\nHello? Hello? Yes? Uh, can you hear me? Uh, sorry, I think it cracked. Um, do you have any allergies at all? Oh, allergies? Uh, no. No.\nOkay. Um, and tell me about your, um, uh, your situation at home. Who do you live with? Uh, so, um, I live with a few flatmates. I'm a— so, you know, I'm 31. Uh, I— yeah, I'm— I have a full-time job and so I'm living with a few people to save money. Okay. And what do you do for work?\nUh, I work, uh, at a pharmaceutical company. So it's been, uh, it's been a few years now. Uh, it's, uh, it's kind of interesting. We're working— I'm a, like, a kind of project manager. Uh, I'm in— do you want to, to know more about it? Okay. Uh, no, no, no. That's absolutely— that's absolutely fine.\nUm, just a couple of questions I wanted to ask you, which can sometimes affect your symptoms.\nIs— do you smoke at all?\nNo. No. And do you drink much in a way of alcohol?\nUh, you know, o-once in a while, I can— I like hanging out with people once in a while. So, yeah, I'd say a few— a few beers per week, something like this. Nothing— nothing crazy. I used to drink a lot more when I was younger, but it's been. Okay. It's been a while. Okay. Okay. I'm going to say at this stage, I'm going to say th-this sound quality is not, uh, great, but I will continue because we've come this far.\nUm, so. Okay. Um, based on everything you mentioned, sir, I, I do wonder whether this is a flare-up of your eczema.\nUm, the reason being that you said it's quite itchy, um, it's mainly affecting your chest and your back. Um, and, uh, having looked at your skin, uh, the, the rash does appear quite familiar. Um, you mentioned you're using steroid creams yesterday.\nUm, from the pharmacy. I wonder whether giving you stronger prescription of a st— of a steroid may be. Beneficial? Uh.\nOkay. Which I'm happy to prescribe to you today.\nAs well as, I'm going to give you something, some emollients, which helps to moisturize the skin. Um, which you can also use in a bath and shower. And it's definitely worth, um, using that for the first 7 to 10 days. Uh.\nOkay. Before we make a decision on whether it's working or not. Um, it's also worth, um, using antihistamines, which you can sometimes buy over-the-counter, things like loratadine or Piritin, which can help with the itchiness of your. Okay. Skin. And, uh, um, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear, or anything you use in terms of shower gels or soap, because if that's causing your symptoms, then we need to have a discussion about that next time I see you. Ok\nay. Just, I, I have tried antihistamines, uh, lately, but it didn't really help.\nOh, could you say that again? Sorry. I have tried the antihistamines. Okay. Uh, but it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different types of antihistamines.\nI can give you something a little bit stronger today as well. Um. Okay. Something like fexofenadine, which I can give to you today.\nIt's definitely worth trying it. It's not going to do you any harm. Um, but I say anything using the steroids and the emollients, um, on a regular basis.\nUm, over the next week to 10 days, should hopefully cu-control your symptoms. But do come back and see me next week if things don't get better.\nThat sounds good. Okay.\nUm, do you have any questions for me?\nUh, no, that's it. Okay. Well, I wish you all the best.\nThank you very much. Thank you. Have a good day. Bye. Thank you, doctor. 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OK.","significant":false},{"start":8837,"end":8858,"said":"","significant":false},{"start":8876,"end":8904,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","States \"4-day history\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Captures sore, red, itchy, cracked skin on chest, hands and inside elbows, but omits the patient correcting that legs are not affected."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"denies any associated bleeding, discharge, pus\"."],["The note captures: Itching disturbs sleep.","yes","\"causing sleep disturbance\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Notes difficulty concentrating at work and hiking being \"super painful\"."],["The note captures: Known eczema and past asthma.","partial","Eczema history captured, but past asthma is not mentioned."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Previously prescribed eczema cream and OTC steroid cream \"have provided no relief\"."],["The note captures: Antihistamines already tried have not helped.","yes","Antihistamines listed among self-treatments that provided no relief."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger or change in toiletries was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"acute flare-up of eczema\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribed a stronger topical steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","Emollients for regular hydration \"including during bathing or showering\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribed fexofenadine, a stronger oral antihistamine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","Diary of triggers such as clothing, shower gels or soaps."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","Follow-up next week if no improvement."]],"claims":[],"note":"S (Subjective):\n- Patient reports a 4-day history of sore, red, and intensely itchy skin affecting the chest, hands, and arms (specifically inside elbows).\n- The pruritus is severe, causing sleep disturbance and difficulty concentrating at work, and was described as \"super painful\" during a recent hiking attempt.\n- Patient has a past medical history of eczema, previously managed with cream and a shower product, but current symptoms are more widespread and significantly more itchy than prior episodes.\n- Self-treatment with a previously prescribed eczema cream, an over-the-counter steroid cream, and antihistamines have provided no relief.\n- Patient reports some cracked skin but denies any associated bleeding, discharge, pus, fever, cough, breathing difficulties, or issues with bowel or urinary function.\n\nO (Objective):\n- The patient presented with clear distress and frustration regarding the severity and impact of their skin condition on daily life.\n- Patient was cooperative and provided a detailed account of their symptoms, history, and previous attempts at self-management.\n- No objective physical examination findings are available from this remote consultation.\n\nA (Assessment):\n- The patient's symptoms are highly suggestive of an acute flare-up of eczema, consistent with their established medical history.\n- The increased distribution and intensity of pruritus indicate a significant exacerbation of their underlying skin condition.\n\nP (Plan):\n- Prescribed a stronger topical steroid cream to address the inflammatory and pruritic components of the rash.\n- Recommended emollients for regular skin hydration, to be used consistently for 7 to 10 days, including during bathing or showering.\n- Prescribed fexofenadine, a stronger oral antihistamine, given the ineffectiveness of previous over-the-counter antihistamines in alleviating pruritus.\n- Advised the patient to keep a detailed diary of potential environmental or product triggers, such as clothing, shower gels, or soaps, for future discussion.\n- Scheduled a follow-up appointment for next week to reassess symptoms and treatment efficacy if no improvement is observed.\n","review":146.44736842105263,"saved":170.05263157894737,"clean":false,"effort":13.333333333333334,"sig":[],"mb":27.613942,"latency":35.613,"signable":167.47136842105263}],"lyrebird":[{"label":"Run 1","wer":18.55176540993417,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything? I like, something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. 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OK.","significant":false},{"start":8227,"end":8248,"said":"","significant":false},{"start":8266,"end":8294,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Sites \"chest, hands, inner arms\" and cracked skin captured, but sore/red character not stated."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"No bleeding, discharge or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration\"; unable to hike."],["The note captures: Known eczema and past asthma.","partial","Eczema captured but asthma recorded as \"childhood asthma (resolved)\", adding an unsupported childhood onset."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid \"no improvement\" captured, but failure of previously helpful prescribed eczema treatments is not."],["The note captures: Antihistamines already tried have not helped.","yes","\"Trialled antihistamines - no improvement\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers (no recent changes to shower gel, clothing...)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribed stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients for bath and shower use\"; regularly 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribed fexofenadine for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"trigger diary documenting clothing and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review appointment in 1 week if no improvement\"."]],"claims":[["childhood asthma (resolved)","Transcript only says \"I just had asthma in the past\"; no childhood onset is stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nNo bleeding, discharge or purulent drainage\n\nSymptoms worse than previous eczema episodes\n\nPrevious eczema confined to arms only\n\nUnable to participate in usual weekend hiking activities due to discomfort\n\nRequires daily showers for symptom relief\n\nPurchased OTC steroid cream on 20/09/2026 - no improvement\n\nTrialled antihistamines - no improvement\n\nNo identified triggers (no recent changes to shower gel, clothing or environmental exposures)\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema (previous episodes affecting arms), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nNo known drug allergies\n\nNo current regular medications\n\n\n\n\nObjective:\n\nExamination findings consistent with eczematous rash\n\nDry, cracked skin noted on affected areas\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribed stronger topical corticosteroid\n\nPrescribed emollients for bath and shower use\n\nPrescribed fexofenadine for pruritus\n\nAdvised to use topical corticosteroid and emollients regularly for 7-10 days\n\nAdvised to maintain trigger diary documenting clothing and shower products\n\nReview appointment in 1 week if no improvement","review":126.98684210526316,"saved":189.51315789473682,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.177454,"latency":20.464,"signable":147.45084210526318},{"label":"Run 2","wer":18.791143028126868,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone else? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, like like, inside the eyebrows. Okay. And anything on your face at all? In my what? Oh,\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well. Yeah. And it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure.\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. 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OK.","significant":false},{"start":8226,"end":8247,"said":"","significant":false},{"start":8265,"end":8293,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","no","Distribution given as \"chest, hands, inner eyebrows\"; inner elbows mislocated to the face, which the patient denied."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Denies bleeding, discharge, or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work concentration\" and \"Unable to participate in weekend hiking\"."],["The note captures: Known eczema and past asthma.","partial","Eczema captured, but asthma recorded as \"childhood asthma\" when only \"asthma in the past\" was stated."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"without improvement\" captured, but prior eczema treatments failing this time not recorded."],["The note captures: Antihistamines already tried have not helped.","yes","\"Trialled antihistamines without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers (no recent changes to shower gel, clothing...)\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical steroid cream\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for use in bath and shower\" and continue regimen 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for pruritus management\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"maintain trigger diary (clothing, shower products...)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if symptoms persist or worsen\"."]],"claims":[["Distribution: chest, hands, inner eyebrows","Patient said \"inside the elbows\" and explicitly denied face involvement; eyebrows is a wrong site."],["childhood asthma (resolved)","Transcript says only \"I just had asthma in the past\"; childhood onset was never stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner eyebrows\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nMore extensive than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in weekend hiking due to symptoms\n\nRequires daily showers for symptom relief\n\nDenies bleeding, discharge, or purulent drainage\n\nNo identified triggers (no recent changes to shower gel, clothing, or environmental exposures)\n\nPurchased over-the-counter steroid cream on 21/09/2026 without improvement\n\nTrialled antihistamines without benefit\n\nDenies fever, cough, dyspnoea, bowel changes, or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower product), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, consumes few beers per week\n\nNo regular medications\n\nNo known allergies\n\n\n\n\nObjective:\n\nExamination findings consistent with eczematous changes\n\nDry, cracked skin noted on affected areas\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical steroid cream\n\nPrescribe emollients for use in bath and shower\n\nPrescribe fexofenadine for pruritus management\n\nContinue treatment regimen for 7-10 days\n\nAdvise patient to maintain trigger diary (clothing, shower products, environmental factors)\n\nReview in 1 week if symptoms persist or worsen","review":155.92105263157896,"saved":160.57894736842104,"clean":false,"effort":26.666666666666668,"sig":[["missing","Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","Affected site recorded as inner eyebrows instead of inner elbows; face involvement was denied."]],"mb":18.260935,"latency":20.587,"signable":176.50805263157895},{"label":"Run 3","wer":18.91083183722322,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked if you see what I mean. Okay. But yeah. You don't have any any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone else? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, like like, inside the eyebrows. Okay. And anything on your face at all? In my what? Oh,\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I'd like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well. Yeah. And it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help with the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure.\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. 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OK.","significant":false},{"start":8236,"end":8257,"said":"","significant":false},{"start":8275,"end":8303,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Distribution chest/hands/inner elbows and cracked skin captured, but soreness and redness of the skin are not recorded (\"pruritic rash\")."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupting sleep and work concentration\"; unable to hike."],["The note captures: Known eczema and past asthma.","yes","\"eczema\" and asthma resolved in PMH."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream \"no improvement\" is captured, but the note lists prior eczema treatments without saying they failed this flare."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines trialled - ineffective\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers, no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescription topical steroid (stronger than OTC preparation)\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for bath and shower use\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Fexofenadine prescribed for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Advised to maintain trigger diary documenting clothing and shower products\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"; \"Trial treatment for 7-10 days\"."]],"claims":[["childhood asthma (resolved)","Transcript only says \"I just had asthma in the past. But not anymore\"; no timing (childhood) is given."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days (onset 18/09/2026)\n\nDistribution: chest, hands, inner elbows\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in areas, no bleeding or discharge\n\nMore widespread and severe than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in usual weekend hiking activities due to discomfort\n\nRequires daily showers for symptom relief\n\nNo identified triggers, no recent changes to shower gel or clothing\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower emollient), childhood asthma (resolved)\n\nMedications: nil regular\n\nAllergies: nil known\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nSelf-treatment attempted: OTC steroid cream purchased 21/09/2026 - no improvement, antihistamines trialled - ineffective\n\n\n\n\nObjective:\n\nExamination findings: dry and cracked skin noted on affected areas\n\nNo pus or blood discharge observed\n\nRash appearance consistent with eczematous changes\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescription topical steroid (stronger than OTC preparation)\n\nEmollients for bath and shower use\n\nTrial treatment for 7-10 days\n\nFexofenadine prescribed for pruritus\n\nAdvised to maintain trigger diary documenting clothing and shower products\n\nReview in 1 week if no improvement","review":120.44736842105263,"saved":196.05263157894737,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.013948,"latency":17.264,"signable":137.71136842105264},{"label":"Run 4","wer":18.791143028126868,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do have any allergies to anything? I something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nI mean, do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been Okay.\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help with the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully cure\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":124,"end":129,"said":"","significant":false},{"start":344,"end":349,"said":"","significant":false},{"start":432,"end":443,"said":"Um whereabouts in","significant":false},{"start":715,"end":719,"said":"I can","significant":false},{"start":786,"end":789,"said":"I can't","significant":false},{"start":797,"end":801,"said":"I can't","significant":false},{"start":927,"end":937,"said":"uh disturbed","significant":false},{"start":963,"end":981,"said":"OK. I'm certain","significant":false},{"start":1258,"end":1270,"said":"shower","significant":false},{"start":1377,"end":1384,"said":"That's those","significant":false},{"start":1415,"end":1418,"said":"appear","significant":false},{"start":1633,"end":1639,"said":"itching","significant":false},{"start":1745,"end":1766,"said":"OK. um","significant":false},{"start":1923,"end":1932,"said":"arm. But","significant":false},{"start":2000,"end":2005,"said":"OK. 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OK.","significant":false},{"start":8231,"end":8252,"said":"","significant":false},{"start":8270,"end":8298,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'pruritic rash for 4 days'."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Pruritus, cracked skin on 'chest, hands, inner arms' recorded, but soreness and redness not captured."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Denies bleeding, discharge, or purulent drainage'."],["The note captures: Itching disturbs sleep.","yes","'Severe pruritus disrupting sleep'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Work concentration disrupted and 'Unable to participate in hiking last weekend'."],["The note captures: Known eczema and past asthma.","yes","PMH eczema and asthma (resolved)."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream with no improvement recorded, but not that previously helpful eczema treatments now fail."],["The note captures: Antihistamines already tried have not helped.","yes","'Trialled antihistamines with no improvement'."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'No identified triggers (no recent changes to shower gel, clothing...)'."],["The note captures: Assessment is a likely eczema flare.","yes","'Eczema flare'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid cream'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Prescribe emollient for bath and shower use' with 7-10 day trial."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribe fexofenadine for pruritus management'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'maintain trigger diary (clothing, shower products...)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Review in 1 week if no improvement' and 7-10 day reassessment."]],"claims":[["childhood asthma (resolved)","Transcript only says 'I just had asthma in the past. But not anymore'; childhood onset is never stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nMore extensive than previous eczema episodes (previously limited to arms only)\n\nUnable to participate in hiking last weekend due to discomfort\n\nRequires daily showers for symptom relief\n\nPurchased OTC steroid cream on 21/09/2026 with no improvement\n\nTrialled antihistamines with no improvement\n\nNo identified triggers (no recent changes to shower gel, clothing, or new exposures)\n\nDenies bleeding, discharge, or purulent drainage\n\nDenies fever, cough, dyspnoea, bowel changes, or urinary symptoms\n\nPast medical history: eczema (previously treated with topical cream and shower emollient), childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company, non-smoker, alcohol consumption few beers per week\n\nNo regular medications\n\nNo known allergies\n\n\n\n\nObjective:\n\nExamination findings consistent with dry, cracked skin\n\nRash appearance consistent with eczematous dermatitis\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical steroid cream\n\nPrescribe emollient for bath and shower use\n\nPrescribe fexofenadine for pruritus management\n\nTrial treatment for 7-10 days before reassessing efficacy\n\nAdvise patient to maintain trigger diary (clothing, shower products, potential irritants)\n\nReview in 1 week if no improvement","review":118.23684210526316,"saved":198.26315789473682,"clean":false,"effort":16.666666666666664,"sig":[],"mb":18.165381,"latency":19.539,"signable":137.77584210526317},{"label":"Run 5","wer":18.67145421903052,"text":"Hello? Hello. Can you hear me well? Yes. I think it's a bit better. So it's a bit it's a bit it's not very clear, but let's let's continue anyway. Okay. Okay. So let's start again. So how can I help you, sir? Yes. So it's been a few days now. I have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like, super annoying. Nice. So I'd like to find something quick to solve it. No. No problem. I'm happy\n\nHelp. Where about your skin is affected? Mostly, like, my chest, my my hands, my arms. Like, like, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and I can't even sleep at night. Like, I really need something quickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always, like,\n\nDisturb it by this disease. No. No. Okay. I understand this is obviously affecting you, and we'll try our very best to get get it sorted out for you. Have you had anything like this before in the past? So, yes, earlier, I was, like, prescribed for my eczema. Okay. And they gave me, like, some cream and something to when I, like, was showered when I was in the shower, I had to put something. Okay. But Did it help?\n\nAnd, I mean, at that time, yes, but the symptoms like, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work. I've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but it apparently didn't help because it's still eating a lot today. Okay. Yeah. Do you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. That's okay. Do would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy, and my eczema was more, like, only in the arms, and now it's also on the chest and in the in the on the hands as well. Okay. Yeah. When like, I like, for instance, hiking during the weekends, and I am I can't really do it anymore because it's, like, very like like, I wanted to do that last weekend, and it was super painful. And Yes. I I have to take, like, showers every day to be able to kind of ease this heat\n\nParts, which is very, very annoying. No. Well well okay. That's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Yeah. Have you noticed any bleeding or discharge from your skins? No. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah. You don't have any other pus or blood coming out of your skin? No. No. And you mentioned it all\n\nStarted 3 days ago. 4 days ago. 4 days ago. Are you aware of any triggers or anything that you may have done that may have caused your symptoms to start? So for example, have you changed your shower gel, any clothing? Have you been around anyone at all? It's actually like, it's very annoying because I'm thinking about maybe I should change something because I I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of, you know,\n\nI don't feel really comfortable asking about these questions. It's kind of intimate, and so I your head now. No. No. Okay. That's okay. Fine. So just to summarize, for the last 4 days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you also mention your arms and legs as well? No. Just the chest, hands, and, like like, inside the eyebrows. Okay. And anything on your face at all? In my what?\n\nOn your face? Oh, on my face? No. No. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers? No. Just itching. Itching? Nothing else. Okay. So your your bowels are working okay? Your chest is okay? No cough? No breathing difficulties? No. Your passing urine okay? I think so. Okay. Alright.\n\nIt's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms? Any what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm I'm not sure. I I really have no idea. Okay. That's okay. So normally, at this stage, I like to examine you to see the rash itself, to see exactly what type of rash it is. But from what you\n\nTold me. You mentioned it's you've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your your your background of eczema Sorry. So there's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No. I just had asthma in the past, but Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything? I like, something. Sorry. Yeah. Just sorry. I was gonna say, do have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry. I think you're you have any allergies at all? Oh, No. No. Okay. And tell me about your\n\nYour situation at home. Who do you live with? So I live with a few flatmates. I'm so, you know, I'm 31. I, yeah, I'm I have a full time job, and so I'm living with a few people to save money. Okay. And what do do for work? I work at a pharmaceutical company. So it's been it's been a few years now. It's it's kind of interesting. We're working. I'm a, like, a kind of project manager\n\nAnd then do you want to to know more about it? Okay. No. No. No. That's absolutely that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is, do you smoke at all? No. No. And do you drink much in a way of alcohol? You know, once in a while, I can I like hanging out with people once in a while? So, yeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink a lot more when I was younger, but it's been\n\nOkay. Okay. I'm gonna say at this stage, I've got to say the the sound quality is not great, but I will continue because we've come this far. So based on everything you mentioned, sir, I I I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned you're using steroid\n\nCreams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a of a steroid may be beneficial Okay. Which I'm happy to prescribe to you today. Well as I'm gonna give you something some emollients, which helps moisturize the skin, which you'll use in the bath and shower. And it's definitely worth using that for the first 7 to 10 days Right. Before we make a decision on whether it's working or not. It's also worth\n\nUsing antihistamines, which you can sometimes buy over the counter, things like loratadine or pyrritin, which can help the itchiness of your Okay. Skin. And, it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about the next time I see you. Okay. Just I I have tried antihistamines lately, but it didn't really\n\nHelp. Oh, could you say that again? Sorry. I have tried the antihistamines. Okay. But it didn't really help. It didn't. Okay. So it's something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Okay. Something like fexofenadine, which I can give to you today. It's definitely worth trying it. It's not gonna do you any harm. But I say anything using the steroids and the emollients on a regular basis over the next week to 10 days should hopefully\n\nControl your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No. That's it. Okay. Well, I wish you all the best. Thank you very much. Thank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":124,"end":129,"said":"","significant":false},{"start":344,"end":349,"said":"","significant":false},{"start":432,"end":443,"said":"Um whereabouts in","significant":false},{"start":715,"end":719,"said":"I can","significant":false},{"start":786,"end":789,"said":"I can't","significant":false},{"start":797,"end":801,"said":"I can't","significant":false},{"start":927,"end":937,"said":"uh disturbed","significant":false},{"start":963,"end":981,"said":"OK. I'm certain","significant":false},{"start":1258,"end":1270,"said":"shower","significant":false},{"start":1377,"end":1384,"said":"That's those","significant":false},{"start":1415,"end":1418,"said":"appear","significant":false},{"start":1633,"end":1639,"said":"itching","significant":false},{"start":1745,"end":1766,"said":"OK. um","significant":false},{"start":1923,"end":1932,"said":"arm. But","significant":false},{"start":2000,"end":2005,"said":"OK. 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OK.","significant":false},{"start":8222,"end":8243,"said":"","significant":false},{"start":8261,"end":8289,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"pruritic rash for 4 days\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","partial","Captures itch, cracked skin, chest/hands/inner arms, but omits soreness/redness and the patient's correction that legs are not affected."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"No bleeding, discharge or purulent drainage\"."],["The note captures: Itching disturbs sleep.","yes","\"Severe pruritus disrupting sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Disrupts work concentration; unable to go hiking."],["The note captures: Known eczema and past asthma.","partial","Eczema and resolved asthma captured, but asthma is labelled \"childhood\", which the patient never said."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema treatments ineffective now; OTC steroid cream bought with no improvement."],["The note captures: Antihistamines already tried have not helped.","yes","\"Antihistamines trialled without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","yes","\"No identified triggers, no recent changes to shower gel or clothing\"."],["The note captures: Assessment is a likely eczema flare.","yes","\"Eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Prescribe stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Prescribe emollients for bath and shower use\" over 7-10 days."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Prescribe fexofenadine for pruritus\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"maintain trigger diary (clothing, shower products, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review in 1 week if no improvement\"."]],"claims":[["childhood asthma (resolved)","Patient only said \"I just had asthma in the past. But not anymore\"; no age of onset or childhood timing was given."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n31-year-old male presenting with pruritic rash for 4 days\n\nDistribution: chest, hands, inner arms\n\nSevere pruritus disrupting sleep and work concentration\n\nSkin cracked in some areas\n\nNo bleeding, discharge or purulent drainage\n\nSymptoms worse than previous eczema episodes\n\nPrevious eczema confined to arms only\n\nPurchased OTC steroid cream on 21/09/2026 with no improvement\n\nPrevious eczema treatments (topical cream and shower product) ineffective for current episode\n\nAntihistamines trialled without benefit\n\nDaily showers provide temporary symptom relief\n\nUnable to participate in hiking (attempted last weekend, too painful)\n\nNo identified triggers, no recent changes to shower gel or clothing\n\nDenies fever, cough, shortness of breath, bowel or urinary symptoms\n\nPast medical history: eczema, childhood asthma (resolved)\n\nSocial history: lives with flatmates, works as project manager at pharmaceutical company\n\nNon-smoker\n\nAlcohol: few beers per week\n\n\n\n\nObjective:\n\nExamination findings consistent with dry, cracked skin\n\nRash appearance familiar with previous eczema presentation\n\n\n\n\nAssessment:\n\nEczema flare\n\n\n\n\nPlan:\n\nPrescribe stronger topical corticosteroid\n\nPrescribe emollients for bath and shower use\n\nPrescribe fexofenadine for pruritus\n\nContinue treatment regimen for 7-10 days\n\nAdvise patient to maintain trigger diary (clothing, shower products, soaps)\n\nReview in 1 week if no improvement","review":105.21052631578947,"saved":211.28947368421052,"clean":false,"effort":13.333333333333334,"sig":[],"mb":18.081891,"latency":21.2,"signable":126.41052631578947}],"preve":[{"label":"Run 1","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now,\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still itchy.\n\nItchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's\n\nbeen it's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say\n\nthe\n\nthe sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":123,"end":128,"said":"","significant":false},{"start":349,"end":354,"said":"","significant":false},{"start":440,"end":454,"said":"Um whereabouts in","significant":false},{"start":698,"end":698,"said":"solve","significant":false},{"start":725,"end":729,"said":"I I can","significant":false},{"start":796,"end":799,"said":"I can't","significant":false},{"start":806,"end":810,"said":"I can't","significant":false},{"start":836,"end":838,"said":"It's","significant":false},{"start":897,"end":897,"said":"I have","significant":false},{"start":962,"end":978,"said":"OK. I'm certain","significant":false},{"start":1382,"end":1389,"said":"That's those","significant":false},{"start":1421,"end":1424,"said":"appear","significant":false},{"start":1639,"end":1652,"said":"itching a lot","significant":false},{"start":1755,"end":1777,"said":"OK. um","significant":false},{"start":1934,"end":1943,"said":"arm. But","significant":false},{"start":2013,"end":2018,"said":"OK. 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You've not haven't uh seen","significant":false},{"start":2661,"end":2666,"said":"uh pus","significant":true},{"start":2760,"end":2774,"said":"Are you","significant":false},{"start":2899,"end":2899,"said":"Four days ago.","significant":false},{"start":3000,"end":3000,"said":"No I .","significant":false},{"start":3030,"end":3034,"said":"really","significant":false},{"start":3092,"end":3092,"said":"something.","significant":false},{"start":3139,"end":3154,"said":"I cannot um","significant":false},{"start":3203,"end":3210,"said":"cannot","significant":false},{"start":3660,"end":3665,"said":"Am I","significant":false},{"start":3844,"end":3865,"said":"very itchy.","significant":false},{"start":3883,"end":3888,"said":"Itchy. 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OK.","significant":false},{"start":8338,"end":8360,"said":"","significant":false},{"start":8378,"end":8406,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset ~4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"chest, hands, and antecubital fossae\"; pruritic, sore, red, dry, cracking."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"sleep disturbed\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"difficulty focusing at work meetings\"; hiking avoided."],["The note captures: Known eczema and past asthma.","yes","Previous eczema documented; \"Past asthma (not current)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior regimen \"not responding this time\"; OTC steroid \"without benefit\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Recent OTC antihistamines tried without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","Absence of an identified trigger/toiletry change is not recorded; only a future diary and trigger discussion."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients in bath/shower and regularly thereafter\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Trial fexofenadine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"diary of potential triggers (clothing, soaps/shower gels)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return next week if not better\"."]],"claims":[["(Consent obtained)","No consent discussion for examination or treatment occurs anywhere in the transcript."]],"note":"Presenting Condition\n\nOnset ~4 days ago\n\nPruritic, sore, red skin affecting chest, hands, and antecubital fossae; very itchy “all the time”\n\nSkin feels dry with some cracking; no bleeding or discharge\n\nWorse at night; sleep disturbed; difficulty focusing at work meetings\n\nHiking last weekend was “super painful,” now avoiding\n\nTried prior prescribed eczema regimen; recurrence not responding this time\n\nTried OTC steroid cream yesterday without benefit\n\nShowers temporarily ease itch\n\nPrevious eczema mainly on arms; current flare more widespread and itchier\n\nNo fevers, cough, breathing issues, bowel or urinary issues\n\n\n\n\nRadiology\n\nNone mentioned\n\n\n\n\nPrevious MSK injuries\n\nPrior eczema treated previously with cream and shower product; helped at that time\n\n\n\n\nPast Medical History\n\nPast asthma (not current)\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular meds\n\nRecent OTC antihistamines tried without benefit\n\nOTC steroid cream tried without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nBleeding/discharge: denies\n\nFever/temperature: denies\n\nRespiratory symptoms: denies cough/breathing difficulties\n\nBowel/urinary issues: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nWorks full-time in a pharmaceutical company (project management)\n\nNon-smoker\n\nAlcohol: a few beers per week\n\nEnjoys hiking on weekends\n\n\n\n\nGoals\n\nRapid relief of itch and skin soreness to sleep and function at work\n\nReturn to hiking without pain\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Clinician reports rash appearance “quite familiar” with eczema\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPrognosis: Expected improvement within 7–10 days with prescribed regimen; review if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical corticosteroid\n\nUse emollients in bath/shower and regularly thereafter for 7–10 days\n\nKeep diary of potential triggers (clothing, soaps/shower gels)\n\nMeds:\n\nPrescribed antihistamine (fexofenadine) to trial despite prior OTC antihistamines not helping\n\nPrescribed stronger topical steroid and emollients\n\n// Plan to monitor symptoms over 7–10 days; return sooner if worsening\n\n\n\n\nPlan\n\nUse steroid + emollients consistently for 7–10 days\n\nTrial fexofenadine\n\nReturn next week if not better; earlier if deteriorating or new symptoms arise\n\nDiscuss triggers and response at next review\n","review":131.86842105263156,"saved":184.63157894736844,"clean":false,"effort":16.666666666666664,"sig":[],"mb":15.733947,"signable":156.48342105263157},{"label":"Run 2","wer":19.80849790544584,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now,\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about from your skin is affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nsolve it because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus on my work, it's\n\nreally annoying because I can't actually think about what I have to say. I'm always\n\nlike, disturbed by this disease.\n\nNo. No. Okay. Understand. I understand.\n\nObviously affecting you, and we'll try our very best to get get us\n\nsorted out for you. Have you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, pre\n\nfor my eczema.\n\nOkay. And\n\nthey gave me, like, some\n\ncream and something to when I, like, was shower\n\nwhen I was in the shower, I had to put something. Okay. But yeah.\n\nDid it help?\n\nAnd\n\nI mean, at that time, yes. But the symptoms like, these symptoms are, like,\n\nwhen the symptoms appear again, I tried those and it didn't work. I've tried a few things, like,\n\nI bought, like, a steroid cream at the pharmacy last night, but\n\nit apparently didn't help because it's still itching a lot today. Okay.\n\nYeah. Do you remember the name of the cream you bought?\n\nSteroid cream.\n\nOkay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's all also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was super painful and\n\nI I have to take, like, showers every day to be able to kind of\n\nease this itching parts, which is very, very annoying.\n\nNo. Well well, okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore. Yeah.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel and your clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's really annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about these questions. It's kind\n\nintimate and so I your head now.\n\nNo. No. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face?\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching. Etching? Nothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties?\n\nNo.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be causing your\n\nAny what?\n\nAny ideas as to what\n\ncould be causing your symptoms?\n\nI so I had eczema before, so maybe it's\n\nthis, but it seems like more like, my eczema was only on the arms.\n\nSo I'm I'm not sure. I I really have no idea.\n\nOkay. That's okay. So\n\nnormally, at these days, I like to examine you.\n\nTo see the rash itself, to see exactly what type of rash it is.\n\nBut from what you've told me, you mentioned it's you've got some dry skin and some,\n\ncracked skin as well. Yeah. And it's been very itchy.\n\nAnd so with your\n\nyour your background of eczema,\n\nthere's a couple of questions I wanted to ask you, which I completely forgot. My apologies. Apart from the\n\ndo you have any other medical problems I should be aware of?\n\nNo.\n\nI just had asthma in the past, but\n\nOkay. Not anymore. Not anymore. Okay. And do you take any regular medication at the moment?\n\nNo.\n\nNo. Okay. Do you have any allergies to anything? I like\n\nsomething. Sorry. Yeah.\n\nSorry. I didn't get any allergies. Do you think?\n\nHello?\n\nHello? Yes.\n\nOh, can you hear me? Sorry. I think you're crack\n\ndo you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay. And tell me about your,\n\nyour situation at home. Who do you live\n\nwith?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on\n\nbackup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay. No. No. No. That's actually\n\nthat's absolutely fine. Just a couple of questions I want to ask you, which can sometimes\n\naffect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in a way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been it's been a while.\n\nOkay. Okay. I'm\n\ngonna say at this stage, I'm gonna say the the sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, sir, I I\n\nI do wonder whether this is a flare up of your eczema.\n\nThe reason being that you said it's quite itchy. It's\n\nmany affecting your chest and your back. And\n\nhaving looked at your skin, the the rash does pick\n\nquite familiar. You mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you\n\nstronger prescription of a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nWell as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth, using antihistamines.\n\nWhich can sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help with the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to have\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really\n\nhelp.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't\n\nreally help. It didn't. Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well. Okay. Something that affects\n\nwhich I can give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut I say anything using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back\n\nsee me next week if things don't get better.\n\nThat sounds good. Okay.\n\nDo you have any questions for me?\n\nNo.\n\nThat's it.\n\nOkay. Well, I wish you all the best.\n\nThank you very much. Thank you.\n\nHave\n\na good day.\n\nBye. Thank you, Victor. Bye.","marks":[{"start":123,"end":128,"said":"","significant":false},{"start":434,"end":450,"said":"Um whereabouts in","significant":false},{"start":724,"end":728,"said":"I I can","significant":false},{"start":795,"end":798,"said":"I can't","significant":false},{"start":805,"end":809,"said":"I can't","significant":false},{"start":971,"end":1002,"said":"OK. 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OK.","significant":false},{"start":8358,"end":8379,"said":"","significant":false},{"start":8400,"end":8428,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago of very itchy, sore, red skin\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","\"chest, hands, inside elbows\", \"dry with some cracked areas\"; legs not included."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disrupts sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"work focus; unable to hike last weekend\"."],["The note captures: Known eczema and past asthma.","yes","History of eczema and \"Past asthma (not current)\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","\"Tried OTC steroid cream last night without improvement\" but prior eczema treatments noted only as helpful then, not failing now."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried antihistamines recently without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified; only a trigger diary is planned."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Use emollients in bath/shower and as moisturiser\" regularly."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Consider stronger antihistamine (clinician to prescribe)\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels, soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if no improvement\" and 7-10 day reassessment."]],"claims":[["(Consent obtained)","Transcript contains no consent discussion for examination or treatment; this is asserted without support."]],"note":"Presenting Condition\n\nOnset 4 days ago of very itchy, sore, red skin\n\nLocations: chest, hands, inside elbows; no face involvement\n\nSkin described as dry with some cracked areas; no bleeding or discharge\n\nItch severe, disrupts sleep and work focus; unable to hike last weekend due to pain/itch\n\nSelf‑management: frequent daily showers to ease itch\n\nPrior eczema historically limited to arms; current episode more widespread and itchier\n\nTried OTC steroid cream last night without improvement\n\nTried antihistamines recently without benefit\n\nDenies fevers, cough, breathing difficulty, bowel or urinary issues\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nHistory of eczema previously treated with creams and shower product; helped at that time\n\n\n\n\nPast Medical History\n\nPast asthma (not current)\n\nNo other medical problems reported\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nRecent OTC steroid cream tried\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory symptoms/cough/breathing difficulty: denies\n\nBowel function: okay\n\nUrination: okay\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nWorks full‑time as project manager at a pharmaceutical company\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nHiking on weekends (currently limited by symptoms)\n\n\n\n\nGoals\n\nRapid relief of itch/pain to sleep and function at work\n\nReturn to hiking\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Clinician states rash appearance looks familiar for eczema (viewed during consult)\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPlan to reassess response over 7–10 days\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid regularly for 7–10 days\n\nUse emollients in bath/shower and as moisturiser\n\nKeep diary of potential triggers (clothing, shower gels, soaps)\n\nMeds:\n\nConsider stronger antihistamine (clinician to prescribe); prior OTC antihistamine ineffective\n\n// Advised steroid + emollient regimen expected to control symptoms within 7–10 days\n\n\n\n\nPlan\n\nTrial prescribed topical steroid and emollients regularly for 7–10 days\n\nConsider stronger antihistamine as adjunct\n\nReview next week if no improvement\n\nMonitor and record triggers for discussion at follow‑up\n","review":150.17105263157896,"saved":166.32894736842104,"clean":false,"effort":20.0,"sig":[],"mb":15.042649,"signable":185.23205263157897},{"label":"Run 3","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still\n\nitchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo, for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's\n\nbeen it's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say\n\nthe\n\nthe sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. 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You've not haven't uh seen","significant":false},{"start":2654,"end":2659,"said":"uh pus","significant":true},{"start":2753,"end":2767,"said":"Are you","significant":false},{"start":2892,"end":2892,"said":"Four days ago.","significant":false},{"start":2994,"end":2994,"said":"No I .","significant":false},{"start":3024,"end":3028,"said":"really","significant":false},{"start":3086,"end":3086,"said":"something.","significant":false},{"start":3133,"end":3148,"said":"I cannot um","significant":false},{"start":3197,"end":3204,"said":"cannot","significant":false},{"start":3654,"end":3659,"said":"Am I","significant":false},{"start":3838,"end":3859,"said":"very itchy.","significant":false},{"start":3877,"end":3882,"said":"Itchy. 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OK I've got to","significant":false},{"start":6247,"end":6256,"said":"I've got to","significant":false},{"start":6386,"end":6386,"said":"Sarah","significant":false},{"start":6472,"end":6476,"said":"it was","significant":false},{"start":6624,"end":6630,"said":"","significant":false},{"start":6831,"end":6836,"said":"going to","significant":false},{"start":6913,"end":6928,"said":"use in","significant":false},{"start":7189,"end":7197,"said":"Piriton","significant":true},{"start":7467,"end":7467,"said":"have","significant":false},{"start":7488,"end":7526,"said":"an eczema CU. OK. Yes","significant":false},{"start":7591,"end":7593,"said":"Ohh","significant":false},{"start":7692,"end":7708,"said":"OK. OK. 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OK.","significant":false},{"start":8332,"end":8354,"said":"","significant":false},{"start":8372,"end":8400,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, cracked skin on \"chest, hands and antecubital fossae\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"Bleeding/discharge from skin: denies\"."],["The note captures: Itching disturbs sleep.","yes","\"disturbing sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Affects focus at work and hiking."],["The note captures: Known eczema and past asthma.","yes","\"Previous eczema\" and \"Past asthma, no current issues\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior prescribed creams \"without benefit this time\" and OTC steroid \"without relief\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried antihistamines recently without help\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Use prescribed stronger topical steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Use emollients in bath/shower regularly\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Start fexofenadine as prescribed\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels/soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Review next week if not better\"."]],"claims":[],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands and antecubital fossae\n\nSkin cracked in some parts\n\nItch severe, disturbing sleep and ability to focus at work; hiking last weekend was “super painful”\n\nPrevious eczema but current episode more itchy and broader distribution than prior (previously arms only)\n\nTried prior prescribed eczema creams and shower products without benefit this time\n\nTried OTC steroid cream last night without relief\n\nShowers provide temporary easing\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nPrior eczema treated with creams and shower product; helped previously\n\n\n\n\nPast Medical History\n\nPast asthma, no current issues\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nTried antihistamines recently without help\n\nPlan to use prescribed stronger topical steroid, emollients, and fexofenadine per clinician today\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nGI: bowels ok\n\nGU: passing urine ok\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nFull‑time job in a pharmaceutical company (project management)\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nHiking on weekends (limited by symptoms)\n\n\n\n\nGoals\n\nRapid relief of itching/pain to sleep and function at work; return to hiking\n\n\n\n\nObjective\n\n(Consent obtained)\n\nRemote consult; clinician reports rash appearance familiar with eczema\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPrognosis: expects improvement with regular steroids/emollients within 7–10 days\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid\n\nUse emollients in bath/shower regularly for 7–10 days\n\nConsider fexofenadine; different antihistamines may help itch\n\nKeep diary of potential triggers (clothing, shower gels/soaps)\n\nPlan to review response in 7–10 days; return sooner if not improving\n\n// Patient agrees; symptoms unchanged today despite OTC steroid and prior antihistamines\n\n\n\n\nPlan\n\nUse steroid and emollients consistently for 7–10 days\n\nStart fexofenadine as prescribed\n\nKeep trigger diary\n\nReview next week if not better; continue if improving\n","review":116.07894736842105,"saved":200.42105263157896,"clean":false,"effort":6.666666666666667,"sig":[],"mb":15.507057,"signable":136.52294736842106},{"label":"Run 4","wer":19.449431478156793,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, but let's let's continue anyway.\n\nOkay. Okay. So let's\n\nstart again. So how can I help you,\n\nsir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\nI can't even sleep at night. Like, I really need something quickly to to\n\nit because even at work, like, when I'm in the meeting and I have to\n\nlike, think about my work and focus like, actually focus my work, it\n\nreally annoying because I can't actually think about what\n\nto say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. Understand this is obviously\n\naffecting you, and we'll try our very best to get get it sorted out for you.\n\nHave you had anything like this before in the past?\n\nSo, yes, earlier, I was, like, prescribed for my eczema.\n\nOkay. And they gave me, like, some cream and something\n\nto\n\nwhen I, like, was shower when I was in the shower, I had to put something.\n\nOkay.\n\nBut\n\nyeah. Did it help?\n\nI mean, at that time, yes. But the symptoms\n\nLike, these symptoms are, like when the symptoms appeared again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at\n\na pharmacy last night, but it apparently didn't help because it's still\n\nitchy today. Okay. Yeah. Do\n\nyou remember the name of the cream you bought?\n\nSteroid\n\ncream. Okay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was\n\nsuper painful. And Yes. I I have to take, like, showers every day to be able to\n\nkind of ease this itching part\n\nwhich is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore.\n\nYeah. Have you noticed any bleeding or discharge from your skin,\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I mean. Okay. But\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin? No. No.\n\nAnd you mentioned it all started three days ago. Four days ago. Four days ago. Are you aware of any\n\ntriggers or anything that you may have done that may have caused your symptoms to start?\n\nSo for example, have you changed your\n\nshower gel, any clothing?\n\nHave you been around anyone else?\n\nIt's actually, like,\n\nit's very annoying because I'm thinking about maybe I should change\n\nbecause I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about\n\nthese questions. It's kind of intimate, and so I your help now.\n\nNo.\n\nNo. Okay. That's okay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the elbows.\n\nOkay. And anything on your face at all?\n\nIn my\n\nwhat? On your face.\n\nOh, on my face? No. No.\n\nOkay. And apart from this, any other symptoms have you noticed\n\nFor example, have you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nItching?\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties? No.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to what could be\n\ncausing your symptoms?\n\nAny whats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my eczema was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nYeah. And it's been very itchy. And so with your\n\nbackground of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but Okay. Not any problem.\n\nNot anymore. Okay. And do you take any regular medications at the moment?\n\nNo. No. Okay. Do you have any allergies to anything?\n\nI like\n\nsomething.\n\nSorry. Yeah.\n\nSorry. I didn't get any allergies to anything.\n\nHello? Hello? Yes.\n\nOh,\n\ncan\n\nyou hear me? Sorry. I think you're you have any allergies at all?\n\nOh, allergies. No.\n\nNo. Okay.\n\nAnd tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We're working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's absolutely fine. Just a couple of questions I wanted to ask you, which can sometimes affect\n\nyour symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been it's been a while.\n\nOkay.\n\nOkay. I'm gonna say at this stage, I'm gonna say the the sound quality is not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. Reason being that you said\n\nit's quite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines, which\n\ncan sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your\n\nOkay. Skin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again? Sorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't really help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well.\n\nOkay.\n\nSomething like fexifenadine, which I\n\ncan give to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget\n\nbetter. That\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well,\n\nI wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":123,"end":128,"said":"","significant":false},{"start":349,"end":354,"said":"","significant":false},{"start":440,"end":454,"said":"Um whereabouts in","significant":false},{"start":698,"end":698,"said":"solve","significant":false},{"start":725,"end":729,"said":"I I can","significant":false},{"start":796,"end":799,"said":"I can't","significant":false},{"start":806,"end":810,"said":"I can't","significant":false},{"start":836,"end":838,"said":"It's","significant":false},{"start":897,"end":897,"said":"I have","significant":false},{"start":962,"end":978,"said":"OK. I'm certain","significant":false},{"start":1382,"end":1389,"said":"That's those","significant":false},{"start":1421,"end":1424,"said":"appear","significant":false},{"start":1640,"end":1645,"said":"itching a lot","significant":false},{"start":1748,"end":1770,"said":"OK. um","significant":false},{"start":1927,"end":1936,"said":"arm. But","significant":false},{"start":2006,"end":2011,"said":"OK. 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OK.","significant":false},{"start":8329,"end":8351,"said":"","significant":false},{"start":8369,"end":8397,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","\"Onset 4 days ago\"."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, dry/cracked skin on \"chest, hands, and inside elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","yes","\"no bleeding or discharge\"."],["The note captures: Itching disturbs sleep.","yes","\"disturbs sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","Disturbs \"concentration at work\" and hiking limited."],["The note captures: Known eczema and past asthma.","yes","\"Past eczema\" and \"Past asthma, currently no issues\"."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","OTC steroid cream without benefit; \"prior prescribed eczema creams helped in past but not this time\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"Tried OTC antihistamines recently without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Probable eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Rx: stronger prescription topical corticosteroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"emollients for bath/shower use; regular moisturising\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Rx: antihistamine (fexofenadine)\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (clothing, shower gels/soaps)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return next week if no improvement\"."]],"claims":[],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands, and inside elbows\n\nItch severe, constant; disturbs sleep and concentration at work\n\nSkin noted dry with some cracked areas; no bleeding or discharge\n\nWorse with hiking; daily showers provide some relief\n\nPrevious similar eczema limited to arms; current flare more widespread and itchier\n\nTried OTC steroid cream last night without benefit; prior prescribed eczema creams helped in past but not this time\n\nReason for visit: rapid relief for severe itch/rash\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries mentioned\n\n\n\n\nPast Medical History\n\nPast eczema\n\nPast asthma, currently no issues\n\nNo known allergies\n\n\n\n\nMedications\n\nNo regular medications\n\nTried OTC antihistamines recently without benefit\n\nTried OTC steroid cream yesterday without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nBowel: normal\n\nUrinary: passing urine ok\n\nBleeding/discharge from skin: denies\n\nFace involvement: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nAge 31\n\nWorks full-time at a pharmaceutical company (project management role)\n\nNon-smoker\n\nAlcohol: a few beers per week\n\nEnjoys weekend hiking; currently limited by symptoms\n\n\n\n\nSport & Exercise History\n\nHiking on weekends; avoided last weekend due to pain/itch\n\n\n\n\nGoals\n\nQuick relief of itch and rash to sleep and function at work\n\n\n\n\nObjective\n\n(Consent obtained)\n\nClinician reports rash appearance familiar with eczema on visual inspection\n\n\n\n\nDiagnosis\n\nProbable eczema flare\n\nPrognosis: expected improvement with regular steroids/emollients over 7–10 days; review if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nRx: stronger prescription topical corticosteroid\n\nRx: emollients for bath/shower use; regular moisturising\n\nRx: antihistamine (fexofenadine) to trial despite limited response to prior OTC antihistamines\n\nEd:\n\nUse steroids and emollients regularly for 7–10 days before judging effect\n\nKeep diary of potential triggers (clothing, shower gels/soaps) for discussion next visit\n\n// Plan to monitor response; patient agrees\n\n\n\n\nPlan\n\nTrial prescribed steroid + emollients + fexofenadine for 7–10 days\n\nKeep trigger diary\n\nReturn next week if no improvement; otherwise continue as advised\n","review":121.44736842105263,"saved":195.05263157894737,"clean":false,"effort":6.666666666666667,"sig":[],"mb":15.409156,"signable":146.07336842105263},{"label":"Run 5","wer":19.50927588270497,"text":"Hello?\n\nHello. Can you hear me well? Yes.\n\nI think it's a bit better. It's a bit it's a bit it's not very clear, let's let's continue anyway.\n\nOkay. Okay.\n\nSo let's start again. So how can I help\n\nyou, sir?\n\nYes. So it's been a few days now.\n\nI have, like, a sore and a red skin. It's kind of it's really itchy, and it's, like,\n\nsuper annoying. Nice. So I'd like to find something quick to solve it.\n\nNo. No problem. I'm happy to help. Where about on your skin is it affected?\n\nMostly, like, my chest, my my hands, my arms, like,\n\nlike, really, it's it's super annoying. Like, it's itching a lot, like, all the time, and\n\ncan't even sleep at night. Like, I really need something\n\nquickly to to solve it because even at work, I like, when I'm in the meeting and I have to, like,\n\nthink about my work and focus like, actually focus on my work, it\n\nreally annoying because I can't actually think about\n\nwhat I have to say. I'm always, like, disturbed by this\n\ndisease.\n\nNo. No. Okay. I understand this is obviously affecting you,\n\ntry our very best to get get it sorted out for you. Have you had anything like this before in the past?\n\nSo, yes,\n\nearlier, I was, like, prescribed for my eczema.\n\nOkay. And\n\nthey gave me, like, some cream and something to\n\nwhen I, like, was shower when I was in the shower, had to put something. Okay.\n\nBut yeah.\n\nDid it help?\n\nI mean, at that time, yes. But the symptoms\n\nlike, these symptoms are, like when the symptoms appear again, I tried those and it didn't work.\n\nI've tried a few things. Like, I bought, like, a steroid cream at the pharmacy last night, but\n\nit apparently didn't help because it's still itching a lot today. Okay.\n\nYeah. Do you remember the name of the cream you bought?\n\nSteroid cream.\n\nOkay. Steroid. Okay. That's okay.\n\nDo would you say these symptoms are very similar to your eczema symptoms or different?\n\nIt's much more, like, itchy and\n\nmy eczema was more, like, only in the arms, and now it's also on the chest.\n\nAnd in the in the on the hands as well. Okay. Yeah. When\n\nlike, I like, for instance, hiking during the weekends and\n\nI I can't really do it anymore because it's, like, very\n\nlike like, I wanted to do that last weekend, and it was super painful and\n\nI I have to take, like, showers every day to be able to kind of\n\nease this itching parts, which is very, very annoying.\n\nNo. Well well okay. That's good. So you mentioned the itchiness.\n\nYou also mentioned it's been quite sore. Yeah.\n\nYou noticed any bleeding or discharge from your skin?\n\nNo. So my skin is a bit\n\ncracked in some parts, like, kind of cracked, if you see what I\n\nmean. Okay.\n\nBut\n\nyeah.\n\nYou don't have any other parts\n\nor blood coming out of your skin?\n\nNo. No. And you mentioned it all started three days ago.\n\nFour days ago. Four days ago. Are you aware of any triggers, anything that you may have done\n\nthat may have caused your symptoms to start? So for example,\n\nhave you changed your, shower gel, any clothing,\n\nHave you been around anyone else?\n\nI\n\nhaven't\n\nit's actually, like,\n\nit's really annoying because I'm thinking about maybe I\n\nchange something because I I haven't, and I don't understand. And I'm kind of\n\nafraid of asking people around me because it's kind of\n\nyou know, I don't feel really comfortable asking about these questions. It's kind of\n\nintimate and so I your help now.\n\nNo. No. Okay. That's\n\nokay.\n\nFine. So just to resummarize, for the last four days, you've had\n\nvery itchy skin, very sore skin all over your body, mainly your chest.\n\nAnd did you also mention your arms and legs as well?\n\nNo. Just the chest, hands, and, like,\n\nlike, inside the eyebrows.\n\nOkay. And anything on your face at\n\nall?\n\nIn my what?\n\nOn your face?\n\nOh, on my face? No. No.\n\nOkay. And\n\napart\n\nfrom\n\nthis, any\n\nother symptoms\n\nhave\n\nyou noticed? For example,\n\nhave you noticed any temperature or fevers?\n\nNo. Just the itching.\n\nEtching.\n\nNothing else.\n\nOkay.\n\nSo your your bowels are working okay? Your\n\nchest is okay? No cough? No breathing difficulties?\n\nNo.\n\nYour passing urine okay?\n\nI think\n\nso. Okay. Alright.\n\nIt's always good to know. So I mean, do you have any ideas as to\n\ncould be causing your symptoms?\n\nAny\n\nwhats?\n\nAny ideas as to what could be causing your symptoms?\n\nSo I had eczema before, so maybe it's this, but it seems\n\nlike more like, my was only on the arm, so I'm I'm not sure. I\n\nI really have no idea.\n\nOkay. That's okay. So\n\nnormally at this stage, I'd like to examine you.\n\nTo see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned it's\n\nyou've got some dry skin and some, cracked skin as well.\n\nAnd it's been very itchy. And so with your\n\nyour background of eczema,\n\nSo there's a couple of questions I wanted to ask you, which I completely forgot. My apologies.\n\nApart from the eczema, do you have any other medical problems I should be aware of?\n\nNo. I just had asthma in the past, but\n\nnot anymore.\n\nNot anymore. Okay. And do you take any regular medication at the moment?\n\nNo.\n\nNo. Okay. Do you have any allergies to anything?\n\nLike, something.\n\nSorry.\n\nYeah.\n\nSorry. I didn't see any ID statement.\n\nK.\n\nHello?\n\nHello? Yes.\n\nOh, can you hear me? Sorry. I think it\n\ncrack\n\nDo you have any allergies at all?\n\nOh, allergies.\n\nNo.\n\nNo. Okay. And tell me about your\n\nyour situation at home. Who do you live with?\n\nSo I live with a few flatmates. I'm\n\nyou know, I'm 31. I've yeah. I'm I have a full time job, and\n\nso I'm living with a few people to save money.\n\nOkay. And what do do for work?\n\nI work at a pharmaceutical company.\n\nSo it's been it's been a few years now.\n\nIt's it's kind of interesting. We are working on a backup\n\nkind of project manager. I mean,\n\nyou want to to know more about it?\n\nOkay.\n\nNo. No. No. That's\n\nactually\n\nthat's actually fine. Just a couple of questions I wanted to ask you, which can sometimes\n\naffect your symptoms, is do you smoke at all?\n\nNo. No. And do you drink much in the way of alcohol?\n\nYou know, once in a while, I can I like hanging out with people once in a while? So\n\nyeah, I'd say a few a few beers per week, something like this. Nothing nothing crazy. I used to drink\n\na lot more when I was younger, but it's been\n\nit's been a while.\n\nOkay. Okay.\n\nI'm gonna say at this stage, I'm gonna say the the sound\n\nquality\n\nis not\n\ngreat, but I will continue because we've come this far.\n\nSo based on everything you mentioned, I do wonder whether this is\n\na flare up of your eczema. The reason being that you said\n\nquite itchy. It's mainly affecting your chest and your back.\n\nAnd having looked at your skin,\n\nthe rash does appear quite familiar.\n\nYou mentioned you're using steroid creams yesterday.\n\nFrom the pharmacy. I wonder whether giving you stronger prescription\n\nof a of a steroid may be beneficial.\n\nWhich I'm happy to prescribe to you today.\n\nAs well as I'm gonna give you something some emollients, which helps moisturize the skin.\n\nWhich you'll be using the bath and shower. And it's definitely worth\n\nusing that for the first seven to ten days.\n\nBefore we make a decision on whether it's working or not.\n\nIt's also worth using antihistamines which can sometimes buy over the counter. Things like loratadine or\n\npyrithin, which can help the itchiness of your Okay.\n\nSkin.\n\nAnd, it's also worth keeping a diary of any\n\ntriggers which are affecting your symptoms, anything you wear, or anything you use in terms of\n\nshower gels or soap. Because if that's causing your symptoms, then we need to\n\na discussion about it next time I see you.\n\nOkay.\n\nJust I I have tried antihistamines lately, but it didn't really help.\n\nOh, could you say again?\n\nSorry.\n\nI have tried the antihistamines.\n\nOkay. But it\n\ndidn't\n\nreally help. It didn't? Okay.\n\nSomething for you to think about. You can get different type of antihistamines. I can give you something\n\na little bit stronger today as well. Okay. Something like fexifenadine, which I\n\ngive to you today. It's definitely worth trying it. It's not gonna do you any harm.\n\nBut as anything, using the steroids and the emollients\n\non a regular basis, over the next week to ten days.\n\nShould hopefully, control your symptoms. But do come back and see me next week if things don't\n\nget better.\n\nThat\n\nsounds good.\n\nOkay. Do you have any questions for me?\n\nNo. That's it.\n\nOkay. Well, I wish you all the best.\n\nThank you very much.\n\nThank you. Have a good day.\n\nBye. Thank you, Victor. Bye.","marks":[{"start":113,"end":118,"said":"But","significant":false},{"start":345,"end":350,"said":"","significant":false},{"start":436,"end":450,"said":"Um whereabouts in","significant":false},{"start":727,"end":731,"said":"I can","significant":false},{"start":799,"end":802,"said":"I can't","significant":false},{"start":809,"end":813,"said":"I can't","significant":false},{"start":842,"end":844,"said":"It's","significant":false},{"start":975,"end":993,"said":"OK. I'm certain","significant":false},{"start":1025,"end":1025,"said":"And uh we'll","significant":false},{"start":1384,"end":1391,"said":"That's those","significant":false},{"start":1423,"end":1426,"said":"appear","significant":false},{"start":1451,"end":1457,"said":"appeared","significant":false},{"start":1757,"end":1779,"said":"OK. um","significant":false},{"start":1936,"end":1945,"said":"arm. But","significant":false},{"start":2015,"end":2020,"said":"OK. 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OK.","significant":false},{"start":8329,"end":8351,"said":"","significant":false},{"start":8370,"end":8398,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","yes","'Onset 4 days ago'."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","no","Lists 'inside eyebrows' as an affected site; patient said inside the elbows and denied facial involvement."],["The note captures: No bleeding or purulent discharge from the skin.","yes","'Skin cracked in some areas; no bleeding or discharge'."],["The note captures: Itching disturbs sleep.","yes","'sleep disturbed'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","'difficulty concentrating at work; hiking last weekend \"super painful\"'."],["The note captures: Known eczema and past asthma.","yes","'Past eczema' and 'Past asthma (no longer active)'."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","Prior eczema regimen 'not responding this time' and OTC steroid last night without relief."],["The note captures: Antihistamines already tried have not helped.","yes","'Recent OTC antihistamines tried without benefit'."],["The note captures: No clear new trigger or change in toiletries identified.","no","No statement that no trigger or toiletry change was identified."],["The note captures: Assessment is a likely eczema flare.","yes","'Likely eczema flare'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribed stronger topical corticosteroid'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","'Use emollients in bath/shower and as moisturiser'."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Prescribed fexofenadine (stronger antihistamine) to trial'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'Keep trigger diary (clothing, soaps, shower gels)'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'review next week if not improving' and 7-10 day reassessment."]],"claims":[["Rash affecting 'inside eyebrows'","Patient said 'inside the elbows' and answered 'No' to anything on the face; eyebrow involvement is a wrong-site claim."]],"note":"Presenting Condition\n\nOnset 4 days ago\n\nVery itchy, sore, red skin affecting chest, hands, arms, inside eyebrows\n\nItch severe, persistent; sleep disturbed; difficulty concentrating at work; hiking last weekend “super painful”\n\nSkin cracked in some areas; no bleeding or discharge\n\nTried prior prescribed eczema regimen previously effective; recurrence not responding this time\n\nTried OTC steroid cream last night without relief\n\nShowers daily to ease itch\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nPast eczema treated previously with creams and shower products; helped at that time\n\n\n\n\nPast Medical History\n\nPast eczema\n\nPast asthma (no longer active)\n\nNo known allergies reported\n\n\n\n\nMedications\n\nNo regular medications\n\nRecent OTC antihistamines tried without benefit\n\nRecent OTC topical steroid tried without benefit\n\n\n\n\nRed Flag/Screening Questions\n\nFever/temperature: denies\n\nRespiratory: no cough, no breathing difficulties\n\nGU: passing urine ok\n\nBowels: ok\n\nBleeding/discharge from skin: denies\n\n\n\n\nSocial History\n\nLives with flatmates\n\nFull‑time job at a pharmaceutical company (project management)\n\nNon‑smoker\n\nAlcohol: a few beers per week\n\nEnjoys hiking; currently limited by symptoms\n\n\n\n\nSport & Exercise History\n\nHiking on weekends; currently unable due to pain/itch\n\n\n\n\nGoals\n\nRapid relief of itch and soreness to sleep and function at work\n\n\n\n\nObjective\n\n(Consent obtained)\n\nRemote consultation; clinician reports rash appearance “familiar” with eczema on inspection\n\n\n\n\nDiagnosis\n\nLikely eczema flare\n\nPlan to reassess response in 7–10 days; review next week if not improving\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nUse prescribed stronger topical steroid regularly for 7–10 days\n\nUse emollients in bath/shower and as moisturiser\n\nKeep trigger diary (clothing, soaps, shower gels)\n\nMeds:\n\nPrescribed stronger topical corticosteroid\n\nPrescribed fexofenadine (stronger antihistamine) to trial\n\nContinue emollients consistently\n\n// Advised to return next week if no improvement\n\n\n\n\nPlan\n\nTrial steroid + emollients + fexofenadine for 7–10 days\n\nReturn next week if not better; discuss triggers and adjust management at review\n","review":164.10526315789474,"saved":152.39473684210526,"clean":false,"effort":20.0,"sig":[["missing","Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","Wrong site: 'inside eyebrows' recorded when the patient said inside elbows and denied facial involvement, which would alter steroid potency choice."]],"mb":15.401105,"signable":184.72126315789473}],"patientnotes":[{"label":"Run 1","wer":19.329742669060444,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have, like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problem. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my. My hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this disease?\nNo, no. Okay this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower, when I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay, Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or.\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. Yeah. Like, I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful. And I have to take, like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nhave not seen any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face? No. No. Okay.\nAnd apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay, so normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Completely my apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry. Yeah, sorry. I was going to say, do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay and what do you do for work?\nI work at a pharmaceutical company so. So it's been a few years now it's kind of interesting we're working I'm like a kind of project manager. Do you want to know more about it?\nOkay no no, no that's absolutely fine. Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo,\nno and do you drink much in a way\nof\nalcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few beers per week something like this Nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower and it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":515,"end":515,"said":"it's","significant":false},{"start":689,"end":693,"said":"I I can","significant":false},{"start":759,"end":762,"said":"I can't","significant":false},{"start":770,"end":774,"said":"I can't","significant":false},{"start":933,"end":937,"said":"OK. 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The patient reports constant itching, cracked skin, and inability to sleep, with no identified triggers such as changes in shower gel or clothing. The symptoms are not relieved by a steroid cream bought from the pharmacy, and previous eczema was limited to the arms.\n\nObjective\n\nExamination revealed a rash with dry and cracked skin on the chest, hands, and inside the elbows.\n\nNot discussed\n\nAssessment\n\nLikely flare‑up of eczema.\n\nPlan\n\nMedications::\n\nPatient previously used a steroid cream purchased from a pharmacy, which did not relieve the current symptoms.\n\nDoctor recommended a stronger prescription steroid cream.\n\nDoctor advised use of emollients to moisturise the skin during bath and shower.\n\nDoctor mentioned over‑the‑counter antihistamines such as loratadine or piriton.\n\nPatient reported having tried antihistamines previously without improvement.\n\nDoctor offered a prescription of fexofenadine.\n\nPatient should apply the prescribed stronger steroid cream and emollients regularly for 7–10 days.\n\nPatient may try a stronger antihistamine such as fexofenadine.\n\nPatient should keep a diary of potential triggers, including soaps and clothing.\n\nPatient to return for review next week if symptoms have not improved.","review":140.61842105263156,"saved":175.88157894736844,"clean":false,"effort":20.0,"sig":[["missing","No bleeding or purulent discharge from the skin.","The note omits the negative infection screen (no bleeding or pus), which justifies steroids without antimicrobials."]],"mb":27.49414,"latency":27.154,"signable":167.77242105263156},{"label":"Run 2","wer":19.569120287253142,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and a red skin. It's kind of. It's really itchy and it's like super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. I really need something quickly to solve it. Because even at work, when I'm in the meeting and I have to think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always disturbed.\nBit by this disease?\nNo, no. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower. When I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes, but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought? Steroid cream. Okay. Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or different?\nAnd it's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. I like, for instance, hiking during the weekends and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful and I have to take showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay, that's good. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nI'm not seeing any other pus or blood coming out of your skin. No.\nAnd you\nmentioned it all started three days ago.\nAre you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't, and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now?\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and, like, inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face.\nNo.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay. So your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties?\nNo.\nYou're passing urine okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this. But it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So, normally at this stage, I like to examine you to see the rash itself and see exactly what type of rash it is. But from what you've told me, you mentioned you've got some dry skin.\nAnd some cracked skin as well. And it's been very itchy. And so with your background of eczema. So there's a couple of questions I wanted to ask you. Richard completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of?\nNo, I just had asthma in the past. But not\nanymore? Not anymore. Okay. And do you take any regular medications at the\nMemantine.\nNo. Okay. Do you have any allergies to anything?\nSorry. Yeah,\nsorry. I'm going to get an allergy to anything.\nHello? Hello? Yes. Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all?\nOh, allergies.\nNo. Okay. And tell me about your situation at home. Who do you live with?\nSo I live with a few flatmates. So, you know, I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay, and what do you do for work?\nI work at a pharmaceutical company. So it's been, it's been a few years now. It's kind of interesting. We're working. I'm a. Like a kind of project manager. I mean, do you want to know more about it?\nOkay. No, no, no, that's absolutely, that's absolutely fine. Just a couple of questions I want to ask you, which can sometimes affect your symptoms is do you smoke at all?\nNo.\nNo. And do you drink much in the way\nof alcohol? You know, once in a while I can. I like hanging out with people once in a while. So yeah, I'd say a few. A few beers per week. Something like this. Nothing, nothing crazy. I used to drink a lot more when I was younger. But it's been a while. Okay.\nI've got to say at this stage, I've got to say the sound corporation.\nIs not great, but I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema, the reason being that you said it's quite itchy. It's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps to moisturize the skin, use in the bath and shower, and it's definitely worth using that for the first seven to 10 days before we make a decision on whether it's working or not. It's also worth using antihistamines, which you can sometimes buy over the counter. So.\nThings like loratadine or pirfenidone, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It's not going to do you any harm. 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Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have, like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like, my chest, my. My hands, my arms. Like, really, it's. It's super annoying. Like, it's itching a lot, like, all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike\ndisturb\nit by this\ndisease? No, no. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower. When I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes, but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay. Steroid.\nOkay.\nWould you say these symptoms are very similar to your eczema symptoms or demonstration?\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well.\nOkay.\nYeah. Like I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful and I have to take like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah.\nHave noticed any other pus or blood coming out of your skin?\nNo.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, That's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and like. Like inside the elbows. Okay.\nAnd anything on your face at all?\nIn\nmy what?\nOn your face.\nOn my face? No.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo, just the itching. Nothing\nelse. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any\nideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So normally at this stage, I like to examine you to see the rash itself.\nExactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy and so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard, please. Forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry? Yeah, Sorry. I was going to say, do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your\nsituation at home who do you live with? So I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money\nokay and what do you do for work?\nI work at a pharmaceutical company so so it's been a few years now it's kind of interesting we're working I'm like a kind of project manager do you want to know more about it?\nOkay no no, no that's absolutely fine Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo\nno and do you drink much in a way of alcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few. A few beers per week something like this Nothing, nothing crazy I used to.\nDrink a lot more when I was younger, but it's been okay. I've got to say at this stage, I've got to say the sound quality is not great. But I will continue because we've come this far. Based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower. And it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say that again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it didn't really\nhelp. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm. 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OK.","significant":false},{"start":7891,"end":7901,"said":"","significant":false},{"start":7919,"end":7947,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States \"3-4 days\" although the dialogue settled on four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red, dry, cracked skin on \"chest, hands, arms, inside elbows\"."],["The note captures: No bleeding or purulent discharge from the skin.","no","Absence of bleeding or discharge is not recorded."],["The note captures: Itching disturbs sleep.","yes","\"disrupts sleep\"."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","yes","\"disrupts ... work concentration\"."],["The note captures: Known eczema and past asthma.","partial","Eczema implied but past asthma is not recorded."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","yes","\"Prior eczema cream and OTC steroid cream ineffective\"."],["The note captures: Antihistamines already tried have not helped.","yes","\"antihistamines tried without benefit\"."],["The note captures: No clear new trigger or change in toiletries identified.","no","No mention that no trigger was identified."],["The note captures: Assessment is a likely eczema flare.","yes","\"Likely eczema flare\"."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","\"Consider prescription stronger steroid\" and \"Apply prescribed steroid\"."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","yes","\"Emollients for regular use in bath/shower\"."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","\"Offered fexofenadine as stronger antihistamine\"."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","\"Keep diary of potential triggers (soaps, clothing, etc.)\"."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","\"Return for review next week if symptoms do not improve\"."]],"claims":[["OTC antihistamines (loratadine, Piriton) previously tried without relief.","Clinician suggested loratadine/Piriton as options; patient only said he had tried unnamed antihistamines."]],"note":"Subjective\n\nChief Complaint::\n\nItchy, sore, red skin for 3‑4 days, wants quick relief.\n\nHistory of Presenting Complaint::\n\nOnset 3‑4 days ago; distribution chest, hands, arms, inside elbows.\n\nSkin dry, cracked, intensely itchy, disrupts sleep and work concentration.\n\nPrior eczema cream and OTC steroid cream ineffective; antihistamines tried without benefit.\n\nObjective\n\nDry, cracked skin with rash appearing consistent with eczema.\n\nNot discussed\n\nAssessment\n\nLikely eczema flare involving chest, hands, arms.\n\nPlan\n\nMedications::\n\nPrior OTC steroid cream purchased from pharmacy.\n\nConsider prescription stronger steroid.\n\nEmollients for regular use in bath/shower.\n\nOTC antihistamines (loratadine, Piriton) previously tried without relief.\n\nOffered fexofenadine as stronger antihistamine.\n\nApply prescribed steroid and emollients daily for 7‑10 days.\n\nTrial fexofenadine for itch control.\n\nKeep diary of potential triggers (soaps, clothing, etc.).\n\nReturn for review next week if symptoms do not improve.","review":110.51315789473685,"saved":205.98684210526315,"clean":false,"effort":30.0,"sig":[["fabrication","OTC antihistamines (loratadine, Piriton) previously tried without relief.","Records loratadine and Piriton as tried; patient only reported unnamed antihistamines, falsifying medication history."]],"mb":27.027012,"latency":22.121,"signable":132.63415789473686},{"label":"Run 4","wer":19.090365050867746,"text":"Hello?\nHello? Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problem. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like my chest, my. My hands, my arms. Like, really, it's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, like when I'm in the meeting and I have to, like, think about my work, focus, like actually focus on my work, it's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this disease?\nNo, no. Okay this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past\nso yes, earlier I was like prescribed for my eczema and they gave me like some cream and something to when I like was shower, when I was in the shower I had to put something.\nOkay, but did it help?\nI mean at that time? Yes but the symptoms like these symptoms like when the symptoms appeared again I tried those and it didn't work. I've tried a few things like I bought like a steroid cream at the pharmacy last night but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay, Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or.\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. Yeah. Like, I like, for instance, hiking during the weekend and I can't really do it anymore because it's like very like I wanted to do that last weekend and it was super painful. And I have to take, like showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like kind of cracked, if you see what I mean. Okay. But yeah,\nhave not seen any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers, anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay, that's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn my what? On\nyour face.\nOn my face? No. No. Okay.\nAnd apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what? Any ideas as to what could be causing your symptoms? So I had eczema before, so maybe it's this, but it seems like more like my eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay, so normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy. And so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard completely forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry. Yeah, sorry, I was. Do you have any allergies to anything? Hello? Hello? Yes. Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money.\nOkay and what do you do for work?\nI work at a pharmaceutical company so. So it's been a few years now it's kind of interesting we're working I'm like a kind of project manager. Do you want to know more about it?\nOkay no no, no that's absolutely fine. Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo,\nno and do you drink much in a way\nof\nalcohol?\nYou know once in a while I like hanging out with people once in a while so yeah I'd say a few beers per week something like this Nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back and having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps moisturize the skin, use in the bath and shower and it's definitely worth using that for the first time. Seven to ten days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Piriton, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing your symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it\ndidn't really help. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It. It's not going to do you any harm, but I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":513,"end":513,"said":"it's","significant":false},{"start":687,"end":691,"said":"I I can","significant":false},{"start":756,"end":756,"said":"I can't","significant":false},{"start":765,"end":769,"said":"I can't","significant":false},{"start":927,"end":931,"said":"OK. I'm certain","significant":false},{"start":977,"end":977,"said":"our","significant":false},{"start":995,"end":1010,"said":"get this sorted out","significant":false},{"start":1294,"end":1301,"said":"That's those","significant":false},{"start":1330,"end":1330,"said":"appear","significant":false},{"start":1809,"end":1818,"said":"arm. But","significant":false},{"start":1871,"end":1871,"said":"OK. 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Can you hear me well? Yes. I think it's a bit better. It's a bit. It's a bit. It's not very clear, but let's continue anyway. Okay. Okay, let's start again. So how can I help you, sir?\nYes. So it's been a few days now. I have like, a sore and red skin. It's kind of. It's really itchy and it's like, super annoying. So I'd like to find something quick to solve it.\nNo, no problems. I'm happy to help. Whereabouts in your skin is it affected?\nMostly, like my chest, my. My hands, my arms. Like, really, it's. It's super annoying. Like, it's itching a lot, like all the time. And I can't even sleep at night. Like, I really need something quickly to solve it. Because even at work, I. Like when I'm in the meeting and I have to, like, think about my work and focus, like, actually focus on my work. It's really annoying because I can't actually think about what I have to say. I'm always.\nLike disturbed by this\ndisease? No. No. Okay, I understand this is obviously affecting you and we'll try very best to get us sort of that for you. Have you had anything like this before in the past,\nso. Yes, earlier I was like prescribed for eczema and they gave me like some cream and something to. When I like was shower. When I was in the shower, I had to put something.\nOkay, but did it help?\nI mean, at that time, yes, but the symptoms like these symptoms like when these symptoms appeared again, I tried those and it didn't work. I've tried a few things, like I bought like a steroid cream at the pharmacy last night, but it apparently didn't help because it's still itching a lot today.\nOkay.\nYeah.\nDo you remember the name of the cream you bought?\nSteroid cream.\nOkay. Steroid. Okay. Would you say these symptoms are very similar to your eczema symptoms or diagnosis?\nDifferent. It's much more like itchy. And my eczema was more like only in the arms. And now it's also on the chest and on the hands as well. I like, for instance, hiking during the weekends, and I can't really do it anymore because it's like very like, I wanted to do that last weekend and it was super painful. And I have to take showers every day to be able to kind of ease this itching part, which is very, very annoying.\nNo. Well, okay. That's okay. So you mentioned the itchiness. You also mentioned it's been quite sore. Have you noticed any bleeding or discharge from your skin?\nNo. So my skin is a bit cracked in some parts, like, kind of cracked, if you see what I mean. Okay. But yeah.\nHave nothing any other pus or blood coming out of your skin.\nAnd you mentioned it all started three days ago. Four days ago. Are you aware of any triggers? So anything that you may have done that may have caused your symptoms to start? So, for example, have you changed your shower gel, any clothing? Have you been around anyone else?\nNo. It's actually. It's very annoying because I'm thinking about maybe I should change something, because I haven't and I don't understand. And I'm kind of afraid of asking people around me because it's kind of. You know, I don't feel really comfortable asking about these questions. It's kind of intimate. And so I. Your head now.\nNo. No. Okay. That's. Okay, fine. So just to re. Summarize, for the last four days, you've had very itchy skin, very sore skin all over your body, mainly your chest. And did you mention your arms and legs as well?\nNo, just the chest, hands, and inside the elbows.\nOkay. Anything on your face at all?\nIn\nmy what?\nOn your face.\nOn my face? No.\nNo. Okay. And apart from this, any other symptoms have you noticed? For example, have you noticed any temperature or fevers?\nNo. Just the itching.\nItching? Nothing else. Okay, so your bowels are working okay. Your chest is okay. No cough? No. Breathing difficulties? No. You're passing urine Okay?\nI think so.\nOkay. All right. It's always good to know. So, I mean, do you have any ideas as to what could be causing your symptoms?\nAny what?\nAny ideas as to what could be causing your symptoms?\nSo I had eczema before, so maybe it's this, but it seems like more like eczema was only on the arm, so I'm not sure. I really have no idea.\nOkay. That's okay. So normally at this stage, I like to examine you to see the rash itself.\nSee exactly what type of rash it is, but from what you've told me you mentioned it's. You've got some dry skin and some cracked skin as well, and it's been very itchy, and so with your background of eczema. Sorry. So there's a couple of questions I wanted to ask you. Richard, please. Forgot. My apologies. Apart from the eczema, do you have any other medical problems I should be aware of? No, I just had asthma in the past, but. Okay. Not anymore. Not anymore. Okay. And do you take any regular medications at the Memantine. No. Okay. Do you have any allergies to anything? Sorry? Yeah. Sorry. Do you have any allergies to anything? Hello? Hello? Yes? Oh, can you hear me? Sorry, I think it cracked. Do you have any allergies at all? Oh, allergies. No. No. Okay.\nAnd tell me about your situation at home who do you live with?\nSo I live with a few flatmates so you know I'm 31, I have a full time job and so I'm living with a few people to save money\nokay and what do you do for work?\nI work at a pharmaceutical company so so it's been a few years now it's kind of interesting we're working I'm like a kind of project manager do you want to know more about it?\nOkay no no, no that's absolutely fine Just a couple of questions I want to ask you which can sometimes affect your symptoms is do you smoke at all?\nNo\nno and do you drink much in a way\nof alcohol? You know once in a while I like hanging out with people once in a while so yeah I'd say a few. A few beers per week something like this Nothing, nothing crazy I used to.\nDrink a lot more when I was younger, but it's been a while. Okay. Okay. I've got to say at this stage, I've got to say the sound quality is not great but I will continue because we've come this far. So based on everything you mentioned, sir, I do wonder whether this is a flare up of your eczema. The reason being that you said it's quite itchy, it's mainly affecting your chest and your back. And having looked at your skin, the rash does appear quite familiar. You mentioned using steroid creams yesterday from the pharmacy. I wonder whether giving you stronger prescription of a steroid may be beneficial, which I'm happy to prescribe to you today as well as I'm going to give you something, some emollients which helps to moisturize the skin, use in the bath and shower and it's definitely worth using that for the first seven to 10 days before we make a decision on whether.\nIs working or not. It's also worth using antihistamines, which you can sometimes buy over the counter things like loratadine or Pirotin, which can help the itchiness of your skin. And it's also worth keeping a diary of any triggers which are affecting your symptoms, anything you wear or anything you use in terms of shower gels or soap. Because if that's causing you symptoms, then we need to have a discussion about it next time I see you.\nOkay? Just. I have tried antihistamines lately, but it didn't really help.\nOh, could you say again? Sorry.\nI have tried the antihistamines.\nOkay.\nBut it didn't really\nhelp. It didn't. Okay. So something for you to think about. You can get different type of antihistamines. I can give you something a little bit stronger today as well. Something like fexofenadine, which I can give to you today. It's definitely worth trying. It's not going to do you any harm. But I certainly think using the steroids and the emollients on a regular basis.\nOver the next week to 10 days should hopefully control your symptoms. But do come back and see me next week if things don't get better. That sounds good. Okay. Do you have any questions for me? No, that's it. Okay. Well, I wish you all the best. Thank you very much. Have a good day. Bye. Thank you, Victor. Bye.","marks":[{"start":386,"end":395,"said":"problem.","significant":false},{"start":697,"end":701,"said":"I can","significant":false},{"start":767,"end":770,"said":"I can't","significant":false},{"start":778,"end":782,"said":"I can't","significant":false},{"start":941,"end":959,"said":"OK. 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OK.","significant":false},{"start":7854,"end":7864,"said":"","significant":false},{"start":7882,"end":7910,"said":"","significant":false}],"facts":[["The note captures: Four-day history of the current skin flare.","partial","States '3-4 days' rather than four days."],["The note captures: Itchy, sore, red/dry and cracked skin on the chest, hands and flexures/inside elbows; patient corrects the suggestion of legs being affected.","yes","Itchy, sore, red skin on chest, hands, inside elbows; dry cracked skin."],["The note captures: No bleeding or purulent discharge from the skin.","no","Absence of bleeding or discharge not recorded."],["The note captures: Itching disturbs sleep.","yes","'sleep disturbed'."],["The note captures: Itching impairs work concentration and/or normal activities such as hiking.","no","Neither work concentration nor hiking impact recorded."],["The note captures: Known eczema and past asthma.","partial","Prior eczema implied ('previous eczema') but past asthma omitted."],["The note captures: Previously helpful eczema treatments and the OTC steroid cream tried the previous night are not relieving the current flare.","partial","OTC steroid cream not relieving recorded; previously helpful eczema treatments failing now omitted."],["The note captures: Antihistamines already tried have not helped.","partial","Records antihistamines tried without benefit but names '(loratadine/cetirizine)', which the patient never said."],["The note captures: No clear new trigger or change in toiletries identified.","yes","'no identified triggers (no new shower gel, clothing)'."],["The note captures: Assessment is a likely eczema flare.","yes","'Likely flare-up of previous eczema'."],["The note captures: Plan for a stronger prescribed topical steroid; no particular steroid name or dose is required because these were not spoken.","yes","'Prescribe stronger topical steroid'."],["The note captures: Plan for regular emollients/moisturisation, including bath/shower use.","partial","'use emollients daily' recorded but bath/shower use omitted."],["The note captures: Fexofenadine or a stronger antihistamine is offered for itch.","yes","'Trial fexofenadine'."],["The note captures: Keep a diary of potential triggers such as clothing, soaps or shower products.","yes","'keep trigger diary'."],["The note captures: Review next week or after roughly 7–10 days if not improving.","yes","'Return in 1 week if no improvement'."]],"claims":[["Tried OTC antihistamines (loratadine/cetirizine) without benefit","Patient only said 'I have tried antihistamines'; no product was named and cetirizine is never mentioned (clinician suggested loratadine or Piriton as options)."]],"note":"Subjective\n\nChief Complaint::\n\nItchy, sore, red skin on chest, hands, inside elbows for 3‑4 days; sleep disturbed.\n\nHistory of Presenting Complaint::\n\nOnset 3‑4 days ago with intense itching and soreness.\n\nSymptoms constant, worse at night, not relieved by OTC steroid cream.\n\nDaily showers attempted for relief; no identified triggers (no new shower gel, clothing).\n\nObjective\n\nDry, cracked skin with rash on chest, hands, inside elbows, resembling prior eczema.\n\nRash appearance familiar to eczema.\n\nNot discussed\n\nAssessment\n\nLikely flare‑up of previous eczema.\n\nPlan\n\nMedications::\n\nPreviously used OTC steroid cream without relief.\n\nTried OTC antihistamines (loratadine/cetirizine) without benefit.\n\nClinician prescribed stronger steroid cream and fexofenadine.\n\nRecommended regular emollient use.\n\nPrescribe stronger topical steroid; use emollients daily for 7‑10 days.\n\nTrial fexofenadine; keep trigger diary.\n\nReturn in 1 week if no improvement.","review":153.06578947368422,"saved":163.43421052631578,"clean":false,"effort":36.666666666666664,"sig":[["missing","No bleeding or purulent discharge from the skin.","Screened-for signs of infection (no bleeding, pus or discharge) are absent, the key negative behind steroid-only treatment without antibiotics."],["partial","Antihistamines already tried have not helped.","Records specific antihistamines (loratadine/cetirizine) as failed that the patient never named, which could wrongly steer future drug choice."]],"mb":26.564626,"latency":50.252,"signable":203.31778947368423}]}},{"id":"day2_consultation07","name":"Chest pain","dictation":false,"language":false,"stress":false,"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. 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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. 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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":[{"start":0,"end":60,"said":"Hi","significant":false},{"start":118,"end":128,"said":"Doctor","significant":false},{"start":134,"end":140,"said":"Resor","significant":false},{"start":146,"end":157,"said":".","significant":false},{"start":178,"end":206,"said":"That's the same thing. 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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. 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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. 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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. 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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? 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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":[{"start":0,"end":48,"said":"Hi","significant":false},{"start":108,"end":114,"said":"Resor","significant":false},{"start":120,"end":130,"said":".","significant":false},{"start":148,"end":170,"said":"That's the same thing. 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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? 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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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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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":59,"end":65,"said":"Resor","significant":false},{"start":71,"end":81,"said":".","significant":false},{"start":99,"end":121,"said":"That's the same thing. OK","significant":false},{"start":253,"end":256,"said":"Jim","significant":true},{"start":283,"end":287,"said":"nineteen fifty eight","significant":false},{"start":300,"end":303,"said":"eighth","significant":false},{"start":393,"end":400,"said":"Yeah. 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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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":58,"end":63,"said":"Resor","significant":false},{"start":69,"end":79,"said":".","significant":false},{"start":98,"end":123,"said":"That's the same thing. 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OK","significant":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. 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OK","significant":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":[{"start":0,"end":40,"said":"Hi","significant":false},{"start":101,"end":106,"said":"Resor","significant":false},{"start":112,"end":122,"said":".","significant":false},{"start":141,"end":166,"said":"That's the same thing. OK","significant":false},{"start":296,"end":299,"said":"Jim","significant":true},{"start":325,"end":329,"said":"nineteen fifty eight uh","significant":false},{"start":337,"end":340,"said":"eighth","significant":false},{"start":422,"end":422,"said":"um Yeah. 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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":[{"start":0,"end":40,"said":"Hi","significant":false},{"start":101,"end":106,"said":"Resor","significant":false},{"start":112,"end":122,"said":".","significant":false},{"start":141,"end":166,"said":"That's the same thing. 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OK","significant":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":[{"start":0,"end":40,"said":"Hi","significant":false},{"start":101,"end":106,"said":"Resor","significant":false},{"start":112,"end":122,"said":".","significant":false},{"start":141,"end":166,"said":"That's the same thing. 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OK","significant":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":[{"start":0,"end":42,"said":"Hi","significant":false},{"start":102,"end":108,"said":"Resor","significant":false},{"start":114,"end":125,"said":".","significant":false},{"start":143,"end":168,"said":"That's the same thing. 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OK OK","significant":false},{"start":6991,"end":7007,"said":"","significant":false},{"start":7036,"end":7043,"said":"after","significant":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 overweight documented but low baseline physical activity 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.","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 (age 60), presented with chest discomfort that started a couple of hours prior while gardening.\n- Symptoms include pressure on the chest, feeling \"someone's sitting on my chest,\" nausea (no vomiting), sweating, and shortness of breath, which are still present.\n- The discomfort is located in the middle of the chest, diffuse, and radiates to the left arm and shoulder.\n- This is the first time the patient has experienced these symptoms.\n- The patient notes palpitations, with their heart beating faster, which they attribute to stress about the situation.\n\nO (Objective):\n- Patient confirmed full name and date of birth.\n- Patient resides alone and has an open front door for ambulance access.\n- Patient is a smoker (10 cigarettes/day for 15 years) and reports a history of high blood pressure but no diabetes. Cholesterol levels are unknown.\n- Patient drinks approximately 7-8 pints of beer per week and is overweight.\n- Family history includes father's death from a heart attack around age 60 and mother's heart problems.\n\nA (Assessment):\n- The patient's described symptoms are indicative of a possible myocardial infarction (heart attack).\n- The primary concern is to exclude acute cardiac event given the chest discomfort, associated symptoms, and significant risk factors.\n- Differential diagnoses include other causes of chest pain, which require further investigation.\n\nP (Plan):\n- An ambulance has been called to transport the patient to the hospital for further assessment and management.\n- The doctor will remain on the line with the patient until the ambulance team arrives.\n- The patient has an allergy to aspirin, which causes mild swelling, and this information needs to be communicated to the hospital team, as aspirin may still be considered despite the allergy.\n- The ambulance team will perform an ECG on arrival to guide further treatment and hospital destination.\n- The doctor will hand over patient details to the ambulance crew upon their arrival.\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":[{"start":0,"end":42,"said":"Hi","significant":false},{"start":102,"end":108,"said":"Resor","significant":false},{"start":114,"end":125,"said":".","significant":false},{"start":143,"end":168,"said":"That's the same thing. 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OK OK","significant":false},{"start":6984,"end":7004,"said":"","significant":false},{"start":7033,"end":7040,"said":"after","significant":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":[{"start":0,"end":42,"said":"Hi","significant":false},{"start":102,"end":108,"said":"Resor","significant":false},{"start":114,"end":125,"said":".","significant":false},{"start":143,"end":168,"said":"That's the same thing. 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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":[{"start":0,"end":42,"said":"Hi","significant":false},{"start":102,"end":108,"said":"Resor","significant":false},{"start":114,"end":125,"said":".","significant":false},{"start":143,"end":168,"said":"That's the same thing. 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OK OK","significant":false},{"start":6954,"end":6970,"said":"","significant":false},{"start":6999,"end":7006,"said":"after","significant":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.","no","Faster heartbeat/palpitations during the episode are not mentioned."],["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 began a couple of hours prior to the call while gardening.\n- Symptoms include pressure on the middle of their chest, feeling \"someone's sitting on my chest,\" nausea (no vomiting), sweating, and shortness of breath.\n- The chest discomfort is diffuse and radiates to the left arm and shoulder.\n- Symptoms are currently present and have not resolved.\n- This is the first time the patient has experienced these symptoms. 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":[{"start":0,"end":42,"said":"Hi","significant":false},{"start":102,"end":108,"said":"Resor","significant":false},{"start":114,"end":125,"said":".","significant":false},{"start":143,"end":168,"said":"That's the same thing. 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OK OK","significant":false},{"start":6944,"end":6960,"said":"","significant":false},{"start":6989,"end":6996,"said":"after","significant":false},{"start":7074,"end":7088,"said":"","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":59,"end":63,"said":"Resor","significant":false},{"start":69,"end":79,"said":".","significant":false},{"start":97,"end":123,"said":"That's the same thing. 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Thank you.","significant":false},{"start":5039,"end":5044,"said":"","significant":false},{"start":5082,"end":5093,"said":"OK OK. OK no.","significant":false},{"start":5348,"end":5352,"said":"you","significant":false},{"start":5437,"end":5444,"said":"swell up um","significant":true},{"start":5557,"end":5571,"said":"OK all right.","significant":false},{"start":5647,"end":5653,"said":"you","significant":false},{"start":5731,"end":5742,"said":"OK OK. Ohh OK. Um","significant":false},{"start":5960,"end":5971,"said":"OK Uh huh. Um","significant":false},{"start":6196,"end":6215,"said":"","significant":false},{"start":6243,"end":6250,"said":"after","significant":false},{"start":6279,"end":6290,"said":"OK Yeah that's OK. OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":58,"end":62,"said":"Resor","significant":false},{"start":68,"end":79,"said":".","significant":false},{"start":97,"end":123,"said":"That's the same thing. OK","significant":false},{"start":250,"end":253,"said":"Jim","significant":true},{"start":280,"end":285,"said":"nineteen fifty eight uh","significant":false},{"start":379,"end":379,"said":"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","significant":true},{"start":521,"end":541,"said":"OK.","significant":false},{"start":682,"end":686,"said":"OK OK. 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Uh","significant":false},{"start":2379,"end":2382,"said":"","significant":false},{"start":2388,"end":2391,"said":"could","significant":false},{"start":2409,"end":2409,"said":"yeah .","significant":false},{"start":2662,"end":2662,"said":"or anything Yeah.","significant":false},{"start":2776,"end":2790,"said":"OK all right. Um","significant":false},{"start":2816,"end":2819,"said":"in","significant":false},{"start":3121,"end":3121,"said":"had","significant":false},{"start":3189,"end":3190,"said":"sixty","significant":false},{"start":3378,"end":3380,"said":"yeah Ohh.","significant":false},{"start":3509,"end":3515,"said":"um you","significant":false},{"start":4085,"end":4085,"said":"line","significant":false},{"start":4131,"end":4141,"said":"OK.","significant":false},{"start":4236,"end":4236,"said":"OK yeah. Thank you.","significant":false},{"start":4247,"end":4252,"said":"","significant":false},{"start":4290,"end":4301,"said":"OK OK. OK no.","significant":false},{"start":4556,"end":4560,"said":"you","significant":false},{"start":4645,"end":4652,"said":"swell up um","significant":true},{"start":4765,"end":4779,"said":"OK all right.","significant":false},{"start":4855,"end":4861,"said":"you","significant":false},{"start":4926,"end":4950,"said":"allergy OK OK. Ohh OK. Um","significant":false},{"start":5168,"end":5179,"said":"OK Uh huh. Um","significant":false},{"start":5380,"end":5390,"said":"OK. Yeah","significant":false},{"start":5403,"end":5412,"said":"we'll end the conversation after the purposes. Is that OK Yeah that's OK. OK thank you very much. thanks Bye Thank you. Bye.","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":59,"end":63,"said":"Resor","significant":false},{"start":69,"end":79,"said":".","significant":false},{"start":97,"end":123,"said":"That's the same thing. 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Um","significant":false},{"start":6197,"end":6216,"said":"","significant":false},{"start":6244,"end":6251,"said":"after","significant":false},{"start":6280,"end":6291,"said":"OK Yeah that's OK. OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":59,"end":63,"said":"Resor","significant":false},{"start":69,"end":79,"said":".","significant":false},{"start":97,"end":123,"said":"That's the same thing. 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Thank you.","significant":false},{"start":5043,"end":5048,"said":"","significant":false},{"start":5086,"end":5097,"said":"OK OK. OK no.","significant":false},{"start":5352,"end":5356,"said":"you","significant":false},{"start":5441,"end":5448,"said":"swell up um","significant":true},{"start":5561,"end":5575,"said":"OK all right.","significant":false},{"start":5651,"end":5657,"said":"you","significant":false},{"start":5735,"end":5746,"said":"OK OK. Ohh OK. Um","significant":false},{"start":5964,"end":5975,"said":"OK Uh huh. Um","significant":false},{"start":6176,"end":6186,"said":"OK. Yeah","significant":false},{"start":6199,"end":6218,"said":"","significant":false},{"start":6246,"end":6253,"said":"after","significant":false},{"start":6282,"end":6293,"said":"OK Yeah that's OK. OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":59,"end":63,"said":"Resor","significant":false},{"start":69,"end":79,"said":".","significant":false},{"start":97,"end":123,"said":"That's the same thing. 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OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":60,"end":64,"said":"Resor","significant":false},{"start":70,"end":80,"said":".","significant":false},{"start":99,"end":123,"said":"That's the same thing. 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OK no.","significant":false},{"start":5280,"end":5280,"said":"uh can I","significant":false},{"start":5611,"end":5619,"said":"swell up um","significant":true},{"start":5735,"end":5749,"said":"OK all right.","significant":false},{"start":5826,"end":5832,"said":"you","significant":false},{"start":5898,"end":5918,"said":"allergy OK OK. Ohh OK. Um","significant":true},{"start":6137,"end":6149,"said":"OK Uh huh. Um","significant":false},{"start":6358,"end":6369,"said":"OK. Yeah","significant":false},{"start":6382,"end":6395,"said":"","significant":false},{"start":6423,"end":6430,"said":"after","significant":false},{"start":6460,"end":6472,"said":"OK Yeah that's OK. OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":60,"end":64,"said":"Resor","significant":false},{"start":70,"end":80,"said":".","significant":false},{"start":99,"end":121,"said":"That's the same thing. 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Can you remember","significant":true},{"start":3525,"end":3525,"said":"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. 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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. 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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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":60,"end":64,"said":"Resor","significant":false},{"start":70,"end":80,"said":".","significant":false},{"start":99,"end":115,"said":"That's the same thing. 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OK","significant":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. 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OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":55,"end":60,"said":"Resor","significant":false},{"start":66,"end":76,"said":".","significant":false},{"start":94,"end":115,"said":"That's the same thing. 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OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":55,"end":60,"said":"Resor","significant":false},{"start":66,"end":77,"said":".","significant":false},{"start":95,"end":99,"said":"That's the same thing. OK","significant":false},{"start":227,"end":230,"said":"Jim","significant":true},{"start":256,"end":260,"said":"nineteen fifty eight uh","significant":false},{"start":268,"end":271,"said":"eighth","significant":false},{"start":351,"end":351,"said":"um Yeah. 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OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":55,"end":60,"said":"Resor","significant":false},{"start":66,"end":77,"said":".","significant":false},{"start":95,"end":99,"said":"That's the same thing. 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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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":55,"end":59,"said":"Resor","significant":false},{"start":65,"end":76,"said":".","significant":false},{"start":94,"end":98,"said":"That's the same thing. 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OK","significant":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":[{"start":0,"end":0,"said":"Hi","significant":false},{"start":55,"end":60,"said":"Resor","significant":false},{"start":66,"end":76,"said":".","significant":false},{"start":94,"end":115,"said":"That's the same thing. 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OK","significant":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}]}},{"id":"day3_consultation01","name":"Allergic reaction","dictation":false,"language":false,"stress":false,"reference":"Hi.\n\n Hello.\n\n Hi, hi I'm Maria.\n\n Hello, I'm Doctor Jacob and welcome to Babylon.\n\n How are you doing?\n\n I'm all right, thank you. Well I feel a little weird today, to be honest.\n\n Yeah, so just before we we start, is it all right if you could confirm your full name for me please?\n\n Yes. Maria Trabalotsa.\n\n OK, day and your date of birth?\n\n That is the first of October, ninety-nine.\n\n OK, and your email address for me please?\n\n Yes, M Traba at Gmail dot com.\n\n OK, and just to confirm that you're in a secure location and we can have a confidential conversation?\n\n Yes I think I am, yeah.\n\n Good, right, you've mentioned in in, in your patient notes that you're having some sort of lip swelling, and you after you had a sandwich. Is that correct?\n\n Yeah that is, well, I don't think, I don't think it was, it it wasn't a sandwich but it was, it was something with prawn so.\n\n Basically, I, I sometimes go with my friends to, to this place called .\n\n And, we, we regularly have like usually I have like a normal vegetarian soup or something.\n\n Mm-hmm.\n\n And yeah, and, then I wanted to try something new.\n\n Mm-hmm.\n\n Um, so what happened was, I, I ordered a prawn soup it it's it it's called laksa, it's like a soup, I ordered a prawn one this time.\n\n Yeah.\n\n And, yeah and then my feel like my lips started feeling a little weird just in the in the corner sort of on the left first.\n\n Mm-hmm.\n\n And then, I don't know and then, we went back we had little bit of chat, of banter I wasn't really, paying attention.\n\n Uh, now I feel the that there is a swelling, there is like a swelling on my, on my upper lip and it's kind of getting bigger. I don't know what to do.\n\n Yeah.\n\n Right.\n\n All right. So when did you have the prawn soup? What time?\n\n That was, that must have been just after work, so maybe like around seven.\n\n OK, around seven o'clock, and um how long did it take to develop the swelling?\n\n Well I wasn't really paying attention so, it must have been like, must have been like, I don't know half an hour maybe.\n\n OK in half an hour you developed the swelling yeah?\n\n Yeah.\n\n OK, and it's getting bigger and bigger?\n\n Yeah it's it it still feel it like, really pumping blood and it's kinda getting bigger it feels like it's getting worse.\n\n OK. So, just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up, any feeling like that?\n\n Yeah actually, I, I feel like I can't breathe that well right now.\n\n OK.\n\n And do you feel like, like your chest is tight?\n\n And I don't know if it's the chest it just generally feels a little difficult, but yeah it might be, I'm not sure.\n\n OK.\n\n OK, right.\n\n And just a few have you ever these any kind of lip swelling in the past? After eating any food?\n\n Yeah, well, maybe, I remember like a year ago.\n\n A year ago I was, out with my friends.\n\n Mm-hmm.\n\n And I think we went like, to a late night kinda Chinese place, and I remember that I was quite drunk to be honest.\n\n Sure, OK.\n\n And I remember that after like having that very late.\n\n I've woke up the next morning quite swollen up and had also I, felt really bad and quite difficult breathing, but I don't know what it was I had it was like a curry or something I think.\n\n OK.\n\n Right.\n\n OK. Uh, and what did you take at that time? Did you use anything like antihistamine or anything, when you had that last time?\n\n But I generally have asthma so, I took I, I take, ohh what's it called? Salbutamol inhalers?\n\n Yeah.\n\n Yeah, so I do take that regularly but I've always taken it. I generally have asthma.\n\n And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n\n Ohh I, no I don't think so, no.\n\n OK right and um so, do you use antihistamines like Cetirizine, Loratadine, Piriton, any of those, kind of things?\n\n Hmm, no. I, I got no I do sometimes but I don't know which ones, but I have a peanut allergy as well, like always had it.\n\n Yeah.\n\n Yeah.\n\n I, think I do get antihistamines for that but I'm not sure which ones.\n\n And any point because you had peanut allergy, any time you have to ever use like an injection?\n\n When I was a kid I think I remember my mom told me about it, but I don't know what it was 'cause I was small and I've changed doctors since.\n\n Right, so has your mum ever said that you had to go to hospital because you had an severe allergic reaction?\n\n Yeah is that well I was like six or something I, I, I think. Ohh sorry, the swelling is getting, ohh my god ohh, yeah I think when I was six.\n\n Oh.\n\n You all right? Are you OK now?\n\n Ohh, I feel a little dizzy right now to be honest, ohh.\n\n Are you .\n\n You're feeling dizzy. OK, right do you have any kind of, uh, antihistamines with you at the moment?\n\n No, I don't think I have no.\n\n OK, right OK, so.\n\n Right, uh, all right I, I'm really a bit worried about you at the moment, Maria. Um I think we need to call an ambulance, because, um, from what history you've been telling me. It sounds like you could be going into what we say an a, an anaphylactic reaction. That's when your throat and your chest, you know closes in and you might need an injection like what your mum's.\n\n Um, you know what your mum told you as you were a young child. OK, all right so is there any, anyone with you at the moment or are you alone?\n\n I'm alone at the moment, yeah.\n\n Ohh no so hang on the line, while I'll call the ambulance OK, and I'll send them right to you, OK and .\n\n Hey ohh somebody just came, somebody just came yes, I'm not alone any more. Thank.\n\n All right, OK somebody just came. So just call the ambulance make sure that person's with you till the ambulance comes, yeah. Uh and because we are worried about an anaphylactic reaction so you need go straight away. Could you ask the person whether they have any antihistamines around, in the interim, while we're waiting.\n\n Yes, uh Mum, Mum do we have any antihistamines around? Yes.\n\n Yes K. Do that straight away and if mum can call. Mum, if you can call the uh nine nine , nine nine nine yeah, and say that your there is a suspected anaphylactic reaction and they need to come straight away. OK.\n\n Ohh yeah yeah we do .\n\n Yes she said she will yes, yes.\n\n All right, so straight away take the antihistamines in the meantime all right.\n\n OK, OK. Yes, thank .\n\n And after you come out from the hospital do give us a ring back we might need to sort you out, um, with your injections and things like that OK?\n\n Yes, yes will do, yes, thank .\n\n All .\n\n OK then, take care.\n\n Thank you very much thank bye bye.\n\n Bye bye, 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1","wer":14.37648927720413,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you.\n\n  I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza.\n\n  Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com.\n\n  Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was— it wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird, just in the— in the corner sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention.\n\n  Mm-hmm.\n\n  Uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— it's— I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, piritin, any of those kind of things?\n\n  Um, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was like 6 or something. I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, okay. Oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  No, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hmm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hmm.\n\n  Okay. Right. So is there any— anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Oh, no. So hang on the line while I call the ambulance, okay? And I'll send them right to you.\n\n  Okay.\n\n  Okay? And I'll probably just— somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Thank you. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 9999, yeah?\n\n  Mm-hmm.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she says she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital. Do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":17,"end":20,"said":"","significant":false},{"start":308,"end":327,"said":"Trabalotsa. OK day","significant":false},{"start":367,"end":370,"said":"first","significant":false},{"start":382,"end":395,"said":"ninety-nine. OK","significant":true},{"start":446,"end":472,"said":"M Traba at Gmail dot com. 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Thank.","significant":false},{"start":5746,"end":5762,"said":"OK","significant":false},{"start":6105,"end":6113,"said":"Mum Mum","significant":false},{"start":6172,"end":6184,"said":"K.","significant":false},{"start":6222,"end":6225,"said":"mum","significant":false},{"start":6236,"end":6239,"said":"Mum","significant":false},{"start":6266,"end":6270,"said":"nine nine nine nine nine","significant":false},{"start":6281,"end":6288,"said":"","significant":false},{"start":6305,"end":6311,"said":"your","significant":false},{"start":6393,"end":6397,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6411,"end":6415,"said":"said","significant":false},{"start":6435,"end":6435,"said":"All","significant":false},{"start":6518,"end":6529,"said":"OK OK. Yes thank .","significant":false},{"start":6537,"end":6543,"said":"after","significant":false},{"start":6553,"end":6555,"said":"out","significant":false},{"start":6717,"end":6727,"said":"","significant":false},{"start":6737,"end":6749,"said":". All . OK","significant":false},{"start":6794,"end":6802,"said":"thank","significant":false},{"start":6822,"end":6830,"said":"Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Prawn laksa consumed at ~19:00\"; food correctly identified as a prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"lip symptoms began within ~30 min.\""],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressive upper-lip swelling; feels increasingly enlarged.\""],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing; unsure if chest tightness.\""],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode ~1 yr ago after late Chinese meal/curry: woke swollen... had breathing difficulty.\""],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"PMH asthma; uses salbutamol inhaler regularly.\""],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"hospital attendance/injection for severe allergic reaction at ~6 yrs.\""],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; \"require emergency assessment.\""],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Advised emergency ambulance attendance urgently for suspected anaphylaxis.\""],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","\"mother arrived during call\"; mother instructed to call and remain with pt."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised pt to take available antihistamine immediately while awaiting ambulance.\""],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Advised pt to contact service after hospital attendance; may need review regarding emergency injections.\""]],"claims":[],"note":"Subjective\nPrawn laksa consumed at ~19:00; lip symptoms began within ~30 min.\nInitial abnormal sensation at left lip corner → progressive upper-lip swelling; feels increasingly enlarged with “pumping” sensation.\nReports difficulty breathing; unsure if chest tightness.\nSimilar episode ~1 yr ago after late Chinese meal/curry: woke swollen, felt unwell and had breathing difficulty; trigger unclear.\nPMH asthma; uses salbutamol inhaler regularly. No other inhaler reported.\nKnown peanut allergy; intermittently uses unspecified antihistamines.\nRecalls mother reporting hospital attendance/injection for severe allergic reaction at ~6 yrs.\nInitially alone; mother arrived during call. No antihistamines immediately available on patient, but mother reported antihistamines at home.\nObjective\nNo objective examination findings documented during remote consultation.\nAssessment\nSuspected anaphylactic reaction, given likely food trigger (prawns), progressive lip swelling and reported breathing difficulty, with background of peanut allergy, asthma and previous possible severe allergic reactions.\nEscalating upper-lip swelling and respiratory symptoms require emergency assessment.\nPlan\nAdvised emergency ambulance attendance urgently for suspected anaphylaxis.\nMother instructed to call 9999, state suspected anaphylactic reaction and request urgent ambulance.\nAdvised mother remain with pt until ambulance arrival.\nAdvised pt to take available antihistamine immediately while awaiting ambulance.\nAdvised pt to contact service after hospital attendance; may need review regarding emergency injections.","review":79.05263157894737,"saved":200.44736842105263,"clean":false,"effort":7.6923076923076925,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during a suspected anaphylaxis suggests circulatory compromise, a key severity feature; omitted entirely."]]},{"label":"Run 2","wer":14.535345512311359,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was— it wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird just in a— in a corner sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention, uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, piritin, any of those kind of things?\n\n  Um, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was like 6 or something. I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, my God. Oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  No, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hmm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hmm.\n\n  Okay. Right. So is there any— anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay?\n\n  Mm-hmm.\n\n  And I'll probably just— somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Oh, okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 99999, yeah?\n\n  Mm-hmm.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital. Do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Mm-hmm. Yes. Yes. Will do. Yes.\n\n  Okay.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye-bye.\n\n  Bye-bye.","marks":[{"start":17,"end":20,"said":"","significant":false},{"start":305,"end":321,"said":"Trabalotsa. OK day","significant":false},{"start":361,"end":364,"said":"first","significant":false},{"start":376,"end":389,"said":"ninety-nine. OK","significant":true},{"start":440,"end":463,"said":"M Traba at Gmail dot com. 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Oh. You","significant":false},{"start":4726,"end":4744,"said":"Ohh I feel a little dizzy","significant":true},{"start":4769,"end":4769,"said":"ohh. Are","significant":false},{"start":4777,"end":4802,"said":". You're feeling dizzy. OK","significant":true},{"start":5192,"end":5199,"said":"","significant":false},{"start":5311,"end":5316,"said":"mum's.","significant":false},{"start":5342,"end":5345,"said":"mum","significant":false},{"start":5385,"end":5401,"said":"OK all","significant":false},{"start":5506,"end":5517,"said":"yeah. Ohh no","significant":false},{"start":5545,"end":5546,"said":"I'll","significant":false},{"start":5606,"end":5622,"said":"OK","significant":false},{"start":5630,"end":5643,"said":". Hey ohh somebody","significant":false},{"start":5648,"end":5648,"said":"came","significant":false},{"start":5689,"end":5697,"said":"any more. Thank.","significant":false},{"start":6067,"end":6075,"said":"Mum Mum","significant":false},{"start":6134,"end":6146,"said":"K.","significant":false},{"start":6184,"end":6187,"said":"mum","significant":false},{"start":6198,"end":6201,"said":"Mum","significant":false},{"start":6228,"end":6233,"said":"nine nine nine nine nine","significant":false},{"start":6244,"end":6251,"said":"","significant":false},{"start":6268,"end":6274,"said":"your","significant":false},{"start":6356,"end":6360,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6398,"end":6398,"said":"All","significant":false},{"start":6481,"end":6492,"said":"OK OK. Yes thank .","significant":false},{"start":6500,"end":6506,"said":"after","significant":false},{"start":6516,"end":6518,"said":"out","significant":false},{"start":6644,"end":6660,"said":"OK","significant":false},{"start":6703,"end":6715,"said":". All . OK","significant":false},{"start":6760,"end":6768,"said":"thank","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after eating prawn laksa\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"onset approx. 30 min post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling \"reportedly enlarging\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing; unsure whether chest tightness present\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode ~1 year ago after ... Chinese meal/curry\" with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"PMH: asthma; uses salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Known peanut allergy ...; hospital attendance for severe allergic reaction at ~6 years old\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Advised urgent ambulance attendance\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived, asked to call emergency services and stay with patient."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact service after hospital attendance regarding need for emergency allergy injections\"."]],"claims":[],"note":"Subjective\nReports upper lip swelling after eating prawn laksa at ~19:00.\nLip symptoms began at left corner of mouth, onset approx. 30 min post-ingestion; swelling reportedly enlarging.\nReports difficulty breathing; unsure whether chest tightness present.\nSimilar episode ~1 year ago after eating an unspecified late-night Chinese meal/curry: woke with swelling, felt unwell and had difficulty breathing.\nPMH: asthma; uses salbutamol inhaler regularly. No other inhaler reported.\nKnown peanut allergy since childhood; reports hospital attendance for severe allergic reaction at ~6 years old, per mother.\nUnsure which antihistamines previously used for peanut allergy; no antihistamine initially available.\nInitially alone; mother arrived during call and confirmed antihistamines available.\nObjective\nNo physical examination or observations documented.\nPatient reported progressive upper-lip swelling and breathing difficulty during consultation.\nAssessment\nSuspected anaphylactic reaction following prawn ingestion.\nProgressive lip swelling with reported respiratory difficulty shortly after likely food exposure, with background of peanut allergy, prior severe allergic reaction and asthma, raises concern for anaphylaxis.\nPlan\nAdvised urgent ambulance attendance/emergency assessment.\nMother asked to call emergency services and state suspected anaphylactic reaction.\nAdvised to take available antihistamine while awaiting ambulance.\nAdvised not to remain alone; mother to stay with patient until ambulance arrival.\nAdvised to contact service after hospital attendance regarding need for emergency allergy injections.","review":81.57894736842105,"saved":197.92105263157896,"clean":false,"effort":7.6923076923076925,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."]],"mb":10.2996,"latency":14.452,"signable":96.03094736842105},{"label":"Run 3","wer":13.97934868943606,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Rania.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So, just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please.\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think— I don't think it was. It wasn't a sandwich, but it was— it was something with prawns. So basically, I— I sometimes go with my friends to— to this place called Fat Fat, and we— we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hmm.\n\n  Um, so what happened was I— I ordered a prawn soup. It's— it's— it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— like, my lips started feeling a little weird just in the— in the corners sort of on the left first.\n\n  Mm-hmm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. It wasn't really paying attention. Uh, now I feel the— that there is a swelling.\n\n  Yeah.\n\n  There is like a swelling on my— on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7:00.\n\n  Okay. Around 7:00. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know, half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— it's— I still feel it like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. Um, so you mentioned about your swelling of your lips. Is there any feeling of swelling in— in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I— I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like— like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell— I— I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  Um, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah. When I was like 6 or something, I— I— I think, oh, sorry, the swelling is getting—\n\n  Okay.\n\n  Oh, I know. Oh, yeah, I think when I was—\n\n  You're right. Are you okay now?\n\n  Uh, I'm a little dizzy right now, to be honest.\n\n  Do you feel dizzy? Okay.\n\n  Yeah.\n\n  Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  Um, no, I don't think I have. No.\n\n  Okay. Right. Okay. So right. Oh, all right. I— I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in. And you might need an injection, like what your mom's— you know, what your mom told you as you were a young child.\n\n  Yeah.\n\n  Okay. Right. So is there any— anyone with you at the moment? Or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay? And if anybody just came— somebody just came, yes. I'm not alone anymore.\n\n  All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Yeah.\n\n  While we're waiting.\n\n  Yes. Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Get that straight away. And if mom can call, mom, if you can call the 9999, yeah?\n\n  Okay.\n\n  And say that you're— there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes.\n\n  Yes. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And if you come up from the hospital, do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":31,"end":33,"said":"","significant":false},{"start":39,"end":45,"said":"Maria.","significant":true},{"start":306,"end":322,"said":"Trabalotsa. OK day","significant":false},{"start":362,"end":365,"said":"first","significant":false},{"start":377,"end":390,"said":"ninety-nine. OK","significant":true},{"start":441,"end":464,"said":"M Traba at Gmail dot com. 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No other inhaler reported.\nKnown peanut allergy; intermittently uses antihistamines, type unknown.\nReports possible childhood severe allergic reaction requiring injection/hospital attendance; details unclear.\nInitially alone; mother arrived during call. No antihistamines initially available, then mother confirmed availability.\nObjective\nNo physical examination or observations documented.\nDuring consultation, pt reported progressive lip swelling, dyspnoea and dizziness.\nAssessment\nSuspected anaphylactic reaction following prawn ingestion.\nProgressive lip swelling with reported breathing difficulty, possible chest tightness and dizziness, in context of food allergy history and prior similar reaction, raises concern for airway/respiratory involvement.\nPlan\nAdvised urgent ambulance attendance/emergency assessment.\nMother instructed to call emergency services and report suspected anaphylactic reaction.\nAdvised pt to take available antihistamine while awaiting ambulance.\nAdvised mother to remain with pt until ambulance arrival.\nAdvised to contact service after hospital assessment to discuss provision of injections if required.","review":64.42105263157895,"saved":215.07894736842104,"clean":true,"effort":0.0,"sig":[],"mb":10.299203,"latency":15.534,"signable":79.95505263157895},{"label":"Run 4","wer":15.409054805401112,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon.\n\n  Mm-hm.\n\n  How are you doing?\n\n  I'm all right, thank you.\n\n  I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza.\n\n  Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please?\n\n  Yes.\n\n  mtraba@gmail.com.\n\n  Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is—well, I don't think—I don't think it was—it wasn't a sandwich, but it was—it was something with prawns. So basically, I—I sometimes go with my friends to—to this place called Fat Pub, and we—we regularly have, like, usually I have, like, a normal vegetarian soup or something, and yeah, and then I wanted to try something new.\n\n  Mm-hm.\n\n  Um, so what happened was I—I ordered a prawn soup. It's—it's—it's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel start—like, my lips start feeling a little weird, just in the—in the corner sort of on the left first.\n\n  Mm-hm.\n\n  And then I don't know, and then we went back, we had a little bit of a chat, a banter. I wasn't really paying attention.\n\n  Mm-hm.\n\n  Uh, now I feel the—that there is a swelling.\n\n  Yeah.\n\n  There is, like, a swelling on my—on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was—that must have been just after work, so maybe, like, around 7:00.\n\n  Okay. Around 7 o'clock. And, um, how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe.\n\n  Okay. In half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's—it's—it's—I still feel it, like, really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions.\n\n  Mm-hm.\n\n  Um, so you mentioned about you swelling of your lips. Is there any feeling of swelling in—in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I—I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like—like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few—have you ever had these—any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember, like, a year ago, a year ago I was out with my friends.\n\n  Mm-hm.\n\n  And I think we went, like, to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after, like, having that very late I woke up the next morning quite swollen up and had also, like.\n\n  Okay.\n\n  Felt really bad and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. Uh, and what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I tell—I—I take—uh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Uh, no, I don't think so. No.\n\n  Okay. Right. And, um, so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point because you've had peanut allergy, any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah, exactly. Well, I was, like, six or something. I—I—I think after I had swelling is getting—ugh, ugh. Yeah, I think when I was.\n\n  All right. Are you okay now?\n\n  Uh, yeah, I'm busy right now, to be honest.\n\n  You feel busy? Okay. Right. Do you have any kind of, uh, antihistamines with you at the moment?\n\n  Mm, no, I don't think I have. No.\n\n  Okay. Right. Okay. So.\n\n  Inhaler.\n\n  Right. Oh, all right. I—I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction.\n\n  Mm-hm.\n\n  That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child.\n\n  Mm-hm.\n\n  Okay. Right. So is there any—anyone with you at the moment, or are you alone?\n\n  I'm alone at the moment.\n\n  Okay.\n\n  Um, so hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay? And I'll.\n\n  Okay.\n\n  Tell them what you just said. Somebody just came, yes. I'm not alone anymore.\n\n  All right.\n\n  Um, okay, somebody just came. So just call the am-ambulance. Make sure that person's with you till the ambulance comes, yeah? Um, and because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes.\n\n  Uh, mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the, uh, 99999, yeah?\n\n  Mm-hm.\n\n  And say that you're there is a suspected anaphylactic reaction and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And if you come up from the hospital, do you give us a ring back? We might need to sort you out, um, with your injections and things like that. Okay?\n\n  Yes. Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then.\n\n  Okay.\n\n  Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye.\n\n  Bye-bye.","marks":[{"start":91,"end":97,"said":"","significant":false},{"start":314,"end":333,"said":"Trabalotsa. OK day","significant":false},{"start":373,"end":376,"said":"first","significant":false},{"start":388,"end":401,"said":"ninety-nine. OK","significant":true},{"start":452,"end":478,"said":"M Traba at Gmail dot com. 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OK","significant":false},{"start":6780,"end":6788,"said":"thank","significant":false},{"start":6808,"end":6816,"said":"Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","partial","Prawn exposure captured, but named 'prawn laksa' where the transcript's dish name is unintelligible."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'progressive upper-lip swelling within ~30 min'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'swelling continuing to enlarge'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing; unsure if chest tightness present.'"],["The note captures: Patient becomes dizzy during the consultation.","no","The patient's dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode ~1 year ago after Chinese food with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'asthma; uses salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Longstanding peanut allergy and possible childhood severe reaction requiring hospital/injection."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction'; emergency ambulance advised."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Advised emergency ambulance attendance urgently'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Remain with mother; 'Mother advised to contact emergency services'."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised immediate antihistamine use while awaiting ambulance'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'contact service after discharge regarding possible injection provision'."]],"claims":[],"note":"Subjective\nAfter prawn laksa at ~19:00, developed abnormal sensation at L lip corner followed by progressive upper-lip swelling within ~30 min.\nReports swelling continuing to enlarge; describes pulsating sensation.\nReports difficulty breathing; unsure if chest tightness present.\nSimilar episode ~1 year ago after eating an unspecified curry/Chinese food: woke with swelling, felt unwell and had breathing difficulty.\nPMH: asthma; uses salbutamol inhaler. Reports longstanding peanut allergy.\nReports possible childhood severe allergic reaction requiring hospital attendance/injection; details unclear.\nNo antihistamine initially available. Mother subsequently present and confirmed antihistamine available.\nObjective\nRemote consultation; no physical examination or vital signs documented.\nAssessment\nSuspected anaphylactic reaction following prawn-containing food, based on rapid-onset progressive lip swelling with reported dyspnoea after ingestion.\nIncreased concern given reported previous food-associated swelling/breathing difficulty, peanut allergy and asthma.\nPlan\nAdvised emergency ambulance attendance urgently for suspected anaphylaxis.\nAdvised patient remain with accompanying person/mother while awaiting ambulance.\nMother advised to contact emergency services and report suspected anaphylactic reaction.\nAdvised immediate antihistamine use while awaiting ambulance, if available.\nAdvised hospital assessment; patient to contact service after discharge regarding possible injection provision.","review":85.86842105263158,"saved":193.63157894736844,"clean":false,"effort":11.538461538461538,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call, a sign of systemic/cardiovascular involvement in anaphylaxis, is omitted."]],"mb":10.359148,"latency":23.48,"signable":109.34842105263158},{"label":"Run 5","wer":17.156473391580622,"text":"Hi.\n\n  Hello.\n\n  Hi.\n\n  Hi—\n\n  Hi, I'm Maria.\n\n  Hello, I'm Dr. Jacob, and welcome to Babylon. How are you doing?\n\n  I'm all right, thank you. I feel a little weird today, to be honest.\n\n  Yeah. So just before we start, is it all right if you could confirm your full name for me, please?\n\n  Yes.\n\n  Maria Trabaloza. Okay. And your date of birth?\n\n  That is the 1st of October 199.\n\n  Okay. And your email address for me, please.\n\n  Yes.\n\n  mtraba@gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation.\n\n  Yes, I think I am, yeah.\n\n  Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\n\n  Yeah, that is— well, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have— usually I have a normal vegetarian soup or something, and yeah, and then I wanted to try something new. So what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time.\n\n  Yep.\n\n  And yeah, and then my feel started— my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know, and then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention. Now I feel that there is a swelling.\n\n  Yeah.\n\n  There is like a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do.\n\n  All right. So when did you have the prawn soup? What time?\n\n  That was— that must have been just after work, so maybe like around 7.\n\n  Okay. Around 7 o'clock. And how long did it take to develop the swelling?\n\n  Well, I wasn't really paying attention, so it must have been like— must have been like— I don't know— half an hour maybe.\n\n  Okay, in half an hour you developed the swelling, yeah?\n\n  Yeah.\n\n  Okay. And it's getting bigger and bigger?\n\n  Yeah, it's— you still feel it like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\n\n  Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\n\n  Yeah, actually, I feel like I can't breathe that well right now.\n\n  Okay. And do you feel like your chest is tight?\n\n  I don't know if it's the chest. It's just generally it feels a little difficult.\n\n  Okay.\n\n  But yeah, it might be. I'm not sure.\n\n  Okay. Right. And just a few— have you ever had these— any kind of lip swelling in the past?\n\n  No.\n\n  After eating any food?\n\n  Yeah. Well, maybe. I remember like a year ago— a year ago I was out with my friends.\n\n  Mm-hmm.\n\n  And I think we went like to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\n\n  Sure. Okay.\n\n  And I remember that after like having that very late I woke up the next morning quite swollen up and had also like—\n\n  Okay.\n\n  —felt really bad, and quite difficult breathing.\n\n  Right.\n\n  But I don't know what it was I had. It was like a curry or something, I think.\n\n  Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n\n  Well, I generally have asthma, so I take— oh, what's it called? Salbutamol inhalers?\n\n  Yeah.\n\n  Yeah. So I do take that regularly, but I've always taken it. I generally have asthma.\n\n  And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\n  Oh, no, I don't think so. No.\n\n  Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Piriton, any of those kind of things?\n\n  No. Well, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\n\n  Yeah.\n\n  Like, I've always had it.\n\n  Yeah.\n\n  And I think I do get antihistamines for that, but I'm not sure which ones.\n\n  And any point— because you've had peanut allergy— any time you had to ever use like an injection?\n\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n\n  Yeah. Well, I was like 6 or something. I think after I had swelling is getting— oh, yeah, I think when I was—\n\n  All right. Are you okay now?\n\n  I feel a little dizzy right now, to be honest.\n\n  You feel dizzy. Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\n  No. I don't think I have.\n\n  Okay. Right. Okay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's— what your mom told you as you were a young child. Right? So is there anyone with you at the moment? Or are you alone?\n\n  I'm alone at the moment.\n\n  Okay. So hang on the line while I call the ambulance, okay? And I'll send them right to you. Okay?\n\n  Okay.\n\n  And if somebody just came— somebody just came, yes. I'm not alone anymore.\n\n  Okay.\n\n  All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes.\n\n  Okay.\n\n  Yeah? And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\n\n  Okay.\n\n  While we're waiting.\n\n  Yes. Mom, mom, do we have any antihistamines around?\n\n  Yes.\n\n  Yes.\n\n  Oh, yeah, we do.\n\n  Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\n\n  Okay.\n\n  And say that there is a suspected anaphylactic reaction, and they need to come straight away. Okay?\n\n  Yes, she said she will. Yes. Yes.\n\n  Right. So straight away take the antihistamines in the meantime. All right?\n\n  Okay. Okay.\n\n  And ask if you come up from the hospital— do you give us a ring back? We might need to sort you out with your injections and things like that.\n\n  Okay.\n\n  Okay?\n\n  Yes. Will do. Yes.\n\n  All right.\n\n  Thank you.\n\n  Okay then. Take care.\n\n  Thank you very much.\n\n  Bye-bye.\n\n  Bye.\n\n  Bye-bye.\n\n  Bye-bye.","marks":[{"start":17,"end":20,"said":"","significant":false},{"start":305,"end":321,"said":"Trabalotsa. OK day","significant":false},{"start":361,"end":364,"said":"first","significant":false},{"start":376,"end":389,"said":"ninety-nine. 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Thank.","significant":false},{"start":5741,"end":5749,"said":"uh Mum Mum","significant":false},{"start":5808,"end":5820,"said":"K.","significant":false},{"start":5858,"end":5861,"said":"mum","significant":false},{"start":5872,"end":5875,"said":"Mum","significant":false},{"start":5897,"end":5901,"said":"uh nine nine nine nine nine","significant":false},{"start":5933,"end":5933,"said":"your","significant":false},{"start":6015,"end":6019,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6057,"end":6057,"said":"All","significant":false},{"start":6140,"end":6151,"said":"OK OK. Yes thank .","significant":false},{"start":6159,"end":6165,"said":"after","significant":false},{"start":6175,"end":6177,"said":"out","significant":false},{"start":6341,"end":6351,"said":"","significant":false},{"start":6361,"end":6373,"said":". All . OK","significant":false},{"start":6418,"end":6426,"said":"thank","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","partial","Prawn exposure captured, but named 'prawn laksa' where the transcript's dish name is unintelligible."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'upper lip swelling developed within ~30 min'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'progressively enlarging/pulsatile'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports dyspnoea, possible chest tightness'."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the call documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode ~1 year ago after Chinese meal with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'asthma; uses salbutamol inhaler regularly'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with possible childhood severe reaction requiring hospital/injection."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction'; urgent ambulance advised."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Advised urgent ambulance attendance via 999'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and to remain with patient, but her being asked to call emergency services is not documented."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take available antihistamine while awaiting ambulance.'"],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Advised to contact service after hospital assessment regarding need for injections.'"]],"claims":[],"note":"Subjective\nAcute upper lip swelling after prawn laksa at ~19:00.\nLip tingling began at L corner of mouth; upper lip swelling developed within ~30 min and is progressively enlarging/pulsatile.\nReports dyspnoea, possible chest tightness, and dizziness.\nPrior similar episode ~1 year ago after late-night Chinese meal/curry: woke with swelling, felt unwell and had difficulty breathing.\nPMH: asthma; uses salbutamol inhaler regularly. Reports peanut allergy since childhood.\nPossible childhood severe allergic reaction requiring hospital attendance/injection; details unclear.\nNo antihistamine available initially. Mother subsequently present and confirmed antihistamines available.\nObjective\nNo physical examination or observations documented; remote consultation.\nDuring call, pt reported worsening lip swelling, breathing difficulty and dizziness.\nAssessment\nSuspected anaphylactic reaction following prawn-containing meal.\nProgressive lip angioedema with reported dyspnoea/possible chest tightness and dizziness shortly after food exposure is concerning for evolving anaphylaxis.\nBackground asthma, peanut allergy and prior possible severe food-related reaction increase concern.\nPlan\nAdvised urgent ambulance attendance via 999 for suspected anaphylaxis.\nMother to remain with pt until ambulance arrival.\nAdvised to take available antihistamine while awaiting ambulance.\nAdvised to contact service after hospital assessment regarding need for injections.","review":88.0,"saved":191.5,"clean":false,"effort":7.6923076923076925,"sig":[],"mb":10.267532,"latency":13.493,"signable":101.493}],"heidi":[{"label":"Run 1","wer":14.058776806989675,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fed Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxatives. It's like a soup. I ordered a prawn one this time. Yeah. And, yeah, and then my feel stuff like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat of Bento. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nAnd a half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a lot difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take oh, what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nOh, no. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? No. No. I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, I thought oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So right. Al- all right. I'm really a bit worried about you at the moment, Maria. Um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, yeah. So hang on the light while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yes. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":274,"end":296,"said":"Trabalotsa. OK day","significant":false},{"start":351,"end":369,"said":"ninety-nine. OK","significant":false},{"start":414,"end":420,"said":"M Traba","significant":false},{"start":424,"end":440,"said":"Gmail dot com. 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Do that","significant":false},{"start":5780,"end":5783,"said":"mum","significant":false},{"start":5793,"end":5796,"said":"Mum","significant":false},{"start":5948,"end":5952,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5987,"end":5987,"said":"All right","significant":false},{"start":6047,"end":6067,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6072,"end":6076,"said":"","significant":false},{"start":6092,"end":6094,"said":"out","significant":false},{"start":6227,"end":6231,"said":"will","significant":false},{"start":6241,"end":6254,"said":"thank . All . OK","significant":false},{"start":6293,"end":6293,"said":"thank","significant":false},{"start":6312,"end":6312,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn laksa\"; prawn soup captured."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling began ... within 30 mins\"."],["The note captures: Upper lip swelling is progressively worsening.","partial","Progressive worsening captured, but swelling is placed at the \"left corner of mouth\"; the upper lip is not specified."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness recorded as \"a little busy\"; dizziness is not captured."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"similar lip swelling ~1 year ago after curry at Chinese restaurant, with difficult breathing\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Asthma: regular salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy plus \"childhood injection for severe allergic reaction (~age 6), per mother\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\" with urgent ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance called for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother told to call emergency services, but the number is wrong (000 vs 999) and staying with the patient is not recorded."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately if available\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after hospital discharge to discuss injections\"."]],"claims":[["Reports ... general chest tightness","Patient said she was unsure whether it was her chest (\"it might be, I'm not sure\"); stated as definite."],["Mother instructed to call emergency services (000)","Transcript specifies \"nine nine nine\"; 000 is a wrong number."]],"note":"Subjective\n\n- Reports feeling unwell today\n\n- Identity confirmed: Maria Travaloza, DOB 01/10/1999, email mtrava@gmail.com\n\n- Lip swelling after consuming prawn laksa at Fed Park ~7 PM\n\n- Swelling began at left corner of mouth within 30 mins, progressively worsening, pulsatile\n\n- Reports difficulty breathing and general chest tightness\n\n- PMHx: similar lip swelling ~1 year ago after curry at Chinese restaurant, with difficult breathing and waking swollen\n\n- Asthma: regular salbutamol inhaler; no other inhalers\n\n- Allergies: known peanut allergy\n\n- Not currently on antihistamines; believes taken in past for peanut allergy\n\n- Recalls childhood injection for severe allergic reaction (~age 6), per mother\n\n- Currently alone; feeling \"a little busy\"\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan\n\n- Urgent ambulance called for suspected anaphylaxis\n\n- Advised to take antihistamines immediately if available\n\n- Mother instructed to call emergency services (000) and report suspected anaphylactic reaction\n\n- Follow-up after hospital discharge to discuss injections and further management","review":111.0,"saved":168.5,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness mis-transcribed as 'busy', losing a systemic anaphylaxis sign."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency action recorded with the wrong number (000 instead of 999), misstating the escalation given."]],"mb":39.629048,"latency":25.55,"signable":136.55},{"label":"Run 2","wer":14.455917394757744,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with prawn. So, basically, I I sometimes go with my friends to to this place called Fet Park.\n\nAnd we we regularly have like, usually I have like a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I'm not sure what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nOh, no. No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? No. Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, I know. Oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No, right. Okay. So- Right. All, all right. I, I am really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Mm-hmm. Right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, no. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah we do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah. And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":274,"end":296,"said":"Trabalotsa. OK day","significant":false},{"start":351,"end":369,"said":"ninety-nine. OK","significant":false},{"start":414,"end":420,"said":"M Traba","significant":false},{"start":424,"end":440,"said":"Gmail dot com. 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All right OK","significant":false},{"start":5704,"end":5712,"said":"uh Mum Mum","significant":false},{"start":5763,"end":5780,"said":"K.","significant":false},{"start":5807,"end":5810,"said":"mum","significant":false},{"start":5820,"end":5823,"said":"Mum","significant":false},{"start":5975,"end":5979,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6014,"end":6014,"said":"All right","significant":false},{"start":6074,"end":6094,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6099,"end":6103,"said":"","significant":false},{"start":6119,"end":6121,"said":"out","significant":false},{"start":6254,"end":6258,"said":"will","significant":false},{"start":6268,"end":6281,"said":"thank . All . OK","significant":false},{"start":6320,"end":6320,"said":"thank","significant":false},{"start":6339,"end":6339,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"~30 min post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressively worsening\" upper lip swelling."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Difficulty breathing\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"~1 year ago after curry at Chinese restaurant ... swollen with difficulty breathing\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma (salbutamol inhaler)\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"severe allergic reaction ~age 6 requiring hospitalisation, ?injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\" with ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Ambulance called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arriving and being instructed to call captured, but the number is given as \"000\" instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact clinic after hospital discharge to discuss adrenaline auto-injector\"."]],"claims":[["mother instructed to call 000","Transcript says to call \"nine nine nine\"; 000 is a wrong emergency number."]],"note":"Subjective:\n\n- Feeling \"a little weird\" today\n\n- Lip swelling after consuming prawn soup (laksa) at Fet Park, ~7 pm\n\n- Swelling initially left corner of upper lip, ~30 min post-ingestion, progressively worsening, \"pumping blood\"\n\n- Difficulty breathing, general discomfort\n\n- Similar episode ~1 year ago after curry at Chinese restaurant (alcohol involved) - woke next morning swollen with difficulty breathing\n\n- PMHx: asthma (salbutamol inhaler); peanut allergy (antihistamines)\n\n- Hx severe allergic reaction ~age 6 requiring hospitalisation, ?injection (per mother)\n\n- No antihistamines on hand at time of consult\n\n- Initially alone, mother arrived during consult\n\n\n\n\nObjective:\n\n- Telehealth consultation\n\n- Reports progressive lip swelling and breathing difficulty\n\n\n\n\nAssessment:\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan:\n\n- Advised to take antihistamines immediately\n\n- Ambulance called; mother instructed to call 000, report suspected anaphylaxis\n\n- Advised to remain with mother until ambulance arrives\n\n- Advised to contact clinic after hospital discharge to discuss adrenaline auto-injector and further management","review":86.02631578947368,"saved":193.4736842105263,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."]],"mb":35.987198,"latency":24.819,"signable":110.84531578947369},{"label":"Run 3","wer":14.138204924543288,"text":"Hi. Hello? Hi. Hi.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtraba at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fet Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a dental. It wasn't really\n\nPaying attention. And now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting oh, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. Oh, right. Okay. So- Right. Oh, all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any- anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, yeah. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And I'll Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes. Mom mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah. And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And after you come up from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":274,"end":296,"said":"Trabalotsa. OK day","significant":false},{"start":351,"end":369,"said":"ninety-nine. OK","significant":false},{"start":414,"end":420,"said":"M Traba","significant":false},{"start":424,"end":440,"said":"Gmail dot com. 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All right OK","significant":false},{"start":5691,"end":5697,"said":"we're","significant":false},{"start":5712,"end":5719,"said":"uh Mum Mum","significant":false},{"start":5770,"end":5788,"said":"K.","significant":false},{"start":5820,"end":5823,"said":"mum","significant":false},{"start":5833,"end":5836,"said":"Mum","significant":false},{"start":5988,"end":5992,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6022,"end":6022,"said":"yes. All right","significant":false},{"start":6082,"end":6102,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6122,"end":6124,"said":"out","significant":false},{"start":6257,"end":6261,"said":"will","significant":false},{"start":6271,"end":6284,"said":"thank . All . OK","significant":false},{"start":6323,"end":6323,"said":"thank","significant":false},{"start":6342,"end":6342,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after consuming prawn soup'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'~30 mins post-ingestion'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'left corner of upper lip... progressively worsening'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","partial","Difficulty breathing recorded, but chest tightness wrongly stated as denied."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Similar reaction ~1yr ago after Chinese food... swelling and difficulty breathing'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Asthma - managed with salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Peanut allergy' and 'Childhood (~6yo) hospitalisation for severe allergic reaction'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction' with urgent ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Ambulance called for urgent transfer'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and staying with someone recorded, but 000 given instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take antihistamines immediately'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after discharge 'including discussion of adrenaline auto-injector'."]],"claims":[["denies chest tightness","Patient said chest tightness 'might be, I'm not sure'; she did not deny it."],["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."]],"note":"Subjective:\n\n- Lip swelling and difficulty breathing after consuming prawn soup (laksa) ~19:00\n\n- Swelling began in left corner of upper lip ~30 mins post-ingestion, progressively worsening\n\n- Reports sensation of blood pumping in lip\n\n- Difficulty breathing, generally difficult; denies chest tightness\n\n- No antihistamines available at time of call\n\n- Initially alone; mother arrived during consultation\n\n\n\n\nPast Medical History:\n\n- Asthma - managed with salbutamol inhaler regularly\n\n- Peanut allergy\n\n- Childhood (~6yo) hospitalisation for severe allergic reaction (per mother)\n\n- Similar reaction ~1yr ago after Chinese food (curry-like dish) while intoxicated - swelling and difficulty breathing next morning; no antihistamines taken\n\n\n\n\nMedications:\n\n- Salbutamol inhaler\n\n- Antihistamines for peanut allergy (type unknown)\n\n\n\n\nAllergies:\n\n- Peanuts\n\n- Possible prawn/shellfish allergy\n\n\n\n\nObjective:\n\n- Telehealth consultation\n\n- Reports worsening lip swelling and difficulty breathing\n\n\n\n\nAssessment:\n\n- Suspected anaphylactic reaction\n\n\n\n\nPlan:\n\n- Ambulance called for urgent transfer to hospital\n\n- Advised to take antihistamines immediately\n\n- Mother advised to call 000 and report suspected anaphylactic reaction\n\n- Advised to remain with someone until ambulance arrives\n\n- Follow up after hospital discharge for allergy management, including discussion of adrenaline auto-injector","review":123.86842105263158,"saved":155.63157894736844,"clean":false,"effort":30.76923076923077,"sig":[["partial","Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","Chest tightness recorded as denied when patient said it might be present."],["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999."]],"mb":35.726166,"latency":29.793,"signable":153.66142105263157},{"label":"Run 4","wer":14.297061159650518,"text":"Hi. Hello? Hi. Hi, I'm Maria.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety-nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location, and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your, in, in your patient notes that you're having some, uh, sort of lip swelling, and you-- after you had a sandwich? Is that correct? Yeah, that is... Well, I don't think, I don't think it was, it, it wasn't a sandwich, but it was, it was something with crawl. So basically, I, I sometimes go with my friends to, to this place called Fet Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxator. It's like a soup. I ordered a prawn one this time. Yeah. And yeah. And then my feel stuff like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work. So maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if with the test. It's just generally feels a lot difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to a late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something, I think. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any point, because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I've been to doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting oh, I know. Oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So right. Al- all right. I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Um, right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, so hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She says she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll after you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":285,"end":307,"said":"Trabalotsa. OK day","significant":false},{"start":425,"end":431,"said":"M Traba","significant":false},{"start":435,"end":451,"said":"Gmail dot com. 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All right OK","significant":false},{"start":5737,"end":5745,"said":"uh Mum Mum","significant":false},{"start":5796,"end":5814,"said":"K.","significant":false},{"start":5841,"end":5844,"said":"mum","significant":false},{"start":5854,"end":5857,"said":"Mum","significant":false},{"start":6009,"end":6013,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6024,"end":6028,"said":"said","significant":false},{"start":6048,"end":6048,"said":"All right","significant":false},{"start":6108,"end":6128,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6133,"end":6137,"said":"","significant":false},{"start":6289,"end":6293,"said":"will","significant":false},{"start":6303,"end":6316,"said":"thank . All . OK","significant":false},{"start":6355,"end":6355,"said":"thank","significant":false},{"start":6374,"end":6374,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after consuming prawn soup'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'Onset ~30 mins post prawn soup ingestion (~7pm)'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'Swelling progressive, currently affecting upper lip... worsening'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing'."],["The note captures: Patient becomes dizzy during the consultation.","no","Records feeling 'busy' instead of dizzy; dizziness not captured."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'previous similar reaction ~1 year ago (swelling and difficulty breathing after curry...)'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma in background and salbutamol use recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'known peanut allergy' and 'hospital admission age 6 for severe allergic reaction'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction' with immediate ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Ambulance called for immediate transfer to hospital'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and staying with her recorded, but told to call 000 rather than 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised to take antihistamines immediately; mother confirmed availability'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after discharge 'including potential adrenaline auto-injector prescription'."]],"claims":[["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."],["Chest tightness reported as present","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; tightness was not confirmed."]],"note":"Subjective\n\n\n\n\n- Left-sided lip swelling after consuming prawn soup (Laksa) ~30 mins prior\n\n- Swelling progressive, currently affecting upper lip, feels like \"pumping blood,\" worsening\n\n- Reports difficulty breathing and chest tightness\n\n- Onset ~30 mins post prawn soup ingestion (~7pm)\n\n\n\n\nObjective\n\n\n\n\n- Telehealth consultation; no physical examination performed\n\n- Reports feeling \"busy\" during consult\n\n- Initially alone; mother arrived during consult\n\n\n\n\nAssessment\n\n\n\n\n- Suspected anaphylactic reaction given acute onset lip swelling, difficulty breathing and chest tightness following prawn ingestion\n\n- Background: known peanut allergy, asthma, previous similar reaction ~1 year ago (swelling and difficulty breathing after curry, used salbutamol), hospital admission age 6 for severe allergic reaction\n\n\n\n\nPlan\n\n\n\n\n- Ambulance called for immediate transfer to hospital\n\n- Advised mother to call 000\n\n- Advised to take antihistamines immediately; mother confirmed availability\n\n- Advised to remain with mother until ambulance arrives\n\n- Advised to contact clinic for follow-up re allergy management, including potential adrenaline auto-injector prescription, after hospital discharge","review":100.23684210526315,"saved":179.26315789473685,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis replaced by 'busy'; red-flag symptom lost."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999."]],"mb":35.519823,"latency":25.474,"signable":125.71084210526315},{"label":"Run 5","wer":13.820492454328834,"text":"Hi. Hello? Hi. Hi. I'm Maria.\n\nHello, I'm Dr. Jacob, and welcome to Babylon. How are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we, we start, is it all right if you could confirm your full name for me, please? Yes, Maria Travaloza. Okay. Date- and your date of birth?\n\nThat is the first of October ninety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fed Park.\n\nAnd we we regularly have like, usually I have, like, a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxator. It's like a soup. I ordered a prawn one this time. Yep. And, yeah, and then my feels like, my lids started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back. We had a little bit of a chat event, and I wasn't really\n\nPaying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work. So maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nI don't know, half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping blood, and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the chest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No kidding. Right. And, um, so do you use antihistamines like, like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you've had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I've changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. No. Right. Okay. So- Right. Al- all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an, anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right. So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Oh, no. So hang on the line while I'll call the ambulance. Okay? And I'll send them right to you. Okay? And somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine\n\nNine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction, and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. And I'll come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care. Thank you very much. Bye bye. Bye. Bye.","marks":[{"start":285,"end":307,"said":"Trabalotsa. OK day","significant":false},{"start":362,"end":380,"said":"ninety-nine. OK","significant":false},{"start":425,"end":431,"said":"M Traba","significant":false},{"start":435,"end":451,"said":"Gmail dot com. 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All right OK","significant":false},{"start":5719,"end":5727,"said":"uh Mum Mum","significant":false},{"start":5777,"end":5795,"said":"K.","significant":false},{"start":5822,"end":5825,"said":"mum","significant":false},{"start":5835,"end":5838,"said":"Mum","significant":false},{"start":5992,"end":5996,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6032,"end":6036,"said":"All right","significant":false},{"start":6095,"end":6115,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6120,"end":6124,"said":"after you","significant":false},{"start":6130,"end":6132,"said":"out","significant":false},{"start":6265,"end":6269,"said":"will","significant":false},{"start":6279,"end":6292,"said":"thank . All . OK","significant":false},{"start":6330,"end":6330,"said":"thank","significant":false},{"start":6349,"end":6349,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Lip swelling following consumption of prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"~30 mins after eating\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Began left corner of upper lip, \"progressively worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Difficulty breathing; general tightness, possibly in chest."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Previous lip swelling ~1 year ago after curry at Chinese restaurant with difficult breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Asthma: uses Salbutamol inhalers regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Severe childhood reaction (~6yo) requiring hospitalisation."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; ambulance called."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Ambulance called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Another person arriving and being told to call is captured, but not that it was the mother or that she should stay; number given as 000 instead of 999."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately if available\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up required regarding EpiPen prescription\"."]],"claims":[["prawn soup (laxator)","The dish name is blank in the transcript (\"it's called it's like a soup\"); no dish name is stated, so this fills in missing speech."],["Advised to have person present call 000","Clinician said to call \"nine nine nine\"; 000 is never mentioned."]],"note":"Subjective\n\n\n\n\n- Reports feeling unwell today.\n\n- Lip swelling following consumption of prawn soup (laxator) at approx 7 PM.\n\n- Swelling began at left corner of upper lip ~30 mins after eating, progressively worsening.\n\n- Describes sensation of lip \"pumping blood.\"\n\n- Difficulty breathing.\n\n- General feeling of tightness, possibly in chest.\n\n- Initially alone; another person arrived during consult.\n\n\n\n\nPast Medical History\n\n\n\n\n- Asthma: uses Salbutamol inhalers regularly. Denies other inhalers (e.g. brown inhalers).\n\n- Peanut allergy: recalls antihistamines in past, unsure which. Severe allergic reaction in childhood (~6yo) requiring hospitalisation, per mother.\n\n- Previous lip swelling ~1 year ago after curry at Chinese restaurant while intoxicated, with difficult breathing next morning. No antihistamines used at that time.\n\n\n\n\nMedications\n\n\n\n\n- Salbutamol inhalers.\n\n- Denies regular antihistamine use. No antihistamines available at time of consult.\n\n\n\n\nAllergies\n\n\n\n\n- Peanuts.\n\n\n\n\nObjective\n\n\n\n\n- Telehealth consultation; no physical examination performed.\n\n\n\n\nAssessment\n\n\n\n\n- Suspected anaphylactic reaction based on lip swelling, difficulty breathing and general tightness, with rapid onset after consuming known allergen (prawns).\n\n- Previous similar reaction to unknown food substance ~1 year prior.\n\n- History of severe childhood allergic reaction.\n\n\n\n\nPlan\n\n\n\n\n- Ambulance called.\n\n- Advised to stay on line until ambulance arrival.\n\n- Advised to take antihistamines immediately if available.\n\n- Advised to have person present call 000 and report suspected anaphylactic reaction requiring immediate attention.\n\n- Follow-up required regarding EpiPen prescription.","review":119.5,"saved":160.0,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."]],"mb":37.159552,"latency":25.0,"signable":144.5},{"label":"Run 6","wer":14.614773629864972,"text":"Hi. Hello? Hi. Hi. Hello. I'm Doctor. Jacob, and welcome to Babylon.\n\nHow are you doing? I'm all right, thank you. Well, I feel a little weird today, to be honest. Yeah. So just before we we start, is it all right if you could confirm your full name for me, please? Yes. Maria Travaloza. Okay. Date and your date of birth? That is the first of October.\n\nNinety nine. Okay. And your email address for me, please. Yes. Mtrava at gmail.com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient notes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with chron. So, basically, I I sometimes go with my friends to to this place called Fet Fuck.\n\nAnd we we regularly have like, usually I have like a normal vegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called a laxa. It's like a soup. I ordered a prawn one this time. Yeah. And, yeah, and then my feel stuff, like, my lips started feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know. And then we went back, we had a little bit of a chat, a bent. It wasn't really\n\nPaying attention. And now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. Right. I don't know what to do. Alright. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around seven. Okay. Around seven o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like must have been, like,\n\nAnd a half an hour maybe. Okay. In half an hour, you develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's you can still feel it, like, really pumping, but and it's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat, like your throat is closing up? Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight?\n\nI don't know if it's the test. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past? Not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends. Mhmm. And I think we went, like, to late night kinda Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late\n\nI woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma. So I tell I I take what's it called? Salbutamol inhalers. Yeah? Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\n\nUh, no, I don't think so. No. Right. And, um, so do you use antihistamines like cetirizine, loratadine, peritone, any of those kind of things? Mm, no. Well, no, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. And I think I do get antihistamines for that, but I'm not sure which ones. And any p- point, because you had peanut allergy, any time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. When I was, like, six or something, I I I think, oh, sorry. The swelling is getting Oh. Oh, I thought, oh, yeah. I think when I was Right. Are you okay now? I feel a little busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n\nNo, I don't think I have. Oh, right. Okay. So- Right. All, all right. I, I'm really a bit worried about you at the moment, Maria. It, um, I think we need to call an ambulance because, um, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection, like what your mom's, um, you know, what your mom told you as you were a young child. Okay. Right? So is there any, anyone with you at the moment, or are you alone?\n\nI'm alone at the moment. Okay. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And I'll Somebody just came. Somebody just came. Yes. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. And because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom mom, do we have any antihistamines around? Yes.\n\nYes. Oh, yeah. Yeah. We do. Straight away. And if mom can call mom, if you can call the nine nine nine nine nine. Yeah? And say that your there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes. She said she will. Yes. Yes. So straight away, take the antihistamines in the meantime. Alright? Okay. Okay. And I'll ask you come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Alright. Okay then. Take care.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":277,"end":298,"said":"Trabalotsa. OK day","significant":true},{"start":354,"end":372,"said":"ninety-nine. OK","significant":false},{"start":417,"end":423,"said":"M Traba","significant":false},{"start":427,"end":443,"said":"Gmail dot com. 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All right OK","significant":false},{"start":5709,"end":5716,"said":"uh Mum Mum","significant":false},{"start":5767,"end":5785,"said":"K.","significant":false},{"start":5812,"end":5815,"said":"mum","significant":false},{"start":5825,"end":5828,"said":"Mum","significant":false},{"start":5980,"end":5984,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6019,"end":6019,"said":"All right","significant":false},{"start":6079,"end":6099,"said":"all right. OK OK. Yes thank .","significant":false},{"start":6104,"end":6112,"said":"after","significant":false},{"start":6122,"end":6124,"said":"out","significant":false},{"start":6257,"end":6261,"said":"will","significant":false},{"start":6271,"end":6284,"said":"thank . All . OK","significant":false},{"start":6323,"end":6323,"said":"thank","significant":false},{"start":6342,"end":6342,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling onset ~30 mins post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressive upper lip swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing and general tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"previous lip swelling/difficulty breathing ~1 year ago post-curry\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma (salbutamol inhaler)\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"peanut allergy, previous severe allergic reaction ~age 6 requiring hospitalisation\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance (999) called\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother mentioned only confirming antihistamines; being alone, staying with patient and calling 999 are not recorded."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised to take antihistamines immediately\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up call post-discharge to arrange adrenaline auto-injector\"."]],"claims":[],"note":"Subjective\n\n- Lip swelling after consuming prawn soup (~19:00)\n\n- Swelling onset ~30 mins post-ingestion, initially left corner of mouth, progressively worsening\n\n- Reports difficulty breathing and general tightness\n\n- No antihistamines available at time of consult\n\n\n\n\nObjective\n\n- Telehealth consultation\n\n- Reports progressive upper lip swelling, \"pumping\" sensation\n\n- SOB and chest tightness reported\n\n\n\n\nAssessment\n\n- Suspected anaphylactic reaction following prawn ingestion\n\n- Background: asthma (salbutamol inhaler), peanut allergy, previous severe allergic reaction ~age 6 requiring hospitalisation, previous lip swelling/difficulty breathing ~1 year ago post-curry\n\n\n\n\nPlan\n\n- Urgent ambulance (999) called for immediate transport to hospital\n\n- Advised to take antihistamines immediately; mother confirming availability and administering\n\n- Advised to remain on line until ambulance arrives\n\n- Follow-up call post-discharge to arrange adrenaline auto-injector and further management","review":68.02631578947368,"saved":211.4736842105263,"clean":false,"effort":11.538461538461538,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."]],"mb":40.651581,"latency":28.264,"signable":96.29031578947368}],"freed":[{"label":"Run 1","wer":17.31532962668785,"text":"Hi! Hello! Hi! Hi, I'm Maria! Hello, I'm Doctor Jacob, and welcome to Babylon! How are you doing?\n  I'm alright, thank you. I feel a little weird today, to be honest.\n  Yeah, so just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, amtrabba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger? Yeah, you can still feel it, like. really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take, what's it called, salbutamol inhalers. Yeah, so I do take that regularly, but I've always taken it.\n  I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  No, I think sometimes, but I don't know which ones. So I have a peanut allergy as well, like I've always had it, and I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n  Yeah, when I was like 6 or something, I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was six. Are you okay now? I feel a bit dizzy right now, to be honest.\n  You feel dizzy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, all right, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection like what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes.\n  Yes.\n  Oh, yeah, we do. Go straight away, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamine in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. All right.\n  Okay then, take care. Thank you very much. Bye-bye.","marks":[{"start":104,"end":111,"said":"all right","significant":false},{"start":206,"end":213,"said":"all right","significant":false},{"start":277,"end":293,"said":"Trabalotsa. OK day","significant":false},{"start":331,"end":334,"said":"first","significant":false},{"start":347,"end":355,"said":"ninety-nine. 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Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Only 'Ensure companion remains with patient'; mother's arrival and her being asked to call 999 are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Lives alone","Patient only said she was alone at the moment; nothing states she lives alone."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after eating prawn soup. She reports going out with friends after work around 7 PM and ordering a prawn laksa soup at a restaurant. Approximately 30 minutes after eating, her lips started feeling \"a little weird,\" beginning at the left corner of her lip. She initially did not pay much attention to the symptoms but now reports progressively worsening swelling on her upper lip that continues to enlarge. She describes the sensation as feeling like it is \"pumping blood\" and getting worse. She also reports difficulty breathing and feeling dizzy.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, where she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food trigger but believes it may have been a curry. She has a known peanut allergy and reports that she was hospitalized at approximately age 6 due to a severe allergic reaction, though she does not recall the specific details as she was young and has since changed doctors. Her mother has told her she required an injection at that time.\n\nMedical History  \n- Asthma  \n- Peanut allergy, with history of hospitalization at approximately age 6 for a severe allergic reaction\n\nMedications and Supplements  \n- Salbutamol inhaler for asthma  \n- Antihistamines for peanut allergy\n\nAllergies  \n- Peanut allergy (swelling and difficulty breathing)\n\nSocial History  \n- Alcohol: Occasional use  \n- Living Situation: Lives alone\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with asthma and peanut allergy, presenting with lip swelling and breathing difficulty.\n\nAnaphylactic Reaction  \nAssessment: Acute onset lip swelling beginning approximately 30 minutes after consuming prawn soup at 7 PM. Swelling has progressively worsened and is now accompanied by breathing difficulty and dizziness. History of similar reaction approximately one year ago after eating curry, which also caused swelling and breathing difficulties. Known peanut allergy requiring hospitalization at age 6. Current symptoms of lip swelling with respiratory compromise and systemic symptoms are highly concerning for anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call 999 ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamine medication immediately while awaiting emergency services  \n- Ensure companion remains with patient until ambulance arrival  \n- Follow up after hospital discharge for further allergy management and potential epinephrine auto-injector prescription\n","review":150.3421052631579,"saved":129.1578947368421,"clean":false,"effort":11.538461538461538,"sig":[],"mb":15.126379,"latency":44.855,"signable":183.05310526315787},{"label":"Run 2","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fed Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? and say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay, then. Take care. Thank you very much. Bye-bye.","marks":[{"start":10,"end":10,"said":"Hi","significant":false},{"start":276,"end":292,"said":"Trabalotsa. OK day","significant":false},{"start":330,"end":333,"said":"first","significant":false},{"start":346,"end":354,"said":"ninety-nine. 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Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and patient remaining with another person are captured, but mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Lives alone, mother recently arrived","Patient only said she was alone at the moment; nothing states she lives alone."],["Hospital evaluation and treatment for anaphylaxis, likely requiring epinephrine injection","No epinephrine treatment in hospital was stated; the doctor only mentioned sorting out injections after discharge."]],"note":"Subjective\nMaria Chabalotza, a patient with a history of asthma and peanut allergy, presents with acute lip swelling and difficulty breathing after eating prawn soup.\n\nThe patient reports that she went out with friends to a restaurant called Fed Park after work, around 7 PM, and ordered a prawn laksa soup. She notes that her lips started feeling \"a little weird,\" beginning on the left corner of her upper lip, approximately 30 minutes after eating the soup. She initially did not pay much attention to the symptoms but now reports a progressively worsening swelling on her upper lip that she describes as feeling like it is \"really pumping blood\" and \"getting bigger.\" She also reports difficulty breathing and a general feeling of tightness, though she is unsure if it is specifically in her chest. She states the swelling continues to worsen.\n\nThe patient reports a similar episode approximately one year ago after eating at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She notes she was quite drunk at the time and had eaten a curry dish. She has a known peanut allergy and reports that her mother told her she required a hospital visit and an injection for a severe allergic reaction when she was around 6 years old. She changed doctors since that time and does not recall the specific details of the injection she received. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home.\n\nMedical History\n- Asthma\n- Peanut allergy, with history of severe allergic reaction requiring hospitalization and injection at approximately age 6\n\nMedications and Supplements\n- Salbutamol inhaler for asthma\n- Antihistamines for peanut allergy, specific name unknown\n\nAllergies\n- Peanut allergy (swelling and difficulty breathing)\n\nSocial History\n- Alcohol: Occasional, including being quite drunk at a restaurant approximately one year ago\n- Living Situation: Lives alone, mother recently arrived\n- Social Activities: Regularly goes out to eat with friends at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at around 7 PM, with swelling progressively worsening and now involving the upper lip. She reports difficulty breathing and sensation of throat tightness. She has a history of similar reaction approximately one year ago after eating curry, which resulted in facial swelling and breathing difficulties. Patient has known peanut allergy since childhood and history of severe allergic reaction requiring hospitalization at age 6. Current presentation is highly concerning for anaphylaxis given the rapid onset of angioedema, respiratory symptoms, and patient's allergy history.  \nPlan:  \n- Emergency services activation: Call 999 immediately for suspected anaphylactic reaction  \n- Immediate antihistamine administration while awaiting emergency services  \n- Ensure patient remains with another person until ambulance arrives  \n- Hospital evaluation and treatment for anaphylaxis, likely requiring epinephrine injection  \n- Follow-up after hospital discharge for allergy management and epinephrine auto-injector prescription\n","review":212.65789473684208,"saved":66.84210526315792,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call, a sign of systemic anaphylaxis, is not documented."]],"mb":15.030984,"latency":44.913,"signable":244.4168947368421},{"label":"Run 3","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay then. Take care. Thank you very much. Bye-bye.","marks":[{"start":10,"end":10,"said":"Hi","significant":false},{"start":276,"end":292,"said":"Trabalotsa. OK day","significant":false},{"start":330,"end":333,"said":"first","significant":false},{"start":346,"end":354,"said":"ninety-nine. 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Are","significant":false},{"start":4282,"end":4298,"said":". You're feeling dizzy. OK","significant":true},{"start":4396,"end":4396,"said":"no. OK","significant":false},{"start":4419,"end":4426,"said":"uh all right I","significant":false},{"start":4756,"end":4761,"said":"mum's. Um","significant":false},{"start":4783,"end":4786,"said":"mum","significant":false},{"start":4823,"end":4827,"said":"OK all","significant":false},{"start":4847,"end":4847,"said":"any","significant":false},{"start":4920,"end":4920,"said":"yeah. Ohh no","significant":false},{"start":5011,"end":5015,"said":"OK and . Hey ohh","significant":false},{"start":5035,"end":5035,"said":"somebody just came yes","significant":false},{"start":5051,"end":5073,"said":"any more. Thank. All right OK","significant":false},{"start":5258,"end":5271,"said":"straight away.","significant":false},{"start":5382,"end":5390,"said":"uh Mum Mum","significant":false},{"start":5442,"end":5454,"said":"K.","significant":false},{"start":5461,"end":5476,"said":"that straight away","significant":false},{"start":5485,"end":5488,"said":"mum","significant":false},{"start":5499,"end":5502,"said":"Mum","significant":false},{"start":5524,"end":5527,"said":"uh nine nine nine nine nine","significant":false},{"start":5547,"end":5547,"said":"your","significant":false},{"start":5628,"end":5632,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5760,"end":5760,"said":"thank . And","significant":false},{"start":5932,"end":5943,"said":". All . OK","significant":false},{"start":5982,"end":5990,"said":"thank bye bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"acute onset lip swelling and difficulty breathing after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Within approximately 30 minutes of eating\" swelling developed."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"visible swelling of her upper lip ... the swelling is worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Difficulty breathing and throat tightness, \"unsure if her chest feels tight\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode one year ago at a late-night Chinese restaurant with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"She uses a salbutamol inhaler for her asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with hospitalisation for severe reaction at about age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"highly concerning for anaphylaxis requiring immediate emergency intervention\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call ambulance immediately for suspected anaphylactic reaction\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","\"mother present during the encounter\" and someone to remain with patient, but mother being asked to call emergency services and her arrival sequence not clearly captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take antihistamines while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow up after hospital discharge ... potential epinephrine auto-injector prescription\"."]],"claims":[["similar reaction one year ago after eating curry, which required hospitalization as a child","The curry episode a year ago had no hospitalisation; hospital care at age 6 was a separate peanut reaction."]],"note":"Subjective\nMaria Chabalotza, a patient with a history of asthma and peanut allergy, presents with acute onset lip swelling and difficulty breathing after eating prawn soup.\n\nThe patient reports that approximately around 7 PM she ordered a prawn laksa soup at a restaurant. Within approximately 30 minutes of eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. She reports the swelling is worsening and she can feel it \"pumping blood\" and getting bigger. She also reports difficulty breathing and a sensation of throat tightness, though she is unsure if her chest feels tight. She does not have any antihistamines with her at the time of presentation.\n\nThe patient recalls a similar episode approximately one year ago after eating food at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food trigger, though she believes it may have been a curry. She also has a known peanut allergy and reports that at approximately age 6, she required hospitalization for a severe allergic reaction, though she does not recall the specific treatment she received at that time. She uses a salbutamol inhaler for her asthma and does not use any other inhalers. She sometimes takes antihistamines for her peanut allergy but is unsure which ones.\n\nMedical History  \n- Asthma  \n- Peanut allergy, with history of hospitalization for severe allergic reaction at approximately age 6\n\nMedications and Supplements  \n- Salbutamol inhaler for asthma  \n- Antihistamines for peanut allergy, name unspecified\n\nAllergies  \n- Peanut allergy, with history of severe reaction requiring hospitalization at approximately age 6\n\nSocial History  \n- Living Situation: Lives alone at the time of presentation; mother present during the encounter\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup, with progressive worsening and associated breathing difficulty. She has a history of similar reaction approximately one year ago after eating curry, which required hospitalization as a child for severe allergic reaction. Patient has known peanut allergy and asthma managed with salbutamol inhaler. Current symptoms of lip swelling with respiratory compromise are highly concerning for anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamines while awaiting emergency services  \n- Ensure someone remains with patient until ambulance arrives  \n- Follow up after hospital discharge for management of allergies and potential epinephrine auto-injector prescription\n","review":178.23684210526318,"saved":101.26315789473682,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during a suspected anaphylaxis suggests circulatory involvement and is absent from the note."],["fabrication","similar reaction one year ago after eating curry, which required hospitalization as a child","It says the curry episode needed hospitalisation, but that episode had none; the only hospitalisation was the peanut reaction at age 6, so the severity history is wrong."]],"mb":15.138469,"latency":45.211,"signable":211.32584210526318},{"label":"Run 4","wer":17.156473391580622,"text":"Hi. Hello. Hi, I'm Maria. Hello, I'm Doctor Jacob and welcome to Babylon. How are you doing?\n  I'm all right, thank you.\n  I feel a little weird today, to be honest. Yeah, so just before we start, is it all right if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, mtraba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yes. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fed Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger. Yeah, I still feel it, like, really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take what's called salbutamol inhalers.\n  Yeah, so I do take that regularly, but I've always taken it. I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  Well, I do sometimes, but I don't know which ones. So I have a peanut allergy as well. I've always had it. I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was, because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah.\n  When I was, like, 6 or something, I-I-I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was- Right. Are you okay now? I feel busy right now, to be honest.\n  You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, alright, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straightaway. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around?\n  Yes. Yes. Oh, yeah, we do.\n  Go straightaway, and if mom can call, mom, if you can call the 999, yeah? and say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamines in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. Thank you.\n  Okay, then. Take care. Thank you very much. Bye-bye.","marks":[{"start":10,"end":10,"said":"Hi","significant":false},{"start":276,"end":292,"said":"Trabalotsa. OK day","significant":false},{"start":330,"end":333,"said":"first","significant":false},{"start":346,"end":354,"said":"ninety-nine. 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All right OK","significant":false},{"start":5258,"end":5271,"said":"straight away.","significant":false},{"start":5382,"end":5390,"said":"uh Mum Mum","significant":false},{"start":5442,"end":5454,"said":"K.","significant":false},{"start":5461,"end":5476,"said":"that straight away","significant":false},{"start":5485,"end":5488,"said":"mum","significant":false},{"start":5499,"end":5502,"said":"Mum","significant":false},{"start":5524,"end":5527,"said":"uh nine nine nine nine nine","significant":false},{"start":5547,"end":5547,"said":"your","significant":false},{"start":5628,"end":5632,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5760,"end":5760,"said":"thank . And","significant":false},{"start":5932,"end":5943,"said":". All . OK","significant":false},{"start":5983,"end":5991,"said":"thank bye bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States \"ingesting prawn soup\"; food correctly identified as prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Within about 30 minutes of eating, she noticed a strange sensation\" progressing to swelling."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"visible swelling of her upper lip ... the swelling is worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Reports \"difficulty breathing and a sensation of throat tightness, though she is unsure whether her chest feels tight\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar episode ~1 year ago at late-night Chinese restaurant with swelling and difficulty breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma listed; \"used her salbutamol inhaler\" and salbutamol in medications."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with hospital visit and possibly an injection at around age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"highly concerning for anaphylaxis\" with emergency ambulance transport."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance transport to hospital for suspected anaphylactic reaction\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and her contacting emergency services noted, but instruction to stay with patient until ambulance arrives omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate antihistamine administration while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after hospital discharge ... possible epinephrine auto-injector prescription\"."]],"claims":[["Living Situation: Lives alone","Transcript only says \"I'm alone at the moment\"; living arrangements never discussed."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after ingesting prawn soup. She reports going out with friends after work and ordering a prawn laksa soup at approximately 7:00 PM. Within about 30 minutes of eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. She reports the swelling is worsening and feels like it is \"really pumping blood\" and \"getting bigger.\" She also reports difficulty breathing and a sensation of throat tightness, though she is unsure whether her chest feels tight.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, where she woke up the next morning with significant lip swelling and difficulty breathing. She was intoxicated at the time and is unsure of the exact food that triggered the reaction, but believes it may have been a curry. She did not use any antihistamines at that time but used her salbutamol inhaler.\n\nShe has a known peanut allergy and reports that her mother told her she required a hospital visit and possibly an injection for a severe allergic reaction when she was around age 6. She changed doctors since that time and does not recall the specifics of the treatment she received. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home.\n\nMedical History\n- Asthma\n- Peanut allergy, with history of severe allergic reaction requiring hospitalization at approximately age 6\n\nMedications and Supplements\n- Salbutamol inhaler\n- Antihistamines\n\nAllergies\n- Peanut allergy, with history of severe anaphylactic reaction requiring hospitalization at approximately age 6\n\nSocial History\n- Living Situation: Lives alone\n- Social Activities: Regularly goes out with friends to eat at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic Reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at 7 PM, with progressive worsening and associated breathing difficulty. History of similar reaction one year ago after eating curry, as well as known peanut allergy since childhood requiring hospitalization at age 6. Current symptoms of lip swelling with respiratory compromise are highly concerning for anaphylaxis given the rapid onset, progressive nature, and patient's allergic history.  \nPlan:  \n- Emergency ambulance transport to hospital for suspected anaphylactic reaction  \n- Immediate antihistamine administration while awaiting emergency services  \n- Emergency services to be contacted by patient's mother for urgent transport  \n- Follow-up after hospital discharge for anaphylaxis management and possible epinephrine auto-injector prescription\n","review":178.55263157894737,"saved":100.94736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during a suspected anaphylaxis suggests circulatory involvement and is absent from the note."]],"mb":15.579635,"latency":44.14,"signable":210.45163157894737},{"label":"Run 5","wer":17.31532962668785,"text":"Hi! Hello! Hi! Hi, I'm Maria! Hello, I'm Doctor Jacob, and welcome to Babylon! How are you doing?\n  I'm alright, thank you. I feel a little weird today, to be honest.\n  Yeah, so just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Chabalotza. Okay, and your date of birth? That is the 1st of October. 99. Okay, and your email address for me, please? Yes, amtrabba at gmail dot com. Okay, and just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling after you had a sandwich? Is that correct?\n  Yeah, that is, well, I don't think, I don't think it was, it wasn't a sandwich, but it was, it was something with prawns. So basically I, I sometimes go with my friends to, to this place called Fat Park and we, we regularly have like, usually I have like a normal vegetarian soup or something and yeah, and then... I wanted to try something new, so what happened was I ordered a prawn soup, it's called a laksa, it's like a soup, I ordered a prawn one this time, and yeah, and then my lips started feeling a little weird, just in the corner, sort of on the left first, and then, I don't know, and then... We went back, we had a little bit of a chat of banter, I wasn't really paying attention. Now I feel that there is a swelling, there is like a swelling on my upper lip and it's kind of getting bigger, I don't know what to do.\n  Right, so when did you have the prawn soup, what time? That was, that must have been just after work, so maybe like around seven. Okay. Around 7 o 'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like, must have been like, I don't know, half an hour maybe? Okay, in half an hour you developed the swelling, yeah? Yeah. Okay, and it's getting bigger and bigger? Yeah, you can still feel it, like. really pumping blood and it's kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's the chest, it just generally feels a little difficult.\n  Okay.\n  Yeah, it might be, I'm not sure. Okay, right. And just a few, have you ever had these, any kind of lip swelling in the past, after eating any food?\n  Yeah, well, maybe, I remember like a year ago, a year ago I was, out with my friends and I think we went like to a late night kind of Chinese place and I remember that I was quite drunk to be honest and I remember that after like having that very late I woke up the next morning quite swollen up and had also like felt really bad and... quite difficult breathing, but I didn't feel what it was I had, it was like a curry or something.\n  And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time?\n  Well, I generally have asthma, so I take, what's it called, salbutamol inhalers. Yeah, so I do take that regularly, but I've always taken it.\n  I generally have that. And any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers?\n  No, I don't think so.\n  Right. And so do you use antihistamines like cetirizine, loratadine, pyrritin, any of those kind of things?\n  No, I think sometimes, but I don't know which ones. So I have a peanut allergy as well, like I've always had it, and I think I do get antihistamines for that, but I'm not sure which ones.\n  And any point, because you've had peanut allergy, any time you had to ever use like an injection?\n  When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\n  Right. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\n  Yeah, when I was like 6 or something, I think, oh, sorry, the swelling is getting, oh, yeah, I think when I was six. Are you okay now? I feel a bit dizzy right now, to be honest.\n  You feel dizzy? Okay. Right. Do you have any kind of antihistamines with you at the moment?\n  No, I don't think I have.\n  Right. Okay. Right, all right, I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection like what your mom told you as you were a young child. Okay, right, so is there anyone with you at the moment or are you alone? I'm alone at the moment. So hang on the line while I'll call the ambulance, okay? And I'll send them right to you, okay? Somebody just came, I'm not alone anymore. Alright, okay, somebody just came. So just call the ambulance, make sure that person's with you till the ambulance comes, yeah? Because we are worried about anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes.\n  Yes.\n  Oh, yeah, we do. Go straight away, and if mom can call, mom, if you can call the 999, yeah? And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay? Yes, she said she will. Yes. All right. So, straight away take the antihistamine in the meantime. All right? Okay. Okay. Yes. After you come out from the hospital, do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. Will do. Yes. All right.\n  Okay then, take care. Thank you very much. Bye-bye.","marks":[{"start":104,"end":111,"said":"all right","significant":false},{"start":206,"end":213,"said":"all right","significant":false},{"start":277,"end":293,"said":"Trabalotsa. OK day","significant":false},{"start":331,"end":334,"said":"first","significant":false},{"start":347,"end":355,"said":"ninety-nine. 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Are","significant":false},{"start":4304,"end":4308,"said":". You're feeling","significant":false},{"start":4419,"end":4419,"said":"no. OK","significant":false},{"start":4712,"end":4712,"said":"you know","significant":false},{"start":4770,"end":4773,"said":"mum's. Um you know what your mum","significant":false},{"start":4810,"end":4814,"said":"OK all","significant":false},{"start":4834,"end":4834,"said":"any","significant":false},{"start":4907,"end":4907,"said":"yeah. Ohh no","significant":false},{"start":4998,"end":5002,"said":"OK and . Hey ohh","significant":false},{"start":5022,"end":5022,"said":"somebody just came yes","significant":false},{"start":5038,"end":5060,"said":"any more. Thank. All right OK","significant":false},{"start":5370,"end":5378,"said":"uh Mum Mum","significant":false},{"start":5432,"end":5444,"said":"K.","significant":false},{"start":5449,"end":5451,"said":"that","significant":false},{"start":5474,"end":5477,"said":"mum","significant":false},{"start":5488,"end":5491,"said":"Mum","significant":false},{"start":5513,"end":5516,"said":"uh nine nine nine nine nine","significant":false},{"start":5536,"end":5536,"said":"your","significant":false},{"start":5617,"end":5621,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5690,"end":5703,"said":"antihistamines","significant":false},{"start":5748,"end":5748,"said":"thank . And","significant":false},{"start":5913,"end":5913,"said":"thank .","significant":false},{"start":5918,"end":5931,"said":". OK","significant":false},{"start":5970,"end":5978,"said":"thank bye bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and companion staying are captured, but mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["Living Situation: Currently lives alone","Patient only said she was alone at the moment; nothing states she lives alone."]],"note":"Subjective\nMaria Chabalotza presents with acute onset lip swelling and difficulty breathing after eating prawn soup. She reports going out with friends to a restaurant called Fat Park after work, around 7:00 PM, and ordered a prawn laksa soup. She typically orders vegetarian soup at this establishment. Approximately 30 minutes after eating, she noticed a strange sensation at the left corner of her lip, which progressed to visible swelling of her upper lip. The swelling has been progressively worsening and feels like it is \"pumping blood.\" She also reports difficulty breathing and a sensation of throat tightness, though she is unsure if her chest feels tight. She currently feels dizzy.\n\nThe patient recalls a similar episode approximately one year ago after eating at a late-night Chinese restaurant, during which she woke up the next morning with significant swelling and difficulty breathing. She was intoxicated at the time and does not recall the exact food that triggered the reaction, but it was possibly a curry. She has a known peanut allergy and reports that she was hospitalized at approximately age 6 for a severe allergic reaction, during which she may have received an injection, though she does not recall the specifics as she was young and has since changed doctors. Her mother confirmed this hospitalization. She uses a salbutamol inhaler regularly for her asthma and denies using any other inhalers such as a brown preventer inhaler. She does not currently have antihistamines with her but her mother, who just arrived, confirmed they have antihistamines at home. She denies taking any specific antihistamine medication regularly, though she believes she may have been prescribed some in the past for her peanut allergy.\n\nMedical History\n- Asthma\n- Peanut allergy, with hospitalization at approximately age 6 for a severe allergic reaction\n\nMedications and Supplements\n- Salbutamol inhaler, used regularly for asthma\n- Antihistamines, taken occasionally in the past for peanut allergy, specific names unknown\n\nAllergies\n- Peanut (anaphylactic reaction with swelling and difficulty breathing; hospitalized at age 6)\n- Shellfish/prawn (lip swelling, difficulty breathing, throat tightness)\n\nSocial History\n- Alcohol: Occasional use; was intoxicated approximately one year ago at a restaurant\n- Living Situation: Currently lives alone; mother recently arrived\n- Social Activities: Regularly dines out with friends at restaurants\n\nObjective\nN/A\n\nAssessment & Plan\n26-year-old female with history of asthma and peanut allergy, presenting with acute lip swelling and breathing difficulty.\n\nAnaphylactic reaction  \nAssessment: Patient developed acute lip swelling approximately 30 minutes after consuming prawn soup at around 7 PM, with progressive worsening of swelling on upper lip. She reports difficulty breathing and feeling dizzy, which are concerning signs of systemic allergic reaction. Patient has history of similar reaction approximately one year ago after eating curry, which caused lip swelling and breathing difficulties. She has known peanut allergy since childhood and required hospitalization at age 6 for severe allergic reaction. Current presentation with rapid onset lip swelling, respiratory symptoms, and dizziness following shellfish ingestion is highly suggestive of anaphylaxis requiring immediate emergency intervention.  \nPlan:  \n- Call ambulance immediately for suspected anaphylactic reaction  \n- Take antihistamine medication while awaiting emergency services  \n- Ensure companion stays with patient until ambulance arrives  \n- Follow up after hospital discharge for further management including potential epinephrine auto-injector prescription\n","review":195.81578947368422,"saved":83.68421052631578,"clean":false,"effort":11.538461538461538,"sig":[],"mb":15.111116,"latency":44.75,"signable":228.39278947368422}],"cliniscripts":[{"label":"Run 1","wer":17.871326449563146,"text":"Hi.\nHello? Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabalozza.\nOkay. And your date of birth?\nThat is the 1st of October 199. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first.\nAnd then I don't know, and then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late, I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I think sometimes but I don't know which ones. So I have a peanut allergy as well.\nI've always had it.\nAnd I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like 6 or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nI feel a little dizzy right now, to be honest. You feel dizzy?\nOkay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay.\nRight. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So hang on the line while I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes. I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting.\nYes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. Yes. And ask if you come out from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nAll right. Okay, then. Take care.","marks":[{"start":274,"end":291,"said":"Trabalotsa. OK day","significant":false},{"start":328,"end":331,"said":"first","significant":false},{"start":343,"end":353,"said":"ninety-nine. OK","significant":true},{"start":398,"end":421,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":724,"end":724,"said":"I don't think","significant":false},{"start":781,"end":788,"said":"prawn","significant":false},{"start":855,"end":862,"said":".","significant":false},{"start":938,"end":938,"said":"Mm-hmm.","significant":false},{"start":988,"end":988,"said":"Mm-hmm. 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Thank.","significant":false},{"start":5351,"end":5359,"said":"uh Mum Mum","significant":false},{"start":5409,"end":5421,"said":"K.","significant":false},{"start":5456,"end":5459,"said":"mum","significant":false},{"start":5470,"end":5473,"said":"Mum","significant":false},{"start":5495,"end":5499,"said":"uh nine nine nine nine nine","significant":false},{"start":5519,"end":5519,"said":"your","significant":false},{"start":5601,"end":5605,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5640,"end":5640,"said":"All","significant":false},{"start":5733,"end":5733,"said":"thank .","significant":false},{"start":5738,"end":5744,"said":"after","significant":false},{"start":5914,"end":5918,"said":".","significant":false},{"start":5923,"end":5934,"said":". OK","significant":false},{"start":5952,"end":5952,"said":"Thank you very much thank bye bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"lip swelling after consuming prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling began ... approximately 30 minutes after ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","partial","Progressive worsening captured, but upper lip location not stated (only \"left corner of the lip\")."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"difficulty breathing and generalized tightness, possibly in the chest\" matches uncertain characterisation."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"They also reported feeling dizzy.\""],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Similar lip swelling and difficult breathing one year prior at a Chinese restaurant."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"history of asthma, for which they use a Salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with childhood severe reaction requiring injection and hospital visit around age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Assessment: concern for potential anaphylactic reaction; ambulance called immediately."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"advised calling an ambulance immediately\"; mother to call 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arrives and is told to call 999, but instruction to stay with the patient is omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"advised to take any available antihistamines in the interim while waiting for the ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact the clinic after hospital discharge to discuss injections\"."]],"claims":[["born on October 1, 1990","Transcript gives date of birth as \"first of October, ninety-nine\" (1999), not 1990."]],"note":"S (Subjective):\n- The patient, Maria Trabalozza, born on October 1, 1990, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling began on the left corner of the lip approximately 30 minutes after ingestion and has been progressively worsening and feeling \"bigger\" and \"pumping blood.\"\n- The patient reports feeling difficulty breathing and generalized tightness, possibly in the chest. They also reported feeling dizzy.\n- They have a history of a similar lip swelling episode and difficult breathing one year prior after eating \"curry or something\" at a Chinese restaurant while intoxicated.\n- The patient has a known peanut allergy and a history of asthma, for which they use a Salbutamol inhaler regularly. They recall their mother mentioning a severe allergic reaction requiring an injection when they were a child (around 6 years old) and a hospital visit for swelling.\n\nO (Objective):\n- The patient confirmed their full name and date of birth as Maria Trabalozza, 1st October 1990, and email mtraba@gmail.com.\n- The patient confirmed being in a secure location for a confidential conversation.\n- The patient reported feeling \"a little weird today.\"\n- The patient initially stated they were alone, but a family member (mother) arrived during the consultation.\n\nA (Assessment):\n- The doctor expressed concern for a potential anaphylactic reaction based on the patient's reported symptoms of lip swelling, difficulty breathing, dizziness, and history of severe allergic reactions.\n\nP (Plan):\n- The doctor advised calling an ambulance immediately due to the suspected anaphylactic reaction.\n- The doctor instructed the patient's mother to call 999 and report a suspected anaphylactic reaction requiring immediate attention.\n- The patient was advised to take any available antihistamines in the interim while waiting for the ambulance.\n- The patient was asked to contact the clinic after hospital discharge to discuss injections and further management for allergies.\n","review":131.73684210526318,"saved":147.76315789473682,"clean":false,"effort":19.230769230769234,"sig":[["fabrication","born on October 1, 1990","DOB recorded as 1990 when the patient said 1999, a wrong patient identifier."]],"mb":25.289765,"latency":22.591,"signable":142.7568421052632},{"label":"Run 2","wer":18.109610802223987,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Rania. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah, it still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah, actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food?\nYeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something, I think.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah, I'm busy right now, to be honest. Do you feel dizzy?\nYeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line while I call the ambulance, okay? And I'll send them right to you.\nOkay? And if anybody just came somebody just came, yes, I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting.\nYes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes, she said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. Yes. And ask if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nAll right. Okay, then. Take care.\nThank you very much. Bye-bye. Bye. Bye-bye.","marks":[{"start":19,"end":21,"said":"","significant":false},{"start":27,"end":33,"said":"Maria.","significant":true},{"start":278,"end":294,"said":"Trabalotsa. OK day","significant":false},{"start":331,"end":334,"said":"first","significant":false},{"start":346,"end":357,"said":"ninety-nine. 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Thank.","significant":false},{"start":5377,"end":5385,"said":"uh Mum Mum","significant":false},{"start":5435,"end":5447,"said":"K.","significant":false},{"start":5482,"end":5485,"said":"mum","significant":false},{"start":5496,"end":5499,"said":"Mum","significant":false},{"start":5521,"end":5525,"said":"uh nine nine nine nine nine","significant":false},{"start":5545,"end":5545,"said":"your","significant":false},{"start":5627,"end":5631,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5666,"end":5666,"said":"All","significant":false},{"start":5759,"end":5759,"said":"thank .","significant":false},{"start":5764,"end":5770,"said":"after","significant":false},{"start":5780,"end":5782,"said":"out","significant":false},{"start":5939,"end":5943,"said":".","significant":false},{"start":5948,"end":5959,"said":". OK","significant":false},{"start":5999,"end":6007,"said":"thank","significant":false},{"start":6013,"end":6021,"said":"bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","partial","Breathing difficulty captured, but chest tightness is stated as definite ('tightness in the chest') though the patient was unsure."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother joining and patient staying with her are captured, but the mother being asked to call 999 is not."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["The patient reported difficulty breathing and tightness in the chest.","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; chest tightness is asserted as definite."]],"note":"S (Subjective):\n- The patient, Maria Trabaloza, DOB 10/01/1999, presented with lip swelling after consuming prawn soup (laksa) at approximately 7:00 PM.\n- Swelling began on the left corner of the lip and progressed to the entire upper lip within half an hour, continuing to enlarge (\"getting bigger and bigger,\" \"pumping blood\").\n- The patient reported difficulty breathing and tightness in the chest.\n- They have a history of a similar lip swelling episode approximately a year ago after eating Chinese food (curry) while intoxicated, also accompanied by difficulty breathing.\n- The patient has a known peanut allergy and a history of asthma, for which they use a salbutamol inhaler regularly. They recall being told by their mother about an injection for an allergic reaction as a child and a hospital visit for severe swelling at age six.\n- The patient reported feeling dizzy during the consultation.\n\nO (Objective):\n- The patient confirmed their identity and location for a confidential conversation.\n- The patient's reported symptoms of increasing lip swelling, difficulty breathing, and dizziness were noted.\n- The patient was alone initially but was joined by their mother during the call.\n- The patient reported using salbutamol inhalers for asthma.\n- The patient does not currently have antihistamines on hand.\n\nA (Assessment):\n- The patient is presenting with symptoms highly suggestive of an acute allergic reaction, potentially anaphylaxis, given the rapid onset of progressive lip swelling, difficulty breathing, chest tightness, and dizziness following exposure to a new food allergen (prawns).\n- History of similar past reactions and known peanut allergy further supports the diagnosis of an allergic response.\n- The severity of symptoms, particularly respiratory distress and dizziness, indicates a potentially life-threatening condition requiring immediate medical intervention.\n\nP (Plan):\n- Immediate call to emergency services (ambulance/999) for suspected anaphylactic reaction.\n- Administration of antihistamines immediately, which the patient's mother located.\n- Patient advised to remain with their mother until emergency services arrive.\n- Follow-up call requested from the patient after hospital discharge to arrange for an epinephrine auto-injector prescription and further management of allergies.\n","review":150.28947368421052,"saved":129.21052631578948,"clean":false,"effort":15.384615384615385,"sig":[],"mb":25.377368,"latency":24.137,"signable":160.27247368421052},{"label":"Run 3","wer":18.7450357426529,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late, I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah. I'm busy right now, to be honest. Do you feel dizzy?\nYeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes. I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting? Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[{"start":11,"end":14,"said":"","significant":false},{"start":278,"end":294,"said":"Trabalotsa. OK day","significant":false},{"start":331,"end":334,"said":"first","significant":false},{"start":346,"end":357,"said":"ninety-nine. OK","significant":false},{"start":402,"end":425,"said":"M Traba at Gmail dot com. 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Thank.","significant":false},{"start":5374,"end":5382,"said":"uh Mum Mum","significant":false},{"start":5432,"end":5444,"said":"K.","significant":false},{"start":5479,"end":5482,"said":"mum","significant":false},{"start":5493,"end":5496,"said":"Mum","significant":false},{"start":5518,"end":5522,"said":"uh nine nine nine nine nine","significant":false},{"start":5542,"end":5542,"said":"your","significant":false},{"start":5624,"end":5628,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5663,"end":5663,"said":"All","significant":false},{"start":5740,"end":5751,"said":"OK OK. Yes thank .","significant":false},{"start":5756,"end":5758,"said":"after","significant":false},{"start":5768,"end":5770,"said":"out","significant":false},{"start":5927,"end":5936,"said":". All . OK","significant":false},{"start":5954,"end":5954,"said":"Thank you very much thank bye bye. Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call documented but with wrong number '9999' instead of 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Another individual arrived and was told to call, but not identified as mother and staying with patient is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[],"note":"S (Subjective):\n- The patient presents with a chief complaint of lip swelling, which began approximately 30 minutes after consuming prawn soup (laksa) around 7:00 PM.\n- The swelling started on the left corner of their lips, then progressed to the upper lip, and is reported to be getting \"bigger and bigger,\" \"pumping blood,\" and \"worse.\"\n- Associated symptoms include difficulty breathing, a general feeling of tightness or difficulty in the chest, and dizziness.\n- The patient has a history of asthma, for which they regularly use Salbutamol inhalers. They also report a long-standing peanut allergy and occasionally take unspecified antihistamines for it.\n- History includes a previous episode of swelling and difficulty breathing after consuming Chinese food approximately one year ago, and a severe allergic reaction requiring an injection and hospital visit as a child (around 6 years old), as reported by their mother.\n\nO (Objective):\n- The doctor expressed significant concern during the consultation, indicating worry for the patient's current state.\n- The patient's reported symptoms of progressively worsening lip swelling, difficulty breathing, and dizziness suggest an escalating clinical situation.\n- No explicit vital signs, laboratory results, or specific physical examination findings were documented during this teleconsultation.\n- The patient was initially alone but confirmed that another individual arrived during the consultation.\n\nA (Assessment):\n- The patient is assessed to be experiencing a suspected anaphylactic reaction.\n- This assessment is based on the acute onset and rapid progression of lip swelling, coupled with respiratory symptoms (difficulty breathing, chest tightness) and systemic symptoms (dizziness), following exposure to a new food allergen (prawns).\n- The patient's medical history of asthma, peanut allergy, and previous severe allergic episodes further supports the high index of suspicion for anaphylaxis.\n\nP (Plan):\n- An ambulance (9999) was immediately called for the patient due to the suspected anaphylactic reaction.\n- The patient was advised to take any available antihistamines without delay while awaiting emergency services.\n- The patient's accompanying individual was instructed to call 9999 and report a suspected anaphylactic reaction.\n- The patient was advised to contact the clinic again after their hospital visit for further management, including discussion of potential auto-injector prescriptions.\n","review":137.0263157894737,"saved":142.4736842105263,"clean":false,"effort":7.6923076923076925,"sig":[],"mb":25.553921,"latency":31.344,"signable":154.0673157894737},{"label":"Run 4","wer":18.665607625099284,"text":"Hi.\nHello? Hi. Hi, I'm Maria. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah.\nGood. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know. And then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past? After eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something, I think. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, no, I think sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it.\nAnd I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you had to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction? Yeah. Well, I was like 6 or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nYeah. Busy right now, to be honest. You feel busy?\nOkay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in. And you might need an injection like what your mom's what your mom told you as you were a young child. Okay?\nMm-hmm. Right? So is there anyone with you at the moment? Or are you alone? I'm alone at the moment. Okay. So hang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And. I already just came. Somebody just came.\nYes. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting. Yes. Mom. Mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes. She said she will. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And ask if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay?\nYes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[{"start":274,"end":290,"said":"Trabalotsa. OK day","significant":false},{"start":327,"end":330,"said":"first","significant":false},{"start":342,"end":353,"said":"ninety-nine. OK","significant":false},{"start":398,"end":421,"said":"M Traba at Gmail dot com. 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Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not mentioned anywhere in the note."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with severe childhood reaction (hospital/injection around age 6) is recorded."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","Immediate 999/ambulance call documented."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","'The person who arrived was asked to call 999' - not identified as mother and staying with patient is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[["following exposure to a known allergen (prawns)","Transcript describes prawn soup as something new she tried; prawns were never stated to be a known allergen."]],"note":"S (Subjective):\n- Patient, Maria Trabaloza, born October 1, 1999, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling started on the left corner of the upper lip approximately 30 minutes after eating and is progressively worsening.\n- Patient reports difficulty breathing and a general feeling of tightness, possibly in the chest.\n- History includes a similar episode of swelling and difficulty breathing a year prior after consuming Chinese food (curry), at which time they were quite intoxicated and woke up swollen with breathing difficulties.\n- Patient has a known peanut allergy and asthma, for which they use a Salbutamol inhaler regularly. They recall their mother mentioning a severe allergic reaction requiring an injection when they were a child (around 6 years old) and a hospital visit for swelling.\n\nO (Objective):\n- The patient's email address is mtraba@gmail.com.\n- Patient reported feeling \"a little weird\" and \"really pumping blood\" in the swollen area.\n- Patient initially alone but someone arrived during the consultation.\n- There are no other objective findings from a physical examination mentioned in the transcript.\n\nA (Assessment):\n- Suspected anaphylactic reaction due to rapidly progressing lip swelling, difficulty breathing, and chest tightness following exposure to a known allergen (prawns).\n- History of previous similar allergic reactions and known peanut allergy further supports the diagnosis of anaphylaxis.\n- The patient's current symptoms raise significant concern for airway compromise.\n\nP (Plan):\n- Immediate call to emergency services (ambulance/999) for suspected anaphylactic reaction.\n- Patient advised to take any available antihistamines immediately while waiting for emergency services.\n- The person who arrived was asked to call 999 and inform them of a suspected anaphylactic reaction.\n- Patient advised to contact the clinic back after discharge from the hospital to arrange for an adrenaline auto-injector (e.g., EpiPen) and further management.\n","review":134.9736842105263,"saved":144.5263157894737,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call signals systemic/cardiovascular involvement in anaphylaxis and is absent from the note."],["fabrication","following exposure to a known allergen (prawns)","Invents a pre-existing known prawn allergy when prawn was a new food, falsifying allergy history."]],"mb":25.331393,"latency":21.703,"signable":144.9536842105263},{"label":"Run 5","wer":18.34789515488483,"text":"Hi.\nHello? Hi. Hi. Hi, I'm Rania. Hello, I'm Dr.\nJacob, and welcome to Babylon.\nHow are you doing?\nI'm all right, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it all right if you could confirm your full name for me, please? Yes.\nMaria Trabaloza.\nOkay. And your date of birth?\nThat is the 1st of October 1999. Okay.\nAnd your email address for me, please? Yes.\nmtraba@gmail.com.\nOkay. And just to confirm that you're in a secure location and we can have a confidential conversation.\nYes, I think I am, yeah. Good. Right. You've mentioned in your patient notes that you're having some sort of lip swelling, and after you had a sandwich? Is that correct?\nYeah, that is.\nWell, I don't think it was. It wasn't a sandwich, but it was something with prawns. So basically, I sometimes go with my friends to this place called Fat Pub, and we regularly have usually I have a normal vegetarian soup or something, and yeah.\nAnd then I wanted to try something new, so what happened was I ordered a prawn soup. It's called a laksa. It's like a soup. I ordered a prawn one this time. And yeah, and then my feel started my lips started feeling a little weird, just in the corner sort of on the left first, and then I don't know, and then we went back. We had a little bit of a chat, a banter. It wasn't really paying attention.\nNow I feel that there is a swelling. There is a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. All right. So when did you have the prawn soup? What time?\nThat was that must have been just after work, so maybe around 7:00. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like it must have been like I don't know, half an hour maybe. Okay. In half an hour, you developed the swelling, yeah? Yeah.\nOkay. And it's getting bigger and bigger?\nYeah. It still feels like really pumping blood, and it's kind of getting bigger. It feels like it's getting worse.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that?\nYeah. Actually, I feel like I can't breathe that well right now. Okay.\nAnd do you feel like your chest is tight?\nI don't know if it's the chest. It's just generally it feels a little difficult. Okay. But yeah, it might be. I'm not sure.\nOkay. Right.\nAnd just a few have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember a year ago, a year ago, I was out with my friends.\nAnd I think we went to a late-night kind of Chinese place, and I remember that I was quite drunk, to be honest.\nAnd I remember that after having that very late I woke up the next morning quite swollen up and had also felt really bad and quite difficult breathing.\nBut I don't know what it was I had. It was like a curry or something. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I take oh, what's it called? Salbutamol inhalers? Yeah.\nYeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown inhalers?\nNo. No, I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things?\nNo.\nWell, I do sometimes, but I don't know which ones. So I have a peanut allergy as well.\nI've always had it. And I think I do get antihistamines for that, but I'm not sure which ones. And any point because you've had peanut allergy, any time you have to ever use an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. Well, I was like six or something.\nI think after I had swelling is getting yeah, I think when I was. All right. Are you okay now?\nI feel a little dizzy right now, to be honest. Do you feel dizzy? Yeah. Okay. Right. Do you have any kind of antihistamines with you at the moment?\nNo, I don't think I have. No. Okay. Right.\nOkay. So right. All right. I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because from what history you've been telling me, it sounds like you could be going into what we say anaphylactic reaction. That's when your throat and your chest closes in, and you might need an injection like what your mom's what your mom told you as you were a young child. Okay? Mm-hmm. Right? So is there anyone with you at the moment, or are you alone? I'm alone at the moment. Okay. So\nhang on the line. While I call the ambulance, okay? And I'll send them right to you.\nOkay? And if somebody just came somebody just came, yes, I'm not alone anymore.\nAll right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah?\nAnd because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim?\nWhile we're waiting. Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah, we do. Is that straight away? And if mom can call, mom, if you can call the 9999, yeah?\nAnd say that there is a suspected anaphylactic reaction, and they need to come straight away.\nOkay? Yes.\nShe said she will. Yes. Yes. Right. So straight away take the antihistamines in the meantime. All right? Okay.\nOkay. And if you come up from the hospital, do you give us a ring back? We might need to sort you out with your injections and things like that. Okay? Yes. Yes.\nWill do. Yes. Thank you.\nOkay, then. Take care.","marks":[{"start":19,"end":21,"said":"","significant":false},{"start":27,"end":33,"said":"Maria.","significant":true},{"start":278,"end":294,"said":"Trabalotsa. OK day","significant":false},{"start":331,"end":334,"said":"first","significant":false},{"start":346,"end":357,"said":"ninety-nine. OK","significant":false},{"start":402,"end":425,"said":"M Traba at Gmail dot com. 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Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","States food exposure was prawn soup, not a sandwich."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","Onset of lip swelling about 30 minutes after eating is recorded."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling documented as progressively worsening/getting bigger."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Breathing difficulty is documented."],["The note captures: Patient becomes dizzy during the consultation.","yes","Dizziness during the consultation is documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior episode of swelling and breathing difficulty after a Chinese meal about a year ago is recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with salbutamol inhaler use is recorded."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy captured, but the severe childhood reaction requiring hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","Suspected anaphylaxis identified as needing immediate emergency intervention."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call documented but with wrong number '9999' instead of 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mom arriving and being asked to call is captured, but instruction to stay with the patient is missing."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","Immediate antihistamine use while awaiting the ambulance is documented."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Follow-up after hospital discharge for auto-injector/allergy management is documented."]],"claims":[],"note":"S (Subjective):\n- Patient, Maria Trabaloza, born October 1, 1999, presented with lip swelling after consuming prawn soup (laksa) around 7:00 PM.\n- Swelling started on the left corner of the upper lip approximately 30 minutes after eating and is progressively worsening.\n- Patient reports difficulty breathing and a general feeling of tightness, though unsure if it is chest tightness.\n- History of a similar swelling episode a year prior after eating Chinese food (curry or something) while intoxicated, which also involved swelling and difficulty breathing the next morning.\n- Patient has a known peanut allergy and asthma, for which they use a Salbutamol inhaler regularly. They sometimes take antihistamines for their peanut allergy but are unsure which type.\n\nO (Objective):\n- Patient confirmed their full name, date of birth, and email address (mtraba@gmail.com).\n- Patient initially stated they were alone but later confirmed someone (Mom) arrived.\n- Patient reported feeling dizzy during the consultation.\n\nA (Assessment):\n- Suspected anaphylactic reaction.\n- History of previous allergic reactions with swelling and breathing difficulties.\n- Patient has known peanut allergy and asthma, increasing risk for severe allergic responses.\n\nP (Plan):\n- Immediate call to ambulance (9999) by the doctor due to concern for anaphylaxis.\n- Patient's accompanying person (Mom) to call 9999 and report suspected anaphylactic reaction.\n- Patient instructed to take available antihistamines immediately while awaiting emergency services.\n- Post-hospitalization follow-up to arrange for an adrenaline auto-injector prescription and education.\n","review":113.44736842105263,"saved":166.05263157894737,"clean":false,"effort":11.538461538461538,"sig":[["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Prior severe childhood reaction needing hospital/injection is key anaphylaxis history relevant to the adrenaline auto-injector plan."]],"mb":25.332733,"latency":20.274,"signable":122.42536842105262}],"lyrebird":[{"label":"Run 1","wer":15.250198570293886,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[{"start":19,"end":26,"said":"I'm Maria.","significant":true},{"start":99,"end":107,"said":"all right","significant":false},{"start":202,"end":209,"said":"all right","significant":false},{"start":273,"end":290,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":357,"said":"ninety-nine. 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All right OK","significant":false},{"start":5452,"end":5452,"said":"worried","significant":false},{"start":5629,"end":5637,"said":"uh Mum Mum","significant":false},{"start":5687,"end":5705,"said":"K.","significant":false},{"start":5737,"end":5740,"said":"mum","significant":false},{"start":5750,"end":5753,"said":"Mum","significant":false},{"start":5775,"end":5776,"said":"uh","significant":false},{"start":5894,"end":5898,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5933,"end":5933,"said":"All right","significant":false},{"start":5992,"end":6012,"said":"all right. OK OK.","significant":false},{"start":6023,"end":6023,"said":". And after you","significant":false},{"start":6165,"end":6169,"said":"will","significant":false},{"start":6185,"end":6194,"said":". All . OK","significant":false},{"start":6232,"end":6232,"said":"thank","significant":false},{"start":6248,"end":6255,"said":"bye bye.","significant":true}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"prawn soup (laksa) consumption at approximately 7:00 pm\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"approximately 30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"progressing to upper lip\"; \"Reported worsening swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea present\"; \"Possible chest tightness, patient uncertain\"."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"Patient reported feeling dizzy during consultation\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Similar episode approximately one year ago ... following late-night Chinese curry, with lip swelling and dyspnoea\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"History of asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Known peanut allergy ... required hospitalisation at age 6 for severe allergic reaction\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis\" with an emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance requested via 999\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival noted, but not that she was asked to stay or to call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate antihistamine administration (available at home with mother)\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up post-discharge required to arrange adrenaline autoinjector prescription\"."]],"claims":[["Allergy testing and specialist referral to be considered following acute episode","No allergy testing or specialist referral was mentioned; the clinician only asked her to ring back about injections."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 21/09/2026\n\nTime of Consultation: 2:13 am\n\n\n\n\nSubjective:\n\nPresented with acute lip swelling following prawn soup (laksa) consumption at approximately 7:00 pm on 21/09/2026\n\nSwelling commenced in left corner of lip approximately 30 minutes post-ingestion, progressing to upper lip\n\nReported worsening swelling with sensation of blood pumping to area\n\nDyspnoea present at time of consultation\n\nPossible chest tightness, patient uncertain\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese curry, with lip swelling and dyspnoea, patient intoxicated at time\n\nKnown peanut allergy since childhood, required hospitalisation at age 6 for severe allergic reaction\n\nHistory of asthma, managed with salbutamol inhaler\n\nTakes antihistamine for peanut allergy (specific type unknown)\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive lip swelling observed during consultation\n\nPatient reported feeling dizzy during consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown atopic history (asthma, peanut allergy)\n\nPrevious anaphylactic reaction in childhood\n\nPrevious similar reaction to unidentified food allergen\n\n\n\n\nPlan:\n\nEmergency ambulance requested via 999\n\nImmediate antihistamine administration (available at home with mother)\n\nEmergency department transfer for acute management\n\nHospital assessment and treatment\n\nFollow-up post-discharge required to arrange adrenaline autoinjector prescription\n\nAllergy testing and specialist referral to be considered following acute episode\n\n\n\n\nTreating Clinician\n\nGeneral Practitioner","review":98.55263157894737,"saved":180.94736842105263,"clean":false,"effort":15.384615384615385,"sig":[["fabrication","Allergy testing and specialist referral to be considered following acute episode","Allergy testing and specialist referral were never discussed; invented plan item."]],"mb":17.363224,"latency":21.792,"signable":120.34463157894737},{"label":"Run 2","wer":15.091342335186656,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called, we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's can you still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are work\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXhance","marks":[{"start":19,"end":26,"said":"I'm Maria.","significant":true},{"start":99,"end":107,"said":"all right","significant":false},{"start":202,"end":209,"said":"all right","significant":false},{"start":273,"end":290,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":357,"said":"ninety-nine. 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All","significant":false},{"start":1957,"end":1970,"said":"you developed","significant":false},{"start":2050,"end":2062,"said":"it it","significant":false},{"start":2507,"end":2517,"said":"the chest it","significant":false},{"start":2646,"end":2649,"said":"","significant":false},{"start":2694,"end":2697,"said":"After","significant":true},{"start":2801,"end":2801,"said":"Mm-hmm.","significant":false},{"start":2844,"end":2851,"said":"kinda","significant":false},{"start":2919,"end":2919,"said":"Sure OK.","significant":false},{"start":2976,"end":2977,"said":"I've","significant":false},{"start":3158,"end":3169,"said":"something I think. OK. Right. OK. Uh","significant":false},{"start":3323,"end":3327,"said":"took","significant":false},{"start":3336,"end":3336,"said":"ohh","significant":false},{"start":3557,"end":3557,"said":"Ohh I","significant":false},{"start":3654,"end":3661,"said":"Piriton","significant":true},{"start":3696,"end":3704,"said":"","significant":false},{"start":3708,"end":3713,"said":"I got no I do","significant":false},{"start":3802,"end":3806,"said":"","significant":false},{"start":3846,"end":3859,"said":"antihistamines","significant":true},{"start":3945,"end":3952,"said":"any time","significant":false},{"start":3957,"end":3960,"said":"have","significant":false},{"start":4085,"end":4092,"said":"'cause","significant":false},{"start":4110,"end":4111,"said":"I've","significant":false},{"start":4151,"end":4154,"said":"mum","significant":false},{"start":4303,"end":4305,"said":"Ohh","significant":false},{"start":4338,"end":4357,"said":"ohh my god ohh","significant":false},{"start":4384,"end":4387,"said":"six. Oh.","significant":false},{"start":4391,"end":4391,"said":"all","significant":false},{"start":4417,"end":4428,"said":"Ohh I feel a little dizzy","significant":true},{"start":4453,"end":4453,"said":"ohh. Are you .","significant":false},{"start":4469,"end":4480,"said":"dizzy. OK","significant":true},{"start":4605,"end":4617,"said":"uh all right","significant":false},{"start":4950,"end":4955,"said":"mum's. Um","significant":false},{"start":4977,"end":4980,"said":"mum","significant":false},{"start":5017,"end":5022,"said":"OK all","significant":false},{"start":5126,"end":5126,"said":"Ohh no","significant":false},{"start":5153,"end":5154,"said":"I'll","significant":false},{"start":5223,"end":5223,"said":". Hey ohh","significant":false},{"start":5284,"end":5307,"said":"any more. Thank. All right OK","significant":false},{"start":5440,"end":5444,"said":"worried","significant":false},{"start":5621,"end":5629,"said":"uh Mum Mum","significant":false},{"start":5679,"end":5697,"said":"K.","significant":false},{"start":5729,"end":5732,"said":"mum","significant":false},{"start":5742,"end":5745,"said":"Mum","significant":false},{"start":5767,"end":5768,"said":"uh","significant":false},{"start":5886,"end":5890,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5925,"end":5925,"said":"All right","significant":false},{"start":5984,"end":6004,"said":"all right. OK OK.","significant":false},{"start":6015,"end":6015,"said":". And after you","significant":false},{"start":6157,"end":6161,"said":"will","significant":false},{"start":6177,"end":6186,"said":". All . OK","significant":false},{"start":6224,"end":6224,"said":"thank","significant":false},{"start":6240,"end":6246,"said":"bye bye.","significant":true}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"acute lip swelling following prawn laksa consumption\" identifies prawn exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"progressing to upper lip swelling over approximately 30 minutes\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Progressive worsening of swelling during consultation\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea and possible chest tightness reported\"."],["The note captures: Patient becomes dizzy during the consultation.","yes","\"feeling unwell and dizzy during consultation\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"approximately one year ago ... following late-night Chinese curry, with lip swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"peanut allergy with anaphylaxis requiring hospitalisation at age 6\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis\" with emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Emergency ambulance called for immediate transfer\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother arrived, instructed to call 999, patient to remain with her."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","partial","States \"Antihistamine administered immediately (provided by mother)\" as done rather than the advice given; also contradicts \"No antihistamines available at home\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up ... post-hospital discharge for consideration of adrenaline auto-injector\"."]],"claims":[["Antihistamine administered immediately (provided by mother)","Transcript only advises taking antihistamines; administration was never confirmed."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 5:27 am\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn laksa consumption at approximately 7:00 pm on 21/09/2026\n\nInitial tingling sensation left corner of mouth, progressing to upper lip swelling over approximately 30 minutes\n\nProgressive worsening of swelling during consultation\n\nDyspnoea and possible chest tightness reported\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese curry, with lip swelling and breathing difficulty\n\nKnown peanut allergy with anaphylaxis requiring hospitalisation at age 6 (injection administered)\n\nBackground of asthma, managed with salbutamol inhaler\n\nUses antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available in home\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive upper lip swelling observed during consultation\n\nPatient reported feeling unwell and dizzy during consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown history of food allergies (peanut) with previous anaphylaxis\n\nPrevious similar reaction to shellfish/seafood likely\n\nAsthma (comorbidity)\n\n\n\n\nPlan:\n\nEmergency ambulance called for immediate transfer to hospital\n\nAntihistamine administered immediately (provided by mother)\n\nMother instructed to call 999 and report suspected anaphylaxis\n\nPatient to remain with mother until ambulance arrival\n\nFollow-up appointment required post-hospital discharge for consideration of adrenaline auto-injector prescription and allergy management plan\n\nPatient advised to contact practice after hospital discharge","review":104.23684210526315,"saved":175.26315789473685,"clean":false,"effort":11.538461538461538,"sig":[["partial","Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","Records antihistamine as administered when it was only advised, misleading the receiving team about treatment given."]],"mb":17.519787,"latency":26.517,"signable":130.75384210526315},{"label":"Run 3","wer":15.170770452740271,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think, oh, sorry. The swelling is getting Okay. Like that. Oh, yeah. I think when I was Are you right? Are you okay now? You're busy right now, to be honest. You're feeling busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Right. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[{"start":19,"end":26,"said":"I'm Maria.","significant":true},{"start":99,"end":107,"said":"all right","significant":false},{"start":202,"end":209,"said":"all right","significant":false},{"start":273,"end":290,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":357,"said":"ninety-nine. OK","significant":false},{"start":404,"end":409,"said":"Traba","significant":false},{"start":590,"end":594,"said":"","significant":false},{"start":830,"end":838,"said":"prawn","significant":true},{"start":911,"end":921,"said":".","significant":false},{"start":1016,"end":1021,"said":"Mm-hmm.","significant":false},{"start":1072,"end":1077,"said":"Mm-hmm. Um","significant":false},{"start":1130,"end":1139,"said":"it","significant":false},{"start":1152,"end":1156,"said":"laksa","significant":false},{"start":1206,"end":1210,"said":"Yeah.","significant":false},{"start":1234,"end":1242,"said":"feel","significant":false},{"start":1256,"end":1261,"said":"started","significant":false},{"start":1338,"end":1343,"said":"Mm-hmm.","significant":false},{"start":1621,"end":1621,"said":"Yeah. Right. All","significant":false},{"start":1971,"end":1984,"said":"you developed","significant":false},{"start":2064,"end":2074,"said":"it it","significant":false},{"start":2519,"end":2529,"said":"the chest it","significant":false},{"start":2658,"end":2661,"said":"","significant":false},{"start":2706,"end":2709,"said":"After","significant":true},{"start":2813,"end":2813,"said":"Mm-hmm.","significant":false},{"start":2856,"end":2863,"said":"kinda","significant":false},{"start":2931,"end":2931,"said":"Sure OK.","significant":false},{"start":2988,"end":2989,"said":"I've","significant":false},{"start":3170,"end":3181,"said":"something I think. OK. Right. OK. Uh","significant":false},{"start":3335,"end":3339,"said":"took","significant":false},{"start":3348,"end":3348,"said":"ohh","significant":false},{"start":3569,"end":3569,"said":"Ohh I","significant":false},{"start":3672,"end":3679,"said":"Piriton","significant":true},{"start":3714,"end":3722,"said":"","significant":false},{"start":3726,"end":3731,"said":"I got no I do","significant":false},{"start":3820,"end":3824,"said":"","significant":false},{"start":3864,"end":3877,"said":"antihistamines","significant":true},{"start":3963,"end":3970,"said":"any time","significant":false},{"start":3975,"end":3978,"said":"have","significant":false},{"start":4103,"end":4110,"said":"'cause","significant":false},{"start":4128,"end":4129,"said":"I've","significant":false},{"start":4169,"end":4172,"said":"mum","significant":false},{"start":4321,"end":4323,"said":"Ohh","significant":false},{"start":4356,"end":4375,"said":"ohh my god ohh","significant":false},{"start":4402,"end":4405,"said":"six. Oh.","significant":false},{"start":4409,"end":4409,"said":"all","significant":false},{"start":4435,"end":4446,"said":"Ohh I feel a little dizzy","significant":true},{"start":4471,"end":4471,"said":"ohh. Are you .","significant":false},{"start":4487,"end":4498,"said":"dizzy. OK","significant":true},{"start":4623,"end":4635,"said":"uh all right","significant":false},{"start":4968,"end":4973,"said":"mum's. Um","significant":false},{"start":4995,"end":4998,"said":"mum","significant":false},{"start":5035,"end":5040,"said":"OK all","significant":false},{"start":5144,"end":5144,"said":"Ohh no","significant":false},{"start":5171,"end":5172,"said":"I'll","significant":false},{"start":5241,"end":5241,"said":". Hey ohh","significant":false},{"start":5302,"end":5325,"said":"any more. Thank. All right OK","significant":false},{"start":5457,"end":5457,"said":"worried","significant":false},{"start":5634,"end":5642,"said":"uh Mum Mum","significant":false},{"start":5692,"end":5710,"said":"K.","significant":false},{"start":5742,"end":5745,"said":"mum","significant":false},{"start":5755,"end":5758,"said":"Mum","significant":false},{"start":5780,"end":5781,"said":"uh","significant":false},{"start":5899,"end":5903,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5938,"end":5938,"said":"All right","significant":false},{"start":5997,"end":6017,"said":"all right. OK OK.","significant":false},{"start":6028,"end":6028,"said":". And after you","significant":false},{"start":6170,"end":6174,"said":"will","significant":false},{"start":6190,"end":6199,"said":". All . OK","significant":false},{"start":6237,"end":6237,"said":"thank","significant":false},{"start":6253,"end":6260,"said":"bye bye.","significant":true}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Exposure recorded as prawn soup."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'approximately 30 minutes post-ingestion'."],["The note captures: Upper lip swelling is progressively worsening.","yes","Swelling 'progressing to upper lip' and 'increasing during consultation'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Dyspnoea present' and 'Possible chest tightness, though patient uncertain'."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not recorded (only 'increasingly distressed')."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Similar episode approximately one year ago... late-night Chinese meal... lip swelling and breathing difficulty'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'History of asthma, managed with salbutamol inhaler'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Known peanut allergy with anaphylactic reaction requiring hospitalisation at age 6'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylaxis' with emergency ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Emergency ambulance called for immediate transfer'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival and call recorded but number given as 000 not 999, and staying with patient omitted."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Advised immediate administration of antihistamine (sourced by mother)'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Adrenaline auto-injector to be arranged following hospital discharge'."]],"claims":[["Mother to call 000","The clinician said to call 'nine nine nine'; 000 is a different emergency number never stated."],["27-year-old female","DOB 1 October 1999 and session date 22/09/2026 make her 26; the stated age is wrong."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 4:18 pm\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn soup (laksa) consumption at approximately 7:00 pm today\n\nSwelling began in left corner of mouth approximately 30 minutes post-ingestion, progressing to upper lip\n\nReports sensation of swelling increasing during consultation\n\nDyspnoea present - reports difficulty breathing\n\nPossible chest tightness, though patient uncertain\n\nSimilar episode approximately one year ago (September 2025) following late-night Chinese meal (curry), with lip swelling and breathing difficulty\n\nKnown peanut allergy with anaphylactic reaction requiring hospitalisation at age 6\n\nHistory of asthma, managed with salbutamol inhaler\n\nUses antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available in home\n\n\n\n\nObjective:\n\nProgressive lip swelling observed during consultation\n\nPatient became increasingly distressed during consultation\n\nMother present by end of consultation\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nKnown food allergies (peanuts)\n\nAsthma\n\n\n\n\nPlan:\n\nEmergency ambulance called for immediate transfer to emergency department\n\nAdvised immediate administration of antihistamine (sourced by mother)\n\nMother instructed to call 000 for emergency services with notification of suspected anaphylactic reaction\n\nPatient to be assessed in emergency department\n\nAdrenaline auto-injector to be arranged following hospital discharge\n\nFollow-up appointment with practice required after hospital review\n\nPatient advised to contact practice after emergency department assessment\n\n\n\n\nTreating Clinician","review":129.28947368421052,"saved":150.21052631578948,"clean":false,"effort":30.76923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis (possible haemodynamic compromise) not recorded."],["partial","Mother arrives and is asked to stay with the patient and call emergency services.","Emergency number recorded as 000 instead of 999; staying with patient omitted."]],"mb":17.406785,"latency":21.894,"signable":151.18347368421053},{"label":"Run 4","wer":15.170770452740271,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past after eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I didn't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think oh, sorry. The swelling is getting oh, my god. Oh, yeah. I think when I was right. Are you okay now? You're busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. It, I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are work\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[{"start":19,"end":26,"said":"I'm Maria.","significant":true},{"start":99,"end":107,"said":"all right","significant":false},{"start":202,"end":209,"said":"all right","significant":false},{"start":273,"end":290,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":357,"said":"ninety-nine. OK","significant":false},{"start":404,"end":409,"said":"Traba","significant":false},{"start":590,"end":594,"said":"","significant":false},{"start":830,"end":838,"said":"prawn","significant":true},{"start":911,"end":921,"said":".","significant":false},{"start":1016,"end":1021,"said":"Mm-hmm.","significant":false},{"start":1072,"end":1077,"said":"Mm-hmm. Um","significant":false},{"start":1130,"end":1139,"said":"it","significant":false},{"start":1152,"end":1156,"said":"laksa","significant":false},{"start":1206,"end":1210,"said":"Yeah.","significant":false},{"start":1234,"end":1242,"said":"feel","significant":false},{"start":1256,"end":1261,"said":"started","significant":false},{"start":1338,"end":1343,"said":"Mm-hmm.","significant":false},{"start":1621,"end":1621,"said":"Yeah. Right. All","significant":false},{"start":1971,"end":1984,"said":"you developed","significant":false},{"start":2064,"end":2074,"said":"it it","significant":false},{"start":2519,"end":2524,"said":"the chest","significant":false},{"start":2656,"end":2659,"said":"","significant":false},{"start":2812,"end":2812,"said":"Mm-hmm.","significant":false},{"start":2855,"end":2862,"said":"kinda","significant":false},{"start":2930,"end":2930,"said":"Sure OK.","significant":false},{"start":2987,"end":2988,"said":"I've","significant":false},{"start":3116,"end":3122,"said":"don't","significant":false},{"start":3170,"end":3181,"said":"something I think. OK. Right. OK. Uh","significant":false},{"start":3335,"end":3339,"said":"took","significant":false},{"start":3348,"end":3348,"said":"ohh","significant":false},{"start":3569,"end":3569,"said":"Ohh I","significant":false},{"start":3672,"end":3679,"said":"Piriton","significant":true},{"start":3714,"end":3722,"said":"","significant":false},{"start":3726,"end":3731,"said":"I got no I do","significant":false},{"start":3820,"end":3824,"said":"","significant":false},{"start":3864,"end":3877,"said":"antihistamines","significant":true},{"start":3963,"end":3970,"said":"any time","significant":false},{"start":3975,"end":3978,"said":"have","significant":false},{"start":4103,"end":4110,"said":"'cause","significant":false},{"start":4128,"end":4129,"said":"I've","significant":false},{"start":4169,"end":4172,"said":"mum","significant":false},{"start":4320,"end":4322,"said":"Ohh","significant":false},{"start":4355,"end":4357,"said":"ohh","significant":false},{"start":4367,"end":4369,"said":"ohh","significant":false},{"start":4395,"end":4395,"said":"six. Oh. You all","significant":false},{"start":4421,"end":4432,"said":"Ohh I feel a little dizzy","significant":true},{"start":4457,"end":4457,"said":"ohh. Are","significant":false},{"start":4462,"end":4478,"said":". You're feeling dizzy. OK","significant":true},{"start":4596,"end":4608,"said":"uh all right","significant":false},{"start":4945,"end":4950,"said":"mum's. Um","significant":false},{"start":4972,"end":4975,"said":"mum","significant":false},{"start":5011,"end":5011,"said":"OK all","significant":false},{"start":5115,"end":5115,"said":"Ohh no","significant":false},{"start":5142,"end":5143,"said":"I'll","significant":false},{"start":5212,"end":5212,"said":". Hey ohh","significant":false},{"start":5273,"end":5296,"said":"any more. Thank. All right OK","significant":false},{"start":5429,"end":5433,"said":"worried","significant":false},{"start":5610,"end":5618,"said":"uh Mum Mum","significant":false},{"start":5668,"end":5686,"said":"K.","significant":false},{"start":5718,"end":5721,"said":"mum","significant":false},{"start":5731,"end":5734,"said":"Mum","significant":false},{"start":5756,"end":5757,"said":"uh","significant":false},{"start":5875,"end":5879,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5914,"end":5914,"said":"All right","significant":false},{"start":5973,"end":5993,"said":"all right. OK OK.","significant":false},{"start":6004,"end":6004,"said":". And after you","significant":false},{"start":6146,"end":6150,"said":"will","significant":false},{"start":6166,"end":6175,"said":". All . OK","significant":false},{"start":6213,"end":6213,"said":"thank","significant":false},{"start":6229,"end":6236,"said":"bye bye.","significant":true}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Prawn-based soup identified as the exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Swelling commenced approximately 30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Left corner progressing to upper lip, worsening during consultation."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Dyspnoea present, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not documented; note says only \"feeling unwell and anxious\"."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Episode ~1 year ago after Chinese curry with lip swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Background of asthma, managed with salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","Peanut allergy with reaction requiring hospitalisation at age 6."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylaxis secondary to prawn ingestion\" with emergency transfer."],["The note captures: Urgent ambulance/999 call is advised or arranged.","partial","Ambulance call captured but recorded as \"via 000\"; the clinician specified 999."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother's arrival captured, but not that she was asked to stay with the patient and call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Immediate administration of antihistamine (provided by mother)\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Post-discharge follow-up to arrange adrenaline auto-injector."]],"claims":[["27-year-old female","Patient gave DOB 1 October 1999; on the 22/09/2026 session date she is 26, so the age is wrong."],["Emergency ambulance called via 000","Clinician explicitly said to call \"nine nine nine\"; 000 is never mentioned."]],"note":"SOAP Notes\n\n\n\n\nPatient: Maria Trabaloxa\n\nDate of Birth: 01/10/1999\n\nDate of Consultation: 22/09/2026\n\nTime: 5:56 pm\n\n\n\n\nSubjective:\n\n27-year-old female presenting with acute lip swelling following prawn laksa consumption at approximately 7:00 pm today\n\nSwelling commenced approximately 30 minutes post-ingestion, initially left corner of mouth, progressing to upper lip\n\nReports progressive worsening of swelling during consultation\n\nDyspnoea present, possible chest tightness\n\nSimilar episode approximately one year ago (September 2025) following Chinese curry consumption, with lip swelling and breathing difficulty\n\nKnown peanut allergy since childhood with anaphylaxis requiring hospitalisation at age 6\n\nBackground of asthma, managed with salbutamol inhaler\n\nTakes antihistamines for peanut allergy (specific type unknown)\n\nNo antihistamines available at home at time of consultation\n\nMother arrived during consultation and confirmed antihistamines available\n\n\n\n\nObjective:\n\nPatient alone initially, mother arrived during consultation\n\nProgressive lip swelling observed during consultation\n\nPatient reported feeling unwell and anxious\n\n\n\n\nAssessment:\n\nSuspected anaphylaxis secondary to prawn ingestion\n\nLikely shellfish/prawn allergy\n\nKnown peanut allergy with previous anaphylaxis\n\nAsthma\n\n\n\n\nPlan:\n\nEmergency ambulance called via 000\n\nImmediate administration of antihistamine (provided by mother)\n\nTransfer to hospital for adrenaline injection and emergency management\n\nFollow-up post-discharge required to arrange adrenaline auto-injector prescription and allergy action plan\n\nPatient advised to contact practice after hospital discharge\n\n\n\n\nTreating Clinician","review":132.71052631578948,"saved":146.78947368421052,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness is recorded only as 'unwell and anxious', which loses a sign of cardiovascular compromise."]],"mb":17.55461,"latency":23.15,"signable":155.86052631578949},{"label":"Run 5","wer":15.250198570293886,"text":"Hi. Hello? Hi. Hi, Amelia. Hello. I'm doctor Jacob, and welcome to Babylon. How are you doing? I'm alright. Thank you. I feel a little weird today, to be honest. Yeah. So just before we we start, is it alright if you could confirm your full name for me, please? Yes. Maria Trabaloxa.\n\nOkay. Day and your date of birth? That is the first of October 99. Okay. And your email address for me, please? Yes. M Trava at Gmail dot com. Okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes. I think I am. Yeah. Good. Right. You've mentioned in your in in your patient\n\nNotes that you're having some sort of lip swelling and you after you had a sandwich. Is that correct? Yeah. That is well, I don't think I don't think it was it it wasn't a sandwich, but it was it was something with Crohn's. So, basically, I I sometimes go with my friends to to this place called Phet Phap. And we we regularly have like, usually, I have, like, a normal\n\nVegetarian soup or something. Mhmm. And yeah. And then I wanted to try something new. Mhmm. So what happened was I I ordered a prawn soup. It's it's it's it's called lax. It's like a soup. I ordered a prawn 1 this time. Yep. And, yeah, and then my it feels like my lips start feeling a little weird just in the in the corner sort of on the left first. Mhmm. And then I don't know.\n\nAnd then we went back. We had a little bit of a chat, a banter. I wasn't really paying attention. Now I feel that that there is a swelling. Yeah. There is, like, a swelling on my on my upper lip, and it's kind of getting bigger. I don't know what to do. Right. So when did you have the prawn soup? What time? That was that must have been just after work, so maybe, like, around\n\n7. Okay. Around 7 o'clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been, like, must have been, like, I don't know, half an hour maybe. Okay. In half an hour, you'd develop the swelling. Yeah? Yeah. Okay. And it's getting bigger and bigger? Yeah. It's it's I can still feel it, like, really pumping blood in\n\nIt's kinda getting bigger. It feels like it's getting worse. Okay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in in your throat? Like, your throat is closing up. Any feeling like that? Yeah. Actually, I I feel like I can't breathe that well right now. Okay. And do you feel like like your chest is tight? I don't know if it's\n\nTest. It's just generally feels a little difficult. Okay. But, yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these any kind of lip swelling in the past, not eating any food? Yeah. Well, maybe. I remember, like, a year ago a year ago, I was out with my friends.\n\nAnd I think we went, like, to late night kind of Chinese place, and I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like Okay. Felt really bad and quite difficult breathing. Right. But I don't know what it was I had. It was like a curry or some\n\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell I I take what's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asthma. And any other inhalers? Is it just the salbutamol that you use? Any other brown\n\nInhalers? No. I don't think so. No. Okay. Right. And so do you use antihistamines like cetirizine, loratadine, Peritin, any of those kind of things? No. About oh, I think sometimes, but I don't know which ones. So I have a peanut allergy as well. Yeah. Like, I've always had it. Yeah. I think I do get\n\nTo histamines for that, but I'm not sure which ones. And any point because you had peanut allergy, anytime you had to ever use, like, an injection? When I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small, and I changed doctors since. Right. Has your mom ever said that you had to go to hospital because you had an severe allergic reaction? Yeah. Is that well, I was like,\n\n6 or something. I I I think oh, sorry. The swelling is getting oh, my god. Oh, yeah. I think when I was right. Are you okay now? You're busy right now, to be honest. You feel busy? Okay. Right. Do you have any kind of antihistamines with you at the moment? No. I don't think I have. No. Okay. So\n\nRight. Oh, alright. I I'm really a bit worried about you at the moment, Maria. I think we need to call an ambulance because, from what history you've been telling me, it sounds like you could be going into what we say an anaphylactic reaction. That's when your throat and your chest, you know, closes in, and you might need an injection like what your mom's, you know, what your mom told you as you were a young child. Okay.\n\nRight? So is there any anyone with you at the moment, or are you alone? I'm alone at the moment. Yeah. So hang on the line while I call the ambulance. Okay? And I'll send them right to you. Okay? And Somebody just came. Somebody just came. Yeah. I'm not alone anymore. Alright. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah? And because we are\n\nAbout an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes. Mom, mom, do we have any antihistamines around? Yes. Yes. Oh, yeah. Yeah. We do. That straight away. And if mom can call mom, if you can call the 9 9 9 9 9 9, yeah, and say that your there is a suspected anaphylactic reaction, and they need to come\n\nStraight away. Okay? Yes. She said she will. Yes. Yes. So straight away take the antihistamines in the meantime. Alright? Okay. Okay. Yes. Thank come out from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes. I'll do. Yes. Thank you. Okay then. Take care. Thank you very much. Bye bye. Bye.\n\nXiaflex","marks":[{"start":19,"end":26,"said":"I'm Maria.","significant":true},{"start":99,"end":107,"said":"all right","significant":false},{"start":202,"end":209,"said":"all right","significant":false},{"start":273,"end":290,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":357,"said":"ninety-nine. 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Hi. Hi, I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing?\n\nI'm\n\nalright.\n\nThank you. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could\n\nyour full name for me, please?\n\nYes.\n\nMaria Trabowatza.\n\nOkay. Day... And your date of birth?\n\nThat is the 10/01/1999.\n\nOkay. And your email address for me, please?\n\nYes. Mtrava@gmail.com.\n\nOkay.\n\nAnd just to confirm that you're in a secure location, and we can have a confidential\n\nYes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your... In in your patient notes that you're having some...\n\nOf lip swelling and you... After you had a sandwich?\n\nIs that correct?\n\nYeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have... Like, usually, I have\n\nlike, a normal vegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I'm not sure what it was I had. It was like a\n\ncurry or something, I think.\n\nAnd what did\n\nyou take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nLike,\n\nalways had it. Yeah.\n\nI think\n\nI did get antihistamines for that.\n\nBut I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh, you\n\nI think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say an\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at\n\nthe moment. Yeah. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to\n\nyou.\n\nOkay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nOh, okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements\n\naround? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay.\n\nYes.\n\nThank\n\nyou. Out\n\nfrom\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes.\n\nThank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. 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risk of airway compromise\"; needs an ambulance straight away."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Instructed to call 999 for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother arriving and staying is captured, but the note does not say the mother was asked to make the call."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact clinic to arrange adrenaline auto-injector prescription\"."]],"claims":[["Salbutamol inhaler as needed","Patient said \"I do take that regularly\"; 'as needed' contradicts the stated frequency."]],"note":"Presenting Condition\n\nOnset after prawn soup around 19:00; lip swelling began ~30 min later\n\nUpper lip swelling starting left corner, now enlarging; pulsatile sensation\n\nBreathing feels difficult; unsure about chest tightness\n\nPrior similar episode ~1 year ago after late-night Chinese meal with next‑day swelling and difficult breathing\n\nPeanut allergy since childhood\n\nReason for visit: acute swelling after suspected food trigger, concern about worsening symptoms\n\n\n\n\nRadiology\n\n- \n\n\n\n\nPrevious MSK injuries\n\n- \n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nHistory of severe allergic reaction in childhood requiring hospital care (injection administered)\n\n\n\n\nMedications\n\nSalbutamol inhaler as needed\n\nNo regular preventer inhaler reported\n\nNo current antihistamines on hand prior to call\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: reports difficulty breathing\n\nChest tightness: unsure\n\nPrevious lip swelling episodes: yes, ~1 year ago after meal\n\nUse of antihistamines previously: uncertain\n\nUse of adrenaline injection in past: possibly in childhood\n\nCurrent safety: initially alone, later mother present\n\n\n\n\nSocial History\n\nEats out with friends; mother available at home\n\n\n\n\nGoals\n\nAdvised to call back post-hospital for injection prescription planning\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: visible/progressive upper lip swelling reported by patient\n\nFunctional tests: breathing subjectively difficult\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction to seafood (prawn) given rapid onset swelling and breathing difficulty\n\nPrognosis: requires urgent emergency management\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nSuspected anaphylaxis; risk of airway compromise\n\nNeed immediate ambulance attendance\n\nActions:\n\nInstructed to call 999 for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nEnsure accompaniment by mother until ambulance arrives\n\n// Patient reported mother present; antihistamine available and to be taken; ambulance to be called urgently\n\n\n\n\nPlan\n\nImmediate ED assessment and treatment\n\nPost‑hospital: contact clinic to arrange adrenaline auto‑injector prescription and allergy management plan\n","review":130.23684210526315,"saved":149.26315789473685,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call is not documented."],["fabrication","Salbutamol inhaler as needed","Salbutamol frequency changed from regular to as-needed, misrepresenting asthma control relevant to anaphylaxis risk."]],"mb":14.086936,"signable":153.81084210526316},{"label":"Run 2","wer":16.838760921366163,"text":"Hi. Hello?\n\nHi. Hi. I'm Maria. Hello. I'm doctor Jake and welcome to Babylon. Mhmm. How are you doing?\n\nI'm alright. Thank you. I feel a little weird.\n\nToday, to be honest. Yeah. So just before we we start, is it alright if you could\n\nyour full name for me, please? Yes.\n\nMaria Trabalotza. Okay. Day and your date of birth?\n\nThat is the 10/01/1999. Okay. And your email address for me, please?\n\nYes. Mtrava@gmail.com. Okay.\n\nAnd just to confirm that you're in a secure location and we have a confidential\n\nconversation. Yes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your in in your patient notes that you're having some, let's\n\nsort of lip swelling and you after you had a sandwich?\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was it it wasn't a farm rich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have, like, usually, a half\n\nlike, a normal vegetarian soup or something. Mhmm. And, yeah, and\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\nsoup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my it feels like my lips start\n\nfeeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat of banter. It wasn't really\n\npaying attention. Now I feel\n\nthat that there is a swelling. Yep. There is, like, a\n\nswelling on my on my upper lip, and it's kind of getting bigger.\n\nI don't know what to do. Right.\n\nSo when did you have\n\nthe prawn soup? What time?\n\nThat was that must have been just\n\nto work, so maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention, so\n\nit must have been, like, must have been, like,\n\nI don't know, half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah. Okay.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's can you still feel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay.\n\nSo just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I I feel like I can't breathe that\n\nwell right now.\n\nOkay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if it's the chest. It just generally feels a little\n\ndifficult. Okay. But, yeah, it might be. I'm not\n\nsure.\n\nOkay. Right.\n\nAnd just a few. Have you ever had\n\nthese\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends. Mhmm.\n\nAnd I think we went, like,\n\nto late night kinda Chinese place, and I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad. And\n\nquite difficult breathing. Right. But I didn't know what it was I had\n\nwas like a curry or something, I think. Okay.\n\nAnd what did you take\n\nat\n\nthat\n\ntime? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell I I take oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have\n\nasthma. And any other inhalers? Is\n\njust the salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those?\n\nKind of things?\n\nAbout no. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nI always had it.\n\nYeah. I think I do get antihistamines for that, but I'm not\n\nsure which ones.\n\nAnd any point because you've had penitillas,\n\nany time you had to ever use, like, an injection?\n\nWhen I was a kid, I think I remember my mom\n\ntold me about it, but I don't know what it was because I was small. And I changed doctors since.\n\nRight. Has your mom ever said that you had to go to\n\nbecause you had an severe allergic reaction?\n\nYeah. Is that well, I was, like, six or something. I\n\nI I think, oh, sorry. The swelling is getting\n\nOkay. Like that. Ugh. Yeah. I think when I was run.\n\nAre you okay\n\nnow?\n\nYou're busy right now.\n\nBe honest.\n\nYou're\n\nbeing\n\nbusy? Okay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nRight. Alright. I I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because from what\n\nhistory you've been telling me, it sounds like you\n\ncould be going into what we say an anaphylactic reaction.\n\nThat's when your throat and your chest, you know, closes in.\n\nAnd you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any anyone with you at the moment, or\n\nare you alone?\n\nI'm alone at the moment. Oh, no.\n\nSo\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd Somebody just\n\ncame. Somebody just came. Yeah. I'm not alone anymore.\n\nOkay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah?\n\nAnd because we are worried about an anaphylactic reaction\n\nso you need to go straight away. Could you ask the\n\nperson whether they have any antihistamines around in the interim?\n\nWhile we're waiting. Yes.\n\nMom, mom, do we have any announcements around? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away. And if mom can call mom, if you can\n\ncall the, 99999. Yeah?\n\nAnd say that your there is a suspected anaphylactic reaction\n\nand they need to come straight away. Okay?\n\nYes. She said she will. Yes. Yes. So\n\nstraight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank you. Come out from\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out.\n\nWith your injections and things like that. Okay?\n\nYeah.\n\nYes. I'll do. Yes. Thank\n\nyou. Okay then. Take\n\ncare.\n\nThank you very much. Bye bye. Bye. Bye.","marks":[{"start":49,"end":53,"said":"Jacob","significant":false},{"start":78,"end":83,"said":"","significant":false},{"start":108,"end":116,"said":"all right","significant":false},{"start":213,"end":220,"said":"all right","significant":false},{"start":233,"end":233,"said":"confirm","significant":false},{"start":278,"end":295,"said":"Trabalotsa. OK","significant":false},{"start":337,"end":354,"said":"first of October ninety-nine. OK","significant":false},{"start":400,"end":423,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":484,"end":484,"said":"can","significant":false},{"start":579,"end":583,"said":"","significant":false},{"start":634,"end":639,"said":"","significant":false},{"start":785,"end":794,"said":"sandwich","significant":false},{"start":830,"end":837,"said":"prawn","significant":true},{"start":954,"end":960,"said":"I have","significant":false},{"start":1007,"end":1012,"said":"Mm-hmm.","significant":false},{"start":1065,"end":1070,"said":"Mm-hmm. 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Oh. You all right","significant":false},{"start":4515,"end":4526,"said":"Ohh I feel a little dizzy","significant":true},{"start":4549,"end":4549,"said":"ohh. Are you .","significant":false},{"start":4559,"end":4577,"said":"feeling dizzy. OK","significant":false},{"start":4707,"end":4715,"said":"uh all right","significant":false},{"start":5052,"end":5057,"said":"mum's. Um","significant":false},{"start":5079,"end":5082,"said":"mum","significant":false},{"start":5120,"end":5125,"said":"OK all","significant":false},{"start":5225,"end":5227,"said":"yeah. Ohh","significant":false},{"start":5336,"end":5336,"said":". Hey ohh","significant":false},{"start":5398,"end":5413,"said":"any more. Thank. All right OK","significant":false},{"start":5735,"end":5743,"said":"uh Mum Mum","significant":false},{"start":5760,"end":5773,"said":"antihistamines","significant":true},{"start":5793,"end":5812,"said":"K.","significant":false},{"start":5845,"end":5848,"said":"mum","significant":false},{"start":5858,"end":5861,"said":"Mum","significant":false},{"start":5885,"end":5891,"said":"uh nine nine nine nine nine","significant":false},{"start":5998,"end":6002,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6038,"end":6038,"said":"All right","significant":false},{"start":6098,"end":6119,"said":"all right. OK OK.","significant":false},{"start":6130,"end":6130,"said":". And after","significant":false},{"start":6288,"end":6292,"said":"yes will","significant":false},{"start":6309,"end":6318,"said":". All . OK","significant":false},{"start":6358,"end":6358,"said":"thank","significant":false},{"start":6377,"end":6377,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after prawn laksa soup\" identifies prawn soup exposure."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 minutes post-ingestion\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Progression: increasing swelling; pulsatile sensation; worsening\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"breathing difficulty; possible chest tightness\"; throat closing sensation present."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"~1 year ago after late-night Chinese/curry; woke with swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma with \"Salbutamol inhaler\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy since childhood\" with \"Possible prior anaphylaxis in childhood requiring injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction ... urgent medical treatment required\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call emergency services immediately for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and patient to remain with another person, but mother arriving and being asked to call emergency services is not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Post-hospital follow-up for adrenaline autoinjector provision\"."]],"claims":[["asthma review (consider preventer)","No asthma review or preventer inhaler was proposed; the clinician only asked whether she used other inhalers."]],"note":"Presenting Condition\n\nSudden upper lip swelling after prawn laksa soup around 19:00\n\nOnset ~30 minutes post-ingestion\n\nProgression: increasing swelling; pulsatile sensation; worsening\n\nLocation: upper lip, started at left corner\n\nAssociated symptoms: breathing difficulty; possible chest tightness\n\nPrevious episode: ~1 year ago after late-night Chinese/curry; woke with swelling and breathing difficulty\n\nReasons for visit: acute lip swelling and breathing difficulty after meal\n\n\n\n\nRadiology\n\n- \n\n\n\n\nPrevious MSK injuries\n\n- \n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nPossible prior anaphylaxis in childhood requiring injection (per mother’s report)\n\n\n\n\nMedications\n\nSalbutamol inhaler PRN\n\nIntermittent antihistamines for peanut allergy (unsure type)\n\nNo preventer (“brown”) inhaler\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: uncertain\n\nPast similar reactions: present (approx 1 year ago; childhood severe reaction)\n\nCurrent access to antihistamines: initially none on person; mother has antihistamines at home\n\n\n\n\nSocial History\n\nLives with mother (present during call)\n\n\n\n\nGoals\n\nImmediate relief of swelling and breathing difficulty\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: progressive upper lip swelling reported; dyspnoea reported during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following shellfish (prawn) exposure; differential includes isolated angioedema, but respiratory symptoms concerning for anaphylaxis\n\nPrognosis: urgent medical treatment required; risk of rapid deterioration\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nCall emergency services immediately for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nRemain with another person until help arrives\n\nPost-hospital follow-up for adrenaline autoinjector provision and allergy management\n\n// Patient’s mother present; antihistamine available; ambulance to be called; symptoms worsening during call\n\n\n\n\nPlan\n\nImmediate transfer to emergency via ambulance\n\nAfter discharge: contact clinic to arrange prescription/training for adrenaline autoinjector and allergy referral (shellfish/peanut), asthma review (consider preventer)\n","review":128.0263157894737,"saved":151.4736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."],["fabrication","asthma review (consider preventer)","Invents an asthma review and preventer consideration as a follow-up plan item."]],"mb":13.809089,"signable":161.8943157894737},{"label":"Run 3","wer":16.918189038919778,"text":"Hi.\n\nHello? Hi. Hi, I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing?\n\nI'm\n\nalright.\n\nThank you. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could\n\nyour full name for me, please?\n\nYes.\n\nMaria Trabowatza.\n\nOkay. Day... And your date of birth?\n\nThat is the 10/01/1999.\n\nOkay. And your email address for me, please?\n\nYes. Mtrava@gmail.com.\n\nOkay.\n\nAnd just to confirm that you're in a secure location, and we can have a confidential\n\nYes. I think I am. Yeah. Good.\n\nRight. You've mentioned in your... In in your patient notes that you're having some...\n\nOf lip swelling and you... After you had a sandwich?\n\nIs that correct?\n\nYeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends\n\nto to this place called\n\nAnd we we regularly have... Like, usually, I have\n\nlike, a normal vegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\nsoup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd\n\njust\n\na few. Have you ever had\n\nthese\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I'm not sure what it was I had. It was like a\n\ncurry or something, I think.\n\nAnd what did\n\nyou take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight.\n\nAnd so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah.\n\nLike,\n\nalways had it. Yeah.\n\nI think\n\nI did get antihistamines for that.\n\nBut I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh, you\n\nI think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo.\n\nRight. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say an\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at\n\nthe moment. Yeah. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to\n\nyou.\n\nOkay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nOh, okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements\n\naround? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay.\n\nYes.\n\nThank\n\nyou. Out\n\nfrom\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay?\n\nYes.\n\nYes.\n\nI'll\n\ndo. Yes.\n\nThank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[{"start":82,"end":87,"said":"","significant":false},{"start":114,"end":122,"said":"all right","significant":false},{"start":219,"end":226,"said":"all right","significant":false},{"start":239,"end":239,"said":"confirm","significant":false},{"start":285,"end":303,"said":"Trabalotsa. OK","significant":false},{"start":348,"end":366,"said":"first of October ninety-nine. OK","significant":false},{"start":412,"end":436,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":522,"end":522,"said":"conversation","significant":false},{"start":583,"end":590,"said":"","significant":false},{"start":642,"end":642,"said":"sort","significant":false},{"start":834,"end":841,"said":"prawn","significant":true},{"start":1013,"end":1018,"said":"Mm-hmm.","significant":false},{"start":1073,"end":1078,"said":"Mm-hmm. 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OK","significant":false},{"start":6416,"end":6416,"said":"thank","significant":false},{"start":6437,"end":6437,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after eating prawn laksa'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'started ~30 min after eating'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'now enlarging and throbbing'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","Throat narrowing sensation, difficulty breathing, chest tightness uncertain."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","'Previous similar episode ~1 year ago after late-night Chinese curry... swelling and difficult breathing'."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Asthma' and 'Salbutamol inhaler used regularly'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","'Peanut allergy' and 'prior severe allergic reaction in childhood requiring injection and hospital visit'."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction... Urgent condition requiring ambulance transfer'."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Immediate ambulance transfer to hospital'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Mother present and 'Keep companion present' recorded, but mother being asked to call emergency services is not explicit."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'Take available antihistamine while awaiting ambulance'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'contact clinic to arrange autoinjector'."]],"claims":[["Post-hospital follow-up to include 'allergy action plan, and review asthma control'","The clinician only said to ring back to 'sort you out with your injections'; neither an action plan nor asthma review was stated."]],"note":"Presenting Condition\n\nAcute upper lip swelling started ~30 min after eating prawn laksa around 19:00\n\nSensation of throatal narrowing and difficulty breathing; feels chest may be tight\n\nSwelling started left corner of upper lip, now enlarging and throbbing\n\nPrevious similar episode ~1 year ago after late-night Chinese curry with next-morning swelling and difficult breathing\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries mentioned\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy since childhood\n\nHistory suggestive of prior severe allergic reaction in childhood requiring injection and hospital visit\n\nAllergies:\n\nPeanut\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nNo preventer (“brown”) inhaler\n\nIntermittent antihistamine use in past (unsure which)\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: uncertain\n\nPrior lip swelling episodes: present (~1 year ago)\n\nCurrent access to antihistamines: initially none; mother located some during call\n\n\n\n\nSocial History\n\nLives with/has access to mother at time of call\n\n\n\n\nGoals\n\nSeek emergency care for current reaction\n\nPost-hospital: arrange prescriptions for injections (e.g., autoinjector) per doctor advice\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Patient reports progressive upper lip swelling; subjective dyspnoea\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction after shellfish (prawn) exposure; differential includes acute allergic angioedema\n\nUrgent condition requiring ambulance transfer\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nCall emergency services immediately for suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nKeep companion present until ambulance arrives\n\nAfter hospital discharge, contact clinic to arrange autoinjector and management plan\n\n// Ambulance to be called; mother present and locating antihistamines; patient to take antihistamine immediately\n\n\n\n\nPlan\n\nImmediate ambulance transfer to hospital\n\nPost-hospital: follow-up to organise epinephrine autoinjector, allergy action plan, and review asthma control\n\nPatient to ring clinic after discharge to arrange further management\n","review":130.55263157894737,"saved":148.94736842105263,"clean":false,"effort":23.076923076923077,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["fabrication","Post-hospital follow-up to include 'allergy action plan, and review asthma control'","Invented follow-up plan items (allergy action plan, asthma review)."]],"mb":14.370863,"signable":156.25263157894736},{"label":"Run 4","wer":16.997617156473392,"text":"Hi.\n\nHello? Hi. Hi. I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing? I'm alright.\n\nThank\n\nyou. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could confirm your full name for me, please?\n\nYes.\n\nMaria Trabalotza.\n\nOkay. Date and your date of birth? That is the 10/01/1999. Okay.\n\nAnd your email address for me, please? Yes.\n\nMtraba@gmail.com.\n\nOkay. And just to confirm that you're in a secure location, and we can have a\n\nYes. I think\n\nI am. Yeah.\n\nGood. Right. You've mentioned in your in in your patient notes\n\nthat you're having some sort of lip swelling and you after you had a sandwich,\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was it it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends to to the\n\nplace called, and we\n\nwe regularly have, like usually, I have, like,\n\na normal\n\nvegetarian soup or something. Mhmm. And yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my it feels like like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe that there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was that must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah.\n\nIt's it's it's can you still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto a late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I didn't know what it was I had. It was like\n\ncurry or something, I think.\n\nAnd what did you take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell I I take oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight. And so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well.\n\nYeah. Like,\n\nalways had it.\n\nYeah.\n\nI think I did get into his\n\nhistamines for that, but I'm not sure which ones.\n\nAnd any\n\npoint because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh,\n\nYeah. I think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've\n\nbeen\n\nbusy? Okay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo? Right. Okay. So\n\nright. Oh, alright. I I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say and\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at the\n\nmoment. Oh, no. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nAlright. Okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements around? Yes.\n\nYes. Oh, yeah.\n\nYeah. We do. That\n\nstraight away, and\n\nAnd if mom can call mom, if you can call the 99999, yeah, and say that your there is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank\n\nyou. Out from the\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes. Thank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. 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OK","significant":false},{"start":6349,"end":6349,"said":"thank","significant":false},{"start":6370,"end":6370,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"upper lip swelling after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 mins post-meal\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Acute upper lip swelling ... progressive increase in swelling\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports breathing difficulty and possible throat involvement\"; chest tightness unsure."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness is not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","\"Previous similar episode after late-night Chinese food about a year ago with swelling and breathing difficulty\"."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma and \"Salbutamol inhaler used regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy; childhood episode required hospital treatment and injection\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Immediate emergency response required due to suspected anaphylaxis\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Urgent ambulance transfer to hospital now\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Initially alone, mother later present; accompanying person to call emergency services and remain present."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","Post-discharge contact for \"prescription of emergency injection device\"."]],"claims":[["antihistamine ... later confirmed available and taken as advised / antihistamine taken","Transcript only shows antihistamines confirmed available and patient told to take them; taking them is never reported."]],"note":"Presenting Condition\n\nAcute upper lip swelling after eating prawn soup around 19:00\n\nOnset ~30 mins post‑meal; progressive increase in swelling\n\nReports breathing difficulty and possible throat involvement\n\nPrevious similar episode after late-night Chinese food about a year ago with swelling and breathing difficulty\n\nReasons for visit: concern about worsening lip swelling and breathing difficulty\n\n\n\n\nRadiology\n\n\n\n\nPrevious MSK injuries\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy; childhood episode required hospital treatment and injection reported by mother\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nAntihistamines used previously for peanut allergy; specific agent unknown\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present\n\nBreathing difficulty: present\n\nChest tightness: unsure\n\nPrior lip swelling with foods: present\n\nAccess to antihistamines now: initially no, later confirmed available and taken as advised\n\n\n\n\nSocial History\n\nWas alone initially; mother later present to assist and call ambulance\n\n\n\n\nGoals\n\nSeeks urgent relief of swelling and breathing difficulty\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Patient reports rapidly increasing upper lip swelling; dyspnoea subjectively worsening during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following seafood ingestion\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nImmediate emergency response required due to suspected anaphylaxis\n\nTake available antihistamine while awaiting ambulance\n\nHave accompanying person call emergency services and remain present\n\nReferrals/communications:\n\nAdvised calling emergency services for urgent assessment and possible injection (e.g., adrenaline) and hospital care\n\n// Patient’s mother present; antihistamine taken; ambulance call initiated\n\n\n\n\nPlan\n\nUrgent ambulance transfer to hospital now\n\nPost-discharge: contact clinic for allergy management plan and prescription of emergency injection device (per discussion)\n","review":104.0,"saved":175.5,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis signals possible circulatory involvement; omitting it understates severity."],["fabrication","antihistamine ... later confirmed available and taken as advised / antihistamine taken","Records antihistamine as taken when only its availability and advice to take it were stated; misstates treatment given before ED."]],"mb":13.933604,"signable":128.472},{"label":"Run 5","wer":16.997617156473392,"text":"Hi.\n\nHello? Hi. Hi. I'm Maria.\n\nHello. I'm doctor Jacob, and welcome to Babylon.\n\nMhmm.\n\nHow are you doing? I'm alright.\n\nThank\n\nyou. I feel a little weird today, to be honest.\n\nYeah. So just before we we start, is it alright if you could confirm your full name for me, please?\n\nYes.\n\nMaria Trabalotza.\n\nOkay. Date... And your date of birth? That\n\nis\n\nthe 10/01/1999. Okay.\n\nAnd your email address for me, please? Yes.\n\nMtraba@gmail.com.\n\nOkay. And just to confirm that you're in a secure location, and we can have a\n\nYes. I think I am. Yeah.\n\nGood. Right. You've mentioned in your in in your patient notes\n\nthat you're having some sort of lip swelling and you... After you had a sandwich,\n\nIs that correct? Yeah. That is\n\nwell, I don't think I don't think it was... It it wasn't a sandwich, but it was\n\nit was something with crumbs. So, basically,\n\nI I sometimes go with my friends to to the\n\nplace called, and we\n\nwe regularly have, like... Usually, I have,\n\nlike, a normal\n\nvegetarian soup or something. Mhmm. And... Yeah. And\n\nthen I wanted to try something new. Mhmm.\n\nSo what happened was I I ordered a\n\nprawn soup. It's it's it's it's called a laxus. It's like\n\na soup. I ordered a prawn one this time. Yeah. And\n\nYeah. And then my... It feels like... Like, my lips\n\nstart feeling a little weird just in the in the corner sort of on the left first. Mhmm.\n\nAnd then I don't know. And then\n\nwe went back. We had a little bit of a chat, a banter. It wasn't really\n\npaying attention. Now I feel\n\nthe... That there is a swelling. Yep. There is, like, a swelling on my on my\n\nupper lip, and it's kind of getting bigger. I don't know what to do.\n\nRight.\n\nSo when did you have the prawn soup? What time?\n\nThat was... That must have been just after work.\n\nSo maybe, like, around seven. Okay.\n\nAround 07:00. And how long did it take to develop the swelling?\n\nWell, I wasn't really paying attention. So\n\nit must have been, like, must have been, like,\n\nan... Half an hour maybe.\n\nOkay. In half an hour, you'd develop the swelling. Yeah?\n\nYeah.\n\nAnd it's getting bigger and bigger?\n\nYeah. It's it's it's... Can\n\nyou still\n\nfeel it, like,\n\nreally pumping blood, and it's kinda getting bigger. It feels like it's getting worse.\n\nOkay. So just a few more questions.\n\nSo you mentioned about your swelling of your lips. Is there any\n\nfeeling of swelling in in your throat, like your throat is closing up? Any feeling like that?\n\nYeah. Actually, I\n\nI feel like I can't breathe that well right now. Okay.\n\nAnd do you feel like like your chest is tight?\n\nI don't know if\n\nit's the\n\nchest. It just generally feels a little\n\ndifficult.\n\nOkay.\n\nBut, yeah, it might be. I'm not\n\nsure. Okay. Right.\n\nAnd just a few. Have you ever had these\n\nany kind of lip swelling in the past?\n\nNot eating any food?\n\nYeah.\n\nWell, maybe. I remember, like, a year ago,\n\na year ago, I was out with my friends.\n\nMhmm. And I think we went, like,\n\nto a late night kinda Chinese place. And I remember that I was quite drunk to be honest. Sure. Okay. And I remember that after, like,\n\nhaving that very late, I woke up the next morning quite\n\nswollen up and had also, like Okay. Felt really bad and\n\nquite difficult breathing. Right. But I didn't know what it was I had. It was like\n\ncurry or something, I think.\n\nAnd what did you take\n\nat that time? Did you use anything like antihistamine or anything?\n\nWhen you had that last time?\n\nWell, I generally have\n\nasthma. So I tell... I I take... Oh, what's it called?\n\nSalbutamol inhalers? Yeah.\n\nYeah. So I do take that regularly, but I've always take\n\nit. I generally have asthma.\n\nAnd any other inhalers, is it just\n\nthe salbutamol that you use? Any other brown inhalers?\n\nNo. I don't think so. No. Okay.\n\nRight. And so do you use antihistamines like\n\ncetirizine, loratadine, pyrithine, any of those\n\nkind of things?\n\nNo. About\n\nno. I think sometimes, but I don't know which ones.\n\nSo I have a peanut allergy as well. Yeah. Like,\n\nalways had it.\n\nYeah.\n\nI think I did get into his\n\nhistamines for that, but I'm not sure which ones.\n\nAnd any\n\npoint... Because you had penatology, anytime you have to ever use\n\nlike, an injection.\n\nWhen I was a kid, I think I remember my mom told me about it.\n\nBut I don't know what it was because I was small, and I changed doctors since.\n\nRight.\n\nHas your mom ever said that you had to go to hospital because you\n\nsevere allergic reaction?\n\nYeah. Is that... Well, I was like,\n\nsix or something. I I I think\n\noh, sorry. Swelling is getting Okay. Like, oh,\n\nYeah. I think when I was\n\nright. Are you okay now?\n\nYou're busy right now, to be honest.\n\nYou've been busy?\n\nOkay. Right. Do you have any kind\n\nof\n\nantihistamines with you at the moment?\n\nNo. I don't think I have.\n\nNo? Right. Okay. So\n\nright. Oh, alright. I... I'm really a bit worried about you at the moment, Maria.\n\nI think we need to call an ambulance because\n\nfrom what history you've been telling me,\n\nit sounds like you could be going into what we say and\n\nanaphylactic reaction. That's when your throat and your chest\n\nyou know, closes in. And you might need an injection like what your mom's\n\nyou know, what your mom told you as you were a young child.\n\nOkay. Right? So is there any... Anyone with you at\n\nthe moment, or are you alone?\n\nI'm alone at the\n\nmoment. Oh, no. So\n\nhang on the line while I'll call the ambulance. Okay?\n\nAnd I'll send them right to you. Okay?\n\nAnd...\n\nSomebody just came. Somebody just came. Yeah. I'm not alone anymore.\n\nAlright. Okay. Somebody just came. So just call the ambulance. Make sure that\n\nperson's with you till the ambulance comes. Yeah? And\n\nbecause we are worried about an anaphylactic reaction, so you need to go straight away.\n\nCould you ask the person whether they have any antihistamines around in the interim?\n\nWhile we're waiting.\n\nYes.\n\nMom mom, do we have any announcements around? Yes.\n\nYes. Oh,\n\nyeah. Yeah. We do. That straight\n\naway, and\n\nAnd if mom can call... Mom, if you can call the 99999, yeah, and say that your... There is a suspected\n\nanaphylactic reaction, and they need to come straight away.\n\nOkay?\n\nYes. She said she will. Yes.\n\nSo straight away take the antihistamines in the meantime. Alright?\n\nOkay. Okay. Yes. Thank you. Out from\n\nthe\n\nhospital. Do you give us a ring back? We might need to sort you out\n\nwith your injections and things like that. Okay? Yes.\n\nYes. I'll do. Yes. Thank you.\n\nOkay then. Take care.\n\nThank you very much.\n\nBye bye.\n\nBye. Bye.","marks":[{"start":82,"end":87,"said":"","significant":false},{"start":112,"end":120,"said":"all right","significant":false},{"start":218,"end":225,"said":"all right","significant":false},{"start":291,"end":317,"said":"Trabalotsa. OK day","significant":false},{"start":356,"end":373,"said":"first of October ninety-nine. OK","significant":false},{"start":420,"end":444,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":516,"end":516,"said":"confidential conversation","significant":false},{"start":577,"end":581,"said":"","significant":false},{"start":826,"end":833,"said":"prawn","significant":true},{"start":1007,"end":1012,"said":"Mm-hmm.","significant":false},{"start":1067,"end":1072,"said":"Mm-hmm. 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Oh. You all","significant":false},{"start":4548,"end":4559,"said":"Ohh I feel a little dizzy","significant":true},{"start":4586,"end":4610,"said":"ohh. Are you . You're feeling dizzy. OK","significant":true},{"start":4739,"end":4751,"said":"uh all right","significant":false},{"start":5091,"end":5096,"said":"mum's. Um","significant":false},{"start":5118,"end":5121,"said":"mum","significant":false},{"start":5159,"end":5164,"said":"OK all","significant":false},{"start":5268,"end":5270,"said":"yeah. Ohh","significant":false},{"start":5381,"end":5381,"said":". Hey ohh","significant":false},{"start":5443,"end":5467,"said":"any more. Thank. All right OK","significant":false},{"start":5790,"end":5797,"said":"uh Mum Mum","significant":false},{"start":5814,"end":5827,"said":"antihistamines","significant":true},{"start":5847,"end":5866,"said":"K.","significant":false},{"start":5904,"end":5907,"said":"mum","significant":false},{"start":5920,"end":5923,"said":"Mum","significant":false},{"start":5945,"end":5950,"said":"uh nine nine nine nine nine","significant":false},{"start":6062,"end":6066,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":6097,"end":6097,"said":"yes. All right","significant":false},{"start":6157,"end":6178,"said":"all right. OK OK.","significant":false},{"start":6189,"end":6189,"said":". And after","significant":false},{"start":6194,"end":6194,"said":"come","significant":false},{"start":6339,"end":6343,"said":"will","significant":false},{"start":6359,"end":6369,"said":". All . OK","significant":false},{"start":6408,"end":6408,"said":"thank","significant":false},{"start":6429,"end":6429,"said":"bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"after eating prawn soup around 19:00\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Lip swelling began ~30 min after eating\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Progressed to larger upper lip swelling; feels it is worsening."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Reports difficulty breathing and possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Prior swelling episode about a year ago after late-night food with difficult breathing."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","Asthma; salbutamol inhaler used regularly."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","yes","\"Peanut allergy with severe reaction in childhood requiring hospital care\"."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction\"; \"Requires urgent emergency management\"."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Instructed to call emergency services (999) with suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","yes","Mother present; ensure someone stays with patient; ambulance to be called."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Advised taking available antihistamine while awaiting ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Post-discharge: call clinic to arrange adrenaline auto-injector prescription\"."]],"claims":[["Avoid suspected triggers (prawn/shellfish) until specialist assessment","No avoidance advice or specialist assessment was given; the plan was ambulance, antihistamine and a call back after hospital."]],"note":"Presenting Condition\n\nLip swelling began ~30 min after eating prawn soup around 19:00\n\nSwelling started at left upper lip corner, progressed to larger upper lip swelling\n\nReports difficulty breathing and possible chest tightness\n\nFeels swelling is worsening\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nNo musculoskeletal injuries discussed\n\n\n\n\nPast Medical History\n\nAsthma\n\nPeanut allergy with severe reaction in childhood requiring hospital care (per mother’s report)\n\n\n\n\nMedications\n\nSalbutamol inhaler used regularly\n\nHas taken antihistamines previously for peanut allergy, unsure which\n\n\n\n\nRed Flag/Screening Questions\n\nThroat swelling/closing sensation: present (reports difficulty breathing)\n\nChest tightness: uncertain, possibly present\n\nPrior similar swelling episodes: yes, after late-night food about a year ago with difficult breathing\n\nCurrent access to antihistamines: initially no, then found at home and advised to take\n\n\n\n\nSocial History\n\nEats out with friends; tried new prawn soup dish prior to reaction\n\n\n\n\nGoals\n\nAccess emergency care for suspected anaphylaxis\n\nArrange follow-up for allergy management and emergency injection provision\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Progressive upper lip swelling reported; breathing difficulty reported during call\n\n\n\n\nDiagnosis\n\nSuspected anaphylactic reaction following shellfish (prawn) exposure\n\nPrognosis: Requires urgent emergency management\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nExplained concern for anaphylaxis and need for immediate emergency care\n\nAdvised taking available antihistamine while awaiting ambulance\n\nActions:\n\nInstructed to call emergency services (999) with suspected anaphylaxis\n\nEnsure someone stays with patient until ambulance arrives\n\n// Patient’s mother present; antihistamine available and to be taken; ambulance to be called immediately\n\n\n\n\nPlan\n\nImmediate transfer to ED via ambulance\n\nPost-discharge: call clinic to arrange adrenaline auto-injector prescription and allergy management review\n\nAvoid suspected triggers (prawn/shellfish) until specialist assessment\n","review":110.94736842105263,"saved":168.55263157894737,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."]],"mb":14.153843,"signable":136.64536842105264}],"patientnotes":[{"label":"Run 1","wer":18.268467037331217,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trab@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":88,"end":95,"said":"all right","significant":false},{"start":188,"end":195,"said":"all right","significant":false},{"start":259,"end":276,"said":"Trabalotsa. OK day","significant":false},{"start":313,"end":316,"said":"first","significant":false},{"start":329,"end":338,"said":"ninety-nine. OK","significant":false},{"start":383,"end":405,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":793,"end":800,"said":"prawn","significant":false},{"start":875,"end":882,"said":".","significant":false},{"start":973,"end":973,"said":"Mm-hmm.","significant":false},{"start":1024,"end":1024,"said":"Mm-hmm. 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Thank.","significant":false},{"start":5354,"end":5358,"said":"uh Mum Mum","significant":false},{"start":5405,"end":5405,"said":"K. Do that","significant":false},{"start":5429,"end":5432,"said":"mum","significant":false},{"start":5443,"end":5446,"said":"Mum","significant":false},{"start":5468,"end":5472,"said":"uh nine nine nine nine nine","significant":false},{"start":5491,"end":5491,"said":"your","significant":false},{"start":5573,"end":5578,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5607,"end":5607,"said":"yes. All right","significant":false},{"start":5657,"end":5666,"said":"meantime","significant":true},{"start":5678,"end":5689,"said":"OK OK. Yes thank . And after you","significant":false},{"start":5695,"end":5697,"said":"out","significant":false},{"start":5830,"end":5835,"said":"will","significant":false},{"start":5851,"end":5860,"said":". All . OK","significant":false},{"start":5899,"end":5899,"said":"thank","significant":false},{"start":5914,"end":5914,"said":"bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","Records the exposure as \"prawn soup\"; the corrected food is captured."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Approximately 30 minutes later she noticed swelling\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","Upper lip swelling \"has progressively increased in size\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"reports feeling unable to breathe well\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","The prior episode after a Chinese meal a year earlier is omitted."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"uses a Salbutamol inhaler regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy noted, but the severe childhood reaction needing hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"possible anaphylactic reaction\" with advice to call an ambulance immediately."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"advised to call an ambulance immediately\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","Says \"have someone stay with them\" but never mentions the mother arriving or being asked to call emergency services."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"instructed to take any available antihistamine while awaiting the ambulance\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"contact the clinic after hospital discharge ... including possible allergy injections\"."]],"claims":[["She also reports ... a sensation of chest tightness.","Patient explicitly unsure: \"I don't know if it's the chest ... I'm not sure\"; stated as definite."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports swelling of the upper lip that started shortly after eating prawn soup, accompanied by difficulty breathing.\n\nHistory of Presenting Complaint::\n\nThe patient ate a prawn soup at approximately 7 pm. Approximately 30 minutes later she noticed swelling of the left corner of her upper lip, which has progressively increased in size. She also reports feeling unable to breathe well and a sensation of chest tightness. No specific relieving factors were identified.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: possible anaphylactic reaction.\n\nPlan\n\nMedications::\n\nPatient uses a Salbutamol inhaler regularly for asthma.\n\nPatient has a peanut allergy and sometimes uses antihistamines such as cetirizine or loratadine, though the specific agent was not confirmed.\n\nNo other inhalers were reported.\n\nPatient was advised to call an ambulance immediately and have someone stay with them until emergency services arrive.\n\nPatient was instructed to take any available antihistamine while awaiting the ambulance.\n\nPatient was told to contact the clinic after hospital discharge for further management, including possible allergy injections.","review":139.36842105263156,"saved":140.13157894736844,"clean":false,"effort":34.61538461538461,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the call signals systemic involvement in suspected anaphylaxis and is absent."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Prior similar reaction with breathing difficulty a year ago is key allergy history and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction needing hospital/injection bears on adrenaline auto-injector planning and is omitted."]],"mb":24.211212,"latency":28.112,"signable":167.48042105263156},{"label":"Run 2","wer":19.53931691818904,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabaloza. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, mtrabagmail.com. okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your patient notes that.\nYou're having some sort of lip swelling after you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to this place called Fat Puff, and we. We regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called laks. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my feel stuff. Like, my lips started feeling a little weird just in the corner, sort of on the left first, and then. I don't know. And then.\nWe went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is like a swelling on my upper lip and it's kind of getting bigger. I don't know what to do.\nRight. So when did you have the prawn soup? What time? That must have been just after work. So. So maybe like around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like. Must have been like, I don't know, half an hour maybe. Okay, in half an hour you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nYou still feel it, like really pumping blood and it's kind of getting bigger. It feels like.\nOkay. So just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like your chest is tight? I don't know if it's the chest. Just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, mainly I remember like a year ago, a year ago I was out with my friends, and I think.\nI think we went like to a late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nIt. Okay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma, so I tell. I take.\nWhat's it called? Salbutamol inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol that you use? Any other brown inhalers.\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, Periton, any of those kind of things?\nSometimes I don't know which ones. So I have a peanut allergy as well. Yeah. Like always had it? Yeah. Think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors since.\nRight. Has your mom ever said that you had to go to hospital because you hadn't severe allergic reaction? Yeah, when I was like 6 or something. I think.\nOh, sorry. The swelling is getting. Yeah, I think when I was. Are you okay now? I feel busy right now, to be honest. You feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. You know what your mom told you as you were a young child. Right. So is there anyone with you at the moment, or are you all.\nI'm alone at the moment, so hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom. If you can call the 999. Yeah. And say that there is a suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes,\nSo straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yeah. Yes, I'll do. Yes. Okay, then. Take care. Thank you very much.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":88,"end":95,"said":"all right","significant":false},{"start":188,"end":195,"said":"all right","significant":false},{"start":259,"end":275,"said":"Trabalotsa. OK day","significant":false},{"start":312,"end":315,"said":"first","significant":false},{"start":328,"end":337,"said":"ninety-nine. OK","significant":false},{"start":382,"end":404,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":783,"end":790,"said":"prawn","significant":false},{"start":861,"end":869,"said":".","significant":false},{"start":964,"end":964,"said":"Mm-hmm.","significant":false},{"start":1015,"end":1015,"said":"Mm-hmm. 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Bye bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Swelling of upper lip after prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"progressing to swelling within ~30 min\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"Swelling enlarging\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"feeling unable to breathe well and vague chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","The prior episode after a Chinese meal a year earlier is not documented."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Salbutamol inhaler used regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy mentioned only in relation to antihistamines; severe childhood hospital/injection reaction omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Possible anaphylactic reaction\" with immediate ambulance call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call ambulance immediately for suspected anaphylaxis\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Only \"patient alone initially\"; mother's arrival and her instructions are not documented."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take any available antihistamine while awaiting emergency services\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"consider epinephrine autoinjector\" at follow-up after hospital assessment."]],"claims":[["Follow up for allergy testing; arrange future review of asthma and allergy management","Clinician only said they might need to sort out her injections after hospital; allergy testing and asthma review were never mentioned."]],"note":"Subjective\n\nChief Complaint::\n\nSwelling of upper lip after prawn soup with difficulty breathing.\n\nHistory of Presenting Complaint::\n\nOnset ~7 pm after prawn soup; tingling in left upper lip progressing to swelling within ~30 min.\n\nSwelling enlarging, associated with feeling unable to breathe well and vague chest tightness.\n\nNo known relieving measures; patient alone initially.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nPossible anaphylactic reaction.\n\nPlan\n\nMedications::\n\nSalbutamol inhaler used regularly for asthma.\n\nOccasional antihistamines for peanut allergy (specific agent not identified).\n\nNo other inhalers reported.\n\nCall ambulance immediately for suspected anaphylaxis.\n\nTake any available antihistamine while awaiting emergency services.\n\nFollow up with primary care after hospital assessment for allergy testing and consider epinephrine autoinjector.\n\nArrange future review of asthma and allergy management.","review":134.71052631578948,"saved":144.78947368421052,"clean":false,"effort":38.46153846153847,"sig":[["missing","Patient becomes dizzy during the consultation.","New dizziness during suspected anaphylaxis signals possible circulatory compromise and is absent."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Prior similar reaction with breathing difficulty a year ago is omitted, key for allergy risk."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction needing hospital/injection is omitted, key for adrenaline auto-injector decision."],["fabrication","Follow up for allergy testing; arrange future review of asthma and allergy management","Invents allergy testing and asthma review as follow-up plan items."]],"mb":23.199592,"latency":25.236,"signable":159.94652631578947},{"label":"Run 3","wer":18.34789515488483,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trabagmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":88,"end":95,"said":"all right","significant":false},{"start":188,"end":195,"said":"all right","significant":false},{"start":259,"end":276,"said":"Trabalotsa. OK day","significant":false},{"start":313,"end":316,"said":"first","significant":false},{"start":329,"end":338,"said":"ninety-nine. OK","significant":false},{"start":383,"end":405,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":793,"end":800,"said":"prawn","significant":false},{"start":875,"end":882,"said":".","significant":false},{"start":973,"end":973,"said":"Mm-hmm.","significant":false},{"start":1024,"end":1024,"said":"Mm-hmm. 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Uh","significant":false},{"start":3200,"end":3205,"said":"took I","significant":false},{"start":3213,"end":3213,"said":"ohh","significant":false},{"start":3338,"end":3344,"said":"asthma.","significant":true},{"start":3433,"end":3433,"said":"Ohh I","significant":false},{"start":3456,"end":3456,"said":"no. 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Are","significant":false},{"start":4265,"end":4281,"said":". You're feeling dizzy. OK","significant":true},{"start":4344,"end":4353,"said":"moment No","significant":true},{"start":4376,"end":4376,"said":"no. OK","significant":false},{"start":4422,"end":4422,"said":"a bit","significant":false},{"start":4667,"end":4667,"said":"you know","significant":false},{"start":4727,"end":4733,"said":"mum's. Um you know","significant":false},{"start":4746,"end":4754,"said":"mum","significant":false},{"start":4791,"end":4796,"said":"OK all","significant":false},{"start":4815,"end":4815,"said":"any","significant":false},{"start":4889,"end":4889,"said":"yeah. Ohh no","significant":false},{"start":4916,"end":4917,"said":"I'll","significant":false},{"start":4977,"end":4982,"said":"OK and . Hey ohh","significant":false},{"start":5002,"end":5002,"said":"somebody just came yes","significant":false},{"start":5017,"end":5025,"said":"any more. Thank.","significant":false},{"start":5354,"end":5358,"said":"uh Mum Mum","significant":false},{"start":5405,"end":5405,"said":"K. Do that","significant":false},{"start":5429,"end":5432,"said":"mum","significant":false},{"start":5443,"end":5446,"said":"Mum","significant":false},{"start":5468,"end":5472,"said":"uh nine nine nine nine nine","significant":false},{"start":5491,"end":5491,"said":"your","significant":false},{"start":5573,"end":5578,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5607,"end":5607,"said":"yes. All right","significant":false},{"start":5657,"end":5666,"said":"meantime","significant":true},{"start":5678,"end":5689,"said":"OK OK. Yes thank . And after you","significant":false},{"start":5695,"end":5697,"said":"out","significant":false},{"start":5830,"end":5835,"said":"will","significant":false},{"start":5851,"end":5860,"said":". All . OK","significant":false},{"start":5899,"end":5899,"said":"thank","significant":false},{"start":5914,"end":5914,"said":"bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","'after prawn soup ingestion'."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","'Onset 30 min post prawn soup (7 pm)'."],["The note captures: Upper lip swelling is progressively worsening.","yes","'progressive enlargement'."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","'Reports difficulty breathing'."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness not recorded."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","no","Previous episode after a Chinese meal a year earlier is not recorded."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","'Uses salbutamol inhaler for asthma'."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy recorded; childhood severe reaction needing hospital/injection omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","'Suspected anaphylactic reaction to prawns' with immediate ambulance."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","'Call 999; ambulance dispatched immediately'."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","partial","'Have companion stay until ambulance arrives' but mother's arrival and her calling 999 not specified."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","'take any available antihistamine'."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","'Follow-up with GP post-hospital... consider epinephrine auto-injector'."]],"claims":[["Chest tightness reported as present","Patient said 'I don't know if it's the chest... it might be, I'm not sure'; tightness was not confirmed."],["Follow-up 'for allergy testing'","The clinician only mentioned sorting out injections after hospital; allergy testing was never stated."]],"note":"Subjective\n\nChief Complaint::\n\nAcute lip swelling with dyspnea after prawn soup ingestion.\n\nHistory of Presenting Complaint::\n\nOnset 30 min post prawn soup (7 pm).\n\nSwelling started at left upper lip corner, progressive enlargement.\n\nReports difficulty breathing and chest tightness.\n\nNo known relieving measures during call.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction to prawns.\n\nPlan\n\nMedications::\n\nUses salbutamol inhaler for asthma.\n\nHas peanut allergy; occasional antihistamines (cetirizine/loratadine) not specified.\n\nCall 999; ambulance dispatched immediately for suspected anaphylaxis.\n\nHave companion stay until ambulance arrives; take any available antihistamine.\n\nFollow‑up with GP post‑hospital for allergy testing and consider epinephrine auto‑injector.","review":130.8421052631579,"saved":148.6578947368421,"clean":false,"effort":46.15384615384615,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during suspected anaphylaxis not recorded."],["missing","A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","Previous similar reaction a year earlier omitted; key allergy history."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","Severe childhood reaction requiring hospital/injection omitted."],["fabrication","Follow-up 'for allergy testing'","Invented investigation (allergy testing) in follow-up plan."]],"mb":23.949133,"latency":26.153,"signable":156.99510526315788},{"label":"Run 4","wer":18.268467037331217,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, m.trab@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pak, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called Luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my Feel like my lips start feeling a little weird. Just in the corner, sort of on the left first, and then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I\nwasn't really paying attention, so\nit\nmust\nhave been like. Must have been like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nStill feel it\nlike.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest, it just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember, like, a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like always had it? Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors Distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Right. Are you okay now? I feel busy right\nnow,\nto be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there anyone with you at the moment, or are you alone? I'm alone at the moment. So hang on the line while I call the ambulance. Okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we're waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, we'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":88,"end":95,"said":"all right","significant":false},{"start":188,"end":195,"said":"all right","significant":false},{"start":259,"end":276,"said":"Trabalotsa. OK day","significant":false},{"start":313,"end":316,"said":"first","significant":false},{"start":329,"end":338,"said":"ninety-nine. OK","significant":false},{"start":383,"end":405,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":793,"end":800,"said":"prawn","significant":false},{"start":875,"end":882,"said":".","significant":false},{"start":973,"end":973,"said":"Mm-hmm.","significant":false},{"start":1024,"end":1024,"said":"Mm-hmm. 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Thank.","significant":false},{"start":5353,"end":5357,"said":"uh Mum Mum","significant":false},{"start":5404,"end":5404,"said":"K. Do that","significant":false},{"start":5428,"end":5431,"said":"mum","significant":false},{"start":5442,"end":5445,"said":"Mum","significant":false},{"start":5467,"end":5471,"said":"uh nine nine nine nine nine","significant":false},{"start":5490,"end":5490,"said":"your","significant":false},{"start":5572,"end":5577,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5606,"end":5606,"said":"yes. All right","significant":false},{"start":5656,"end":5665,"said":"meantime","significant":true},{"start":5677,"end":5688,"said":"OK OK. Yes thank . And after you","significant":false},{"start":5694,"end":5696,"said":"out","significant":false},{"start":5829,"end":5834,"said":"will","significant":false},{"start":5850,"end":5859,"said":". All . OK","significant":false},{"start":5898,"end":5898,"said":"thank","significant":false},{"start":5913,"end":5913,"said":"bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"after eating prawn soup\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"lip swelling began ~30 min later\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"left upper lip, progressive\"."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"difficulty breathing and vague chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Past episode ~1 yr ago after curry with alcohol, swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"History of asthma, uses salbutamol inhaler regularly\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy captured but the severe childhood reaction requiring hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction secondary to prawn exposure\" with 999 call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call 999 ambulance\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Mother's arrival and her role staying with patient and calling 999 are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Administer any available antihistamine while awaiting EMS\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow up post-discharge for allergy work-up and possible epinephrine autoinjector\"."]],"claims":[["Review asthma control and inhaler technique","No asthma control or inhaler-technique review was planned; the only follow-up discussed was for injections after hospital."],["no clear relieving factors","Relieving factors were never asked about or discussed in the transcript; this is an invented negative."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with acute lip swelling and difficulty breathing after eating prawn soup.\n\nHistory of Presenting Complaint::\n\nPatient ate prawn soup ~19:00, lip swelling began ~30 min later, left upper lip, progressive\n\nReports difficulty breathing and vague chest tightness, no clear relieving factors\n\nPast similar episode ~1 yr ago after curry with alcohol, associated swelling and breathing difficulty\n\nHistory of asthma, uses salbutamol inhaler regularly\n\nKnown peanut allergy, occasional antihistamine use (unspecified)\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction secondary to prawn exposure\n\nPlan\n\nMedications::\n\nSalbutamol inhaler (asthma)\n\nAntihistamines (cetirizine/loratadine) used for peanut allergy (unspecified)\n\nCall 999 ambulance; patient transported to ED\n\nAdminister any available antihistamine while awaiting EMS\n\nFollow up post‑discharge for allergy work‑up and possible epinephrine autoinjector\n\nReview asthma control and inhaler technique","review":120.3157894736842,"saved":159.18421052631578,"clean":false,"effort":42.30769230769231,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","A prior severe reaction that needed hospital care and an injection is key to anaphylaxis risk and auto-injector planning."]],"mb":24.550485,"latency":25.139,"signable":145.4547894736842},{"label":"Run 5","wer":19.142176330420966,"text":"Hi. Hello. Hi. Hi. Hello. I'm Dr. Jacob. And welcome to Babylon. How are you doing? I'm alright, thank you. I feel a little weird today, to be honest. Yeah. So just before we start, is it alright if you could confirm your full name for me, please? Yes, Maria Trabalovsa. Okay. And your date of birth? That is the 1st of October, 99. Okay. And your email address for me, please. Yes, mtraba@gmail.com okay. And just to confirm that you're in a secure location and we can have a confidential conversation. Yes, I think I am. Yeah. Good. Right. You've mentioned in your.\nPatient notes that you're having some sort of lip swelling and you. After you had a sandwich. Is that correct? Yeah, that is. Well, I don't think. I don't think it was. It wasn't a sandwich, but it was. It was something with prawns. So, basically, I. I sometimes go with my friends to. To this place called Fat Pap, and we regularly have, like. Usually I have, like, a normal vegetarian soup or something. And. Yeah. And then I wanted to try something new. So what happened was I ordered a prawn soup. It's called a luxe. It's like a soup. I ordered a prawn one this time. Yeah. And. Yeah. And then my feel like my lips start feeling a little weird just in the corner, sort of on the left first. And then.\nI don't know. And then we went back, we had a little bit of a chat of banter. I wasn't really paying attention. Now I feel that there is a swelling. There is, like, a swelling on my upper lip, and it's kind of getting bigger. I don't know what to do. Right.\nSo when did you have the prawn soup? What time that was? That must have been just after work. So maybe like, around seven? Okay, around seven o'. Clock. And how long did it take to develop the swelling? Well, I wasn't really paying attention, so it must have been like. Must have been, like, I don't know, half an hour maybe. Okay, in half an hour, you develop the swelling. Yeah. Yeah. Okay. And it's getting bigger and bigger.\nYeah.\nPumping blood in it kind of getting bigger. It feels like it's getting worse. Okay, so just a few more questions. So you mentioned about your swelling of your lips. Is there any feeling of swelling in your throat, like your throat is closing up? Any feeling like that? Yeah, actually, I feel like I can't breathe that well right now. Okay. And do you feel like. Like your chest is tight? I don't know. With the chest. Just generally feels a little difficult. Okay. Yeah, it might be. I'm not sure. Okay. Right. And just a few. Have you ever had these, any kind of lip swelling in the past after eating any food? Yeah. Well, maybe I remember like a year ago. A year ago I was.\nOut with my friends, and I think we went like to late night kind of Chinese place. And I remember that I was quite drunk, to be honest. And I remember that after, like, having that very late, I woke up the next morning quite swollen up and had also, like, felt really bad and quite difficult breathing. But I don't know what it was. I had. It was like a curry or something.\nOkay. And what did you take at that time? Did you use anything like antihistamine or anything when you had that last time? Well, I generally have asthma,\nso I tell. I take. What's it called? Salbutamol. Inhalers. Yeah. Yeah. So I do take that regularly, but I've always taken it. I generally have asked.\nAnd any other inhalers? Is it just the Salbutamol.\nThat you use any other brown inhalers?\nNo, I don't think so.\nRight. And so do you use antihistamines like cetirizine, loratadine, peritoneum, any of those kind of things?\nNo, I think sometimes I don't know which ones. I have a peanut allergy as well. Yeah. Like I always had it. Yeah. I think I do get antihistamines for that, but I'm not sure which ones.\nAnd any point, because you had peanut allergy anytime you had to ever use like an injection?\nWhen I was a kid, I think I remember my mom told me about it, but I don't know what it was because I was small and I changed doctors distance.\nRight. Has your mom ever said that you had to go to hospital because you had a severe allergic reaction?\nYeah. When I was like, six or something, I think. Oh, sorry. Swelling is getting. Yeah, I think when I was. Are you okay now? You're a little busy right now, to be honest.\nYou feel busy. Okay. Right. Do you have any kind of antihistamines with you at the Memantine, I don't think I have. Right. Okay. So. Right. All right. I'm really worried about you at the moment, Maria. I think we need to call an ambulance. Because from what history you've been telling me, it sounds like you could be going into what we say, an anaphylactic reaction. That's when your throat and your chest closes in and you might need an injection. Like what? Your mom's. What? Your.\nYour mom told you as you were a young child. Okay. Right. So is there any. Anyone with you at the moment, or are you alone? I'm alone at the Memantine. So hang on the line while I call the ambulance, okay. And I'll send them right to you. Okay. Somebody just came. I'm not alone anymore. All right. Okay. Somebody just came. So just call the ambulance. Make sure that person's with you till the ambulance comes. Yeah. Because we are worried about an anaphylactic reaction, so you need to go straight away. Could you ask the person whether they have any antihistamines around in the interim while we are waiting? Yes, Mom. Do we have any antihistamines around? Yes, yes, straight away. And if mom can call. Mom, if you can call the 999. Yeah. And say that there is.\nA suspected anaphylactic reaction and they need to come straight away. Okay. Yes, she said she will. Yes. So straight away. Take the antihistamines in the Memantine All right? Okay. Okay. Come up from the hospital. Do give us a ring back. We might need to sort you out with your injections and things like that. Okay? Yes. Yes, I'll do. Yes, thank you. Okay, then. Take care. Thank you very much. Bye. Bye. Bye.","marks":[{"start":18,"end":18,"said":"I'm Maria.","significant":false},{"start":88,"end":95,"said":"all right","significant":false},{"start":188,"end":195,"said":"all right","significant":false},{"start":259,"end":276,"said":"Trabalotsa. OK day","significant":false},{"start":313,"end":316,"said":"first","significant":false},{"start":329,"end":338,"said":"ninety-nine. OK","significant":false},{"start":383,"end":405,"said":"M Traba at Gmail dot com. OK","significant":false},{"start":793,"end":800,"said":"prawn","significant":false},{"start":875,"end":882,"said":".","significant":false},{"start":973,"end":973,"said":"Mm-hmm.","significant":false},{"start":1024,"end":1024,"said":"Mm-hmm. 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Thank.","significant":false},{"start":5322,"end":5328,"said":"we're","significant":false},{"start":5343,"end":5347,"said":"uh Mum Mum","significant":false},{"start":5394,"end":5394,"said":"K. Do that","significant":false},{"start":5418,"end":5421,"said":"mum","significant":false},{"start":5432,"end":5435,"said":"Mum","significant":false},{"start":5457,"end":5461,"said":"uh nine nine nine nine nine","significant":false},{"start":5480,"end":5480,"said":"your","significant":false},{"start":5562,"end":5567,"said":"OK. Ohh yeah yeah we do .","significant":false},{"start":5596,"end":5596,"said":"yes. All right","significant":false},{"start":5646,"end":5655,"said":"meantime","significant":true},{"start":5667,"end":5678,"said":"OK OK. Yes thank . And after you","significant":false},{"start":5684,"end":5686,"said":"out","significant":false},{"start":5819,"end":5823,"said":"will","significant":false},{"start":5839,"end":5848,"said":". All . OK","significant":false},{"start":5887,"end":5887,"said":"thank","significant":false},{"start":5902,"end":5902,"said":"bye bye.","significant":false}],"facts":[["The note captures: Food exposure is prawn soup, correcting the initial sandwich description.","yes","\"Acute lip swelling with dyspnea after prawn soup ingestion\"."],["The note captures: Lip swelling develops roughly thirty minutes after eating.","yes","\"Onset ~30 min post-prandial\"."],["The note captures: Upper lip swelling is progressively worsening.","yes","\"left upper lip first, now larger\" - progression captured."],["The note captures: Breathing difficulty or possible airway/throat/chest involvement develops; certainty about chest tightness is not required.","yes","\"Associated difficulty breathing, possible chest tightness\"."],["The note captures: Patient becomes dizzy during the consultation.","no","Dizziness during the consultation is not documented."],["The note captures: A previous episode of swelling and breathing difficulty occurred after a Chinese meal about a year earlier.","yes","Past episode ~1 yr ago after curry with alcohol, with swelling and breathing difficulty."],["The note captures: History of asthma treated with salbutamol inhaler.","yes","\"Salbutamol inhaler used regularly for asthma\"."],["The note captures: Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","partial","Peanut allergy mentioned only via antihistamine use; the severe childhood reaction needing hospital/injection is omitted."],["The note captures: Suspected anaphylactic reaction is identified as an emergency.","yes","\"Suspected anaphylactic reaction to prawns\" with immediate 999 call."],["The note captures: Urgent ambulance/999 call is advised or arranged.","yes","\"Call 999 ambulance immediately\"."],["The note captures: Mother arrives and is asked to stay with the patient and call emergency services.","no","Mother's arrival and her being asked to stay and call emergency services are not captured."],["The note captures: Immediate antihistamine use is advised while awaiting the ambulance, as stated in the dialogue.","yes","\"Take any available antihistamine while awaiting EMS\"."],["The note captures: Post-hospital follow-up is advised to arrange/review emergency allergy injections or an adrenaline auto-injector.","yes","\"Follow-up after discharge for allergy work-up and possible injectable therapy\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nAcute lip swelling with dyspnea after prawn soup ingestion.\n\nHistory of Presenting Complaint::\n\nOnset ~30 min post‑prandial at ~7 pm; swelling progressed, left upper lip first, now larger.\n\nAssociated difficulty breathing, possible chest tightness.\n\nPast similar episode ~1 yr ago after curry with alcohol, with swelling and breathing difficulty.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nSuspected anaphylactic reaction to prawns.\n\nPlan\n\nMedications::\n\nSalbutamol inhaler used regularly for asthma.\n\nOccasional antihistamines (cetirizine/loratadine) for peanut allergy, specific agent not confirmed.\n\nCall 999 ambulance immediately; go to ED for suspected anaphylaxis.\n\nTake any available antihistamine while awaiting EMS.\n\nFollow‑up after discharge for allergy work‑up and possible injectable therapy.","review":89.36842105263158,"saved":190.13157894736844,"clean":false,"effort":19.230769230769234,"sig":[["missing","Patient becomes dizzy during the consultation.","Dizziness during the reaction suggests cardiovascular involvement in anaphylaxis and is omitted."],["partial","Known peanut allergy with a severe childhood reaction requiring hospital care/injection.","A prior severe reaction that needed hospital care and an injection is key to anaphylaxis risk and auto-injector planning."]],"mb":23.754246,"latency":35.13,"signable":124.49842105263158}]}},{"id":"day4_consultation08","name":"Low mood","dictation":false,"language":false,"stress":false,"reference":"Hello.\n\n Hi there.\n\n Hi! Hi there. Uh, my name's Joe. I'm one of the doctors at Babylon. I, just, can I confirm your name please?\n\n , yeah. Uh, my name's .\n\n Makes sense. Yeah.\n\n So, . Sorry, your name is?\n\n Name was Brian.\n\n Brian. Hi Brian. Nice to\n\n Hi.\n\n Um, uh, and your date of birth.\n\n Yeah, my date of birth is the eighth of August, nineteen eighty two.\n\n Great. And uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n Yeah. No, no one else can hear me.\n\n Great. And you're happy to continue with the consultation.\n\n Yes.\n\n Marvelous. OK. So, um, how can i help today?\n\n Yeah, um. So basically it's, just been happening over the last few weeks or so.\n\n But I don't really feel like um, like, getting up in the morning's really difficult, and I don't have much energy at all, during the day, um.\n\n Often.\n\n Yeah just like, doing most things that I would normally find, easy , is become quite difficult.\n\n OK. So, things have become quite difficult for you.\n\n Yeah.\n\n Is there anything else?\n\n Um, no it's quite hard to say like. Things like, I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n OK. I'm sorry to hear that.\n\n Um, so you had difficulty waking up. No energy, not eating.\n\n And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? how many hours of sleep?\n\n Actually, well, now I kind of think about it maybe, maybe even longer, um. I guess uh, , might be related to, so I also started a new job, um, slightly recently.\n\n Um. It might of even coincided, coincided with uh, with that, job, a couple of months ago.\n\n When did you start your new job? Two months ago, did you say?\n\n Yeah.\n\n OK. And, um, so this has been going on perhaps for um, sort of, six weeks or so?\n\n More like, , two months, I would say, yeah.\n\n OK.\n\n Alright. So, um,\n\n Is there anything that you're particularly, sort of concerned about, um, or hoping to get out of this consultation?\n\n Well, um, I, I know that it's not really normal for me, so, before this phase. So I'd have thing, you know I wouldn't have, uh, any problems sort of.\n\n , eating, what I want to eat, or you know, doing standard things in life, and, and, what I want, to do is just like, kind of return to that previous state.\n\n Uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah. Do you have some advice or?\n\n Whatever, that'd be really useful.\n\n OK. Sure. OK. Um, well what would I like to do is just ask you a few more, sort of questions around what's been going on, um, and also around your background health and um, and things like that.\n\n And then we can go on to sort of what can be done from there. Is that alright?\n\n OK.\n\n OK, great. so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that , do you tend to wake up early, and then stay in bed in the morning?\n\n Um, actually I'm, just uh, not, not really waking up early. It's more like I'm just having trouble sleeping at all, really. I think that's probably closer.\n\n , difficulty sleeping as well.\n\n Yeah.\n\n Um, and have you, and, how, how has your mood been over this period?\n\n Have you been feeling your usual self?\n\n Um.\n\n Distracted, , I'd say. Uh, I, I kind of, um.\n\n Yeah, uh, finding it really hard to, quite, difficult to keep focusing, I would say.\n\n Um, not unhappy or, happy, but just uh, quite, just , not focused.\n\n OK. So difficulty focusing, quite distracted.\n\n And, would you say you've been in good spirits? Or is your mood low?\n\n Um.\n\n Actually uh, now you, you, you mention it like, my, mood is a bit lower recently.\n\n Um, and so I've noticed like, uh, my sex drive has kind of decreased, um, a bit over the, the past few months as well, so, yeah.\n\n Right.\n\n K. And uh, so lower mood, decreased sex drive recently as well.\n\n And, just on that note, just a few questions around that.\n\n Are you able to, uh, it may be slightly personal questions, but if you're O. O. K. to answer this,\n\n Do you tend to, to have morning erections like you, is that something that you've noticed, ?\n\n Yeah.\n\n Um, I haven't noticed anything like that, specifically, no.\n\n So, you've not, so you're saying you have not noticed morning erections, and usually you would. So, normal thing to have, uh, waking up in the morning with something. But you have not noticed those recently.\n\n Yes.\n\n I have not noticed those recently.\n\n OK. So, and that's been a change, has it?\n\n Um.\n\n Important one I don't think, um, yeah. Not, I don't think it's important to change, no.\n\n Sorry?\n\n Uh, so you, you, you, you don't think there's been a change there. You\n\n No, there hasn't been a change there.\n\n Ohh OK, sorry. Right, so\n\n OK. So, um,\n\n Just going back to the mood symptoms as well. Uh, you have had uh, difficulty focusing, easily distracted. Your mood has been uh, slightly lower, with lower sex drive.\n\n Yeah.\n\n Yeah.\n\n Um, and in what way has your sex drive been lower? are you in a relationship at the moment?\n\n Yeah, I, I'm married, um, have been for, many years.\n\n Mm-hmm.\n\n And, uh, yeah just, um. Over the last few months, just uh, been disinterested.\n\n Disinterested.\n\n OK.\n\n OK. Sorry, you froze there for a moment.\n\n Um, . So less interested as well, OK.\n\n Yeah.\n\n And, just to ask you a few questions before we uh, wrap up is, uh, any significant past medical history?\n\n Um, so do you suffer from any, uh, mental health problems in the past, or any, uh, physical health problems?\n\n Um, so, in the past, um, I have a, a history of, hypothyroidism, um.\n\n Hypo?\n\n Hypothyroidism.\n\n Hyperthyroid.\n\n Yeah.\n\n K, so that's high thyroid, just to sort of confirm that.\n\n Um.\n\n Sorry, can you say that again please?\n\n hyper, as in high, hyperthyroid.\n\n Hypo.\n\n Hypo, OK. Hypothyroid. Thank you.\n\n Thank you. Um.\n\n Yeah, and uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses, along these lines.\n\n OK.\n\n Um, but the suspicion, that it may have uh, had an impact on me, but my father has commited suicide, um, about fifteen years ago.\n\n OK.\n\n OK. And um,\n\n Uh, do you take any medications?\n\n I had a, a, drug history of Thyroxine.\n\n Mm-hmm.\n\n So, maybe, yes.\n\n Do you, do you continue to take Thyrocsin now?\n\n Yes.\n\n You do. You're, so you're taking Thyrocsin at the moment?\n\n Um.\n\n Yes.\n\n Cool. And any drug allergies? Are you allergic to any medications?\n\n No, I have no uh, medication allergies, no.\n\n No.\n\n No allergies. And you mentioned the , the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions, or psychiatric conditions?\n\n No.\n\n No depression or anything like that running in your family, or uh,\n\n Uh, nothing, nothing, that sort.\n\n OK. And your mother is, is well? Any brothers or sisters?\n\n Yeah she's fine, um, and no, I'm an only child. Um.\n\n Um,\n\n OK.\n\n So, I just uh, uh, sorry it might seem like a slightly random question, but any uh, change in vision?\n\n No\n\n No, no, nothing like that.\n\n . OK. And, just to go back to your, you were saying you had low mood. Some people who , who do have low mood, uh, and low sex drive can sometimes feel uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n No.\n\n No.\n\n No, not , not really, no.\n\n and are you able to get the usual enjoyment out of your daily activities, that you have done in the past?\n\n Sometimes, I mean, I guess, um, most of the activites, but, when I've been doing sports as well, , I find sometimes it's quite difficult to breathe, um.\n\n So, I have some kind of like, shortness of breath um, when doing, sports, compared to maybe a couple of months ago.\n\n OK. So you, you've become more short of breath over the last few months.\n\n Yeah.\n\n Um, and you've had a\n\n OK. So uh, any other things around that? So, more fatigue, more shortness of breath, um, over the last few months?\n\n Mmm.\n\n Um, with a low, lower mood, decreased sex drive. Um, is there, just before we wrap up, is there anything else that you would like to talk about?\n\n Um, no, nothing specific, no.\n\n So, um,\n\n We're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um,\n\n I would like to, probably see you in person, and do an examination. And, and also, we would probably like to do some blood tests um, as well.\n\n So, do you think it would be possible to see uh, to to book an appointment in the next few days uh, with your GP? Or, or um, that would be ideal, I think here.\n\n Um, and then we can, we can probably do some more uh, we'll do an examination and uh, do some investigations really, to see what's going on here a little bit more.\n\n , yes.\n\n That makes sense, yeah.\n\n Is that alright?\n\n Yeah, that's very useful, thank you, um.\n\n OK.\n\n Yeah, it feels, better to have some kind of plan, uh.\n\n Yeah. Yeah, yeah. I think , I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry, we've run out of time now.\n\n Uh, but we've at least started the ball rolling with um, some further investigations and tests.\n\n I'm glad you're, you know, you're, you're , you're, although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that.\n\n Mm-hmm, yes.\n\n And, and you're, uh, and uh, we'll hopefully get to the bottom of some your tiredness, and your other symptoms, when we see you. OK?\n\n Thank you very much, for taking the time. Thank you.\n\n OK. Thank you. 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1","wer":13.321898227558604,"text":"Actually, sorry.\n\n  Hello?\n\n  Hi there.\n\n  Hi, hi there. Uh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\n\n  Hi there, yeah. Uh, my name's Joe.\n\n  So what— sorry, your name was?\n\n  My name was Brian.\n\n  Brian, hi Brian. Nice to meet you.\n\n  Hi.\n\n  Um, uh, and your date of birth?\n\n  Yeah, my date of birth is the 8th of August 1982.\n\n  Great. And, uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n  Yeah. No, no one else can hear me.\n\n  Great. And you're happy to continue with your consultation?\n\n  Yes.\n\n  Marvelous. Okay, so, um, how can I help today?\n\n  Yeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\n\n  Okay. So things have become quite difficult for you?\n\n  Yeah.\n\n  Is there anything else?\n\n  Um, I don't know. It's quite hard to say. Like, things like I'm not, not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n  Okay. Um, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\n\n  Roughly.\n\n  Now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\n\n  When did you start your new job? Two months ago, did you say?\n\n  Yeah.\n\n  Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so?\n\n  More like two, two months, I would say. Yeah.\n\n  Okay. Okay. All right. So, um, it— Is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\n  Well, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of, you know, eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is. Uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\n\n  Okay. Sure. Okay. Um, well, what— what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\n\n  Okay.\n\n  Okay, great. So you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n\n  Um, actually, I'm just, uh, not— not really wakeing up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n\n  Do you have difficulty sleeping as well?\n\n  Yeah.\n\n  Um, and have you— and how, how is your mood been over this period? Have you been—\n\n  Um, distracted?\n\n  Feeling distracted?\n\n  I, I'd say. Uh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say. Um, not unhappy or happy, but just, uh, quite just not focused.\n\n  Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low?\n\n  Um, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well.\n\n  All right.\n\n  So yeah.\n\n  Okay. And, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these. Do you tend to, to have morning erections like you— is that something that you've noticed?\n\n  Um, I have noticed anything like that specifically, no.\n\n  So you've not— so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings.\n\n  Yes.\n\n  With something, but you have not noticed those recently?\n\n  I have not noticed those recently.\n\n  Okay. So and that's been a change, has it?\n\n  Um, Important one, I don't think. Um.\n\n  Sorry?\n\n  Yeah. Not I don't think it's an important change, no.\n\n  I, I— sorry. Are you— you don't think there's been a change there?\n\n  No, there hasn't been a change there.\n\n  Oh, okay. Sorry. Right. Sorry. Okay. So um, just going back to the mood symptoms as well.\n\n  Yeah.\n\n  Uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been um, slightly lower, with lower sex drive.\n\n  Yeah.\n\n  Um, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment?\n\n  Yeah, I— I'm married. Um, I've been for, for many years.\n\n  Mm-hmm.\n\n  And, uh, yeah, just, um, over the last few months, just, uh, been decent.\n\n  Disinterested. Sorry. Okay. So are you phrased there for a moment? Um, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems? No?\n\n  Um, so in the past, um, I have a history of hypothyroidism, uh.\n\n  Hypo.\n\n  Hypothyroidism.\n\n  Hypothyroidism.\n\n  Yeah.\n\n  Okay. So that's.\n\n  Um.\n\n  High thyroid, just to sort of confirm that.\n\n  Sorry, can you say that again, please?\n\n  Hyper as in high. Hyperthyroid.\n\n  Hypo.\n\n  Hypo? Okay, hypothyroid. Thank you.\n\n  Thank you. Um, yeah.\n\n  Okay.\n\n  And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there are suspicions that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\n\n  Okay. Okay. And, um, uh. Do you take any medications?\n\n  I have a drug history of thyroxine.\n\n  Mm-hmm.\n\n  So maybe, yes.\n\n  Do you— do you continue to take thyroxine now?\n\n  Yes.\n\n  You do? You're so you're taking thyroxine at the moment?\n\n  Um, Yes.\n\n  Cool. And any drug allergies? Are you allergic to any medications?\n\n  No, I have no, uh, medication allergies, no.\n\n  No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions?\n\n  No.\n\n  No depression or anything like that running in the family, or?\n\n  No.\n\n  Nothing, nothing at all?\n\n  No.\n\n  Okay. And your mother is, is well? Any brothers or sisters?\n\n  Yeah, she's fine. Um, and I'm an only child. Um, okay.\n\n  Okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision?\n\n  No, no, nothing like that.\n\n  No change in vision? Okay. And just to go back to your— you were saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n  No.\n\n  No?\n\n  No, not re not really, no.\n\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\n  Sometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, uh, my— I found sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago.\n\n  Okay. So you— you've become more short of breath over the last few months?\n\n  Yeah.\n\n  Um, and you've had, uh, okay. So, uh, any, uh, other things around this? Are you more fatigued, more shortness of breath, um, over the last few months?\n\n  Hmm.\n\n  Um, with a sli lower, lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about?\n\n  Um, no, nothing specific, no.\n\n  Okay. So um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can.\n\n  Yes.\n\n  We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more.\n\n  That makes sense, yeah.\n\n  Is that all right?\n\n  Yeah, that's very useful. Thank you. Um, yeah.\n\n  Okay.\n\n  Better to have some kind of plan, um.\n\n  Yeah, yeah, yeah. I think we I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that.\n\n  Mm-hmm.\n\n  Um, and you're.\n\n  Yes.\n\n  Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms.\n\n  Mm-hmm.\n\n  When we see you. Okay?\n\n  Thank you very much for taking the time.\n\n  Okay.\n\n  Thank you.\n\n  Thank you. Thanks.","marks":[{"start":0,"end":16,"said":"","significant":false},{"start":102,"end":110,"said":"Babylon.","significant":false},{"start":155,"end":163,"said":"","significant":false},{"start":185,"end":189,"said":". Makes sense. 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Married. No change in morning erections.\nUsually able to enjoy most activities, though intermittently reduced.\n↑ SOB during sport vs a few months ago.\nDenies SI.\nNo visual change.\nPMH: hypothyroidism. No prior MH diagnosis.\nMeds: thyroxine.\nNKDA.\nFHx: father died by suicide ~15 yrs ago. Mother well; only child. No other reported medical/psychiatric FHx.\nWishes to return to previous baseline; seeks advice/management plan.\nObjective\nNo physical examination, observations or investigations documented during this consultation.\nAssessment\nFatigue, insomnia, ↓ appetite, impaired concentration, low mood and ↓ libido x ~2 months.\nHypothyroidism on thyroxine may contribute to fatigue/low mood; requires clinical review and blood tests.\nExertional SOB over recent months also requires in-person assessment.\nNo current SI reported; paternal suicide history noted.\nPlan\nAdvised to book in-person GP review within next few days; pt agreed.\nPlan for physical examination and blood tests to investigate fatigue and associated symptoms.","review":72.06578947368422,"saved":225.43421052631578,"clean":false,"effort":3.125,"sig":[]},{"label":"Run 2","wer":12.521440823327614,"text":"I need one second—\n\n  Hello?\n\n  Hi there.\n\n  Hi, hi there. Uh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\n\n  Hi there, yeah. Uh, my name's Zoe.\n\n  So what— sorry, your name was?\n\n  Name was Brian.\n\n  Brian, hi Brian. Nice to meet you.\n\n  Hi Brian.\n\n  Um, uh, and your date of birth?\n\n  Yeah, my date of birth is the 8th of August 1982.\n\n  Great. And, uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n  Yeah. No, no one else can hear me.\n\n  Great. And you're happy to continue with the consultation.\n\n  Yes.\n\n  Marvelous. Okay, so, um, how can I help today?\n\n  Yeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\n\n  Okay. So things have become quite difficult for you.\n\n  Yeah.\n\n  Is there anything else?\n\n  Um, oh, no, it's quite hard to say. Like, things like I'm not, not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n  Okay. Um, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\n\n  Uh, roughly. Now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\n\n  When did you start your new job? Two months ago, did you say?\n\n  Yeah.\n\n  Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so?\n\n  More like two, two months, I would say. Yeah.\n\n  Okay. Okay. All right. So, um, it— Is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\n  Well, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of, you know, eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what, what the best way is of doing that are, but, yeah, give some advice or whatever. That'd be really useful.\n\n  Okay. Sure. Okay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\n\n  Okay.\n\n  Okay, great. Can you— so you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n\n  Um, actually, I'm just, uh, not— not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n\n  Does difficulty sleeping as well?\n\n  Yeah.\n\n  Um, and have you— and how, how is your mood been over this period? Have you been—\n\n  Um, feeling—\n\n  Your usual?\n\n  Distracted. I, I'd say. Uh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say. Um, not unhappy or happy, but just, uh, quite just not focused.\n\n  Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low?\n\n  Um, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently, um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well.\n\n  All right.\n\n  So yeah.\n\n  Okay. And, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these. Do you tend to, to have morning erections like you— is that something that you've noticed?\n\n  Yeah.\n\n  In recent—\n\n  Um, I haven't noticed anything like that specifically, no.\n\n  So you've not— so you're saying you have not noticed morning erections and usually you would, so it's a normal thing to have a waking up in the morning with something, but you have not noticed those recently.\n\n  I have not noticed those recently.\n\n  Okay. So and that's been a change, has it?\n\n  Um, Important one, I don't think. Um.\n\n  Sorry?\n\n  Yeah. Not— I don't think it's an important change, no.\n\n  I, I— sorry. Are you— you don't think there's been a change there? You—\n\n  No, there hasn't been a change there.\n\n  Oh, okay. Sorry. Right. Sorry. Okay. So um, just going back to the mood symptoms as well, uh.\n\n  Yeah.\n\n  When you've had, uh, difficulty focusing, easily distracted, your mood has been um, slightly lower with lower sex drive.\n\n  Yeah.\n\n  Um, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment?\n\n  Yeah, I— I'm married. Um, I've been for many years.\n\n  Mm-hmm.\n\n  And, uh, yeah, just, um, over the last few months, just, uh, been decent.\n\n  Disinterested. Sorry. Okay. Sorry, you froze there for a moment. Um, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems, you know?\n\n  Um, so in the past, um, I have a history of hypothyroidism, uh.\n\n  Hypo?\n\n  Hyperthyroidism.\n\n  Hyperthyroidism.\n\n  Yeah.\n\n  Okay. So that's—\n\n  Um.\n\n  High thyroid, just to sort of confirm that.\n\n  Sorry, can you say that again, please?\n\n  Hyper as in high. Hyperthyroid.\n\n  Hypo.\n\n  Hypo? Okay, hypothyroid. Thank you.\n\n  Thank you. Um, yeah.\n\n  Okay.\n\n  And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\n\n  Okay. Okay. And, um, uh. Do you take any medications?\n\n  I have a drug history of thyroxine.\n\n  Mm-hmm.\n\n  So maybe, yes.\n\n  Do you— do you continue to take thyroxine now?\n\n  Yes.\n\n  You do?\n\n  Yeah.\n\n  You're— so you're taking thyroxine at the moment?\n\n  Um, Yes.\n\n  Cool. And any drug allergies? Are you allergic to any medications?\n\n  No, I have no, uh, medication allergies, no.\n\n  No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions?\n\n  No.\n\n  No depression or anything like that running in the family, or?\n\n  No.\n\n  No?\n\n  Nothing, nothing at all.\n\n  Okay. And your mother is, is well? Any brothers or sisters?\n\n  Yeah, she's fine. Um, and I'm an only child. Um, okay.\n\n  Okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision?\n\n  No, no, nothing like that.\n\n  No change in vision? Okay. And just to go back to your— you were saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n  No.\n\n  No?\n\n  No, no, not really, no.\n\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\n  Sometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I— I found sometimes it's quite difficult to breathe, um, so. I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago.\n\n  Okay. So you— you've become more short of breath over the last few months.\n\n  Yeah.\n\n  Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months?\n\n  Hmm.\n\n  Um, with a slight lower, lower mood, decreased sex drive. Um, is there— just before we wrap up, is there anything else that you would like to talk about?\n\n  Um, no, nothing specific, no.\n\n  Okay. So um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can—\n\n  Yes.\n\n  —we could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more.\n\n  That makes sense, yeah.\n\n  Is that all right?\n\n  Yeah, that's very useful. Thank you. Um, yeah.\n\n  Okay.\n\n  Uh, better to have some kind of plan, um.\n\n  Yeah, yeah, yeah. I think we— I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that.\n\n  Mm-hmm.\n\n  Um, and you're.\n\n  Yes.\n\n  Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms, when we see you. Okay?\n\n  Thank you very much for taking the time.\n\n  Okay.\n\n  Thank you.\n\n  Thank you. Thanks.","marks":[{"start":0,"end":17,"said":"","significant":false},{"start":104,"end":112,"said":"Babylon.","significant":false},{"start":157,"end":165,"said":"","significant":false},{"start":187,"end":191,"said":". Makes sense. 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OK.","significant":false},{"start":7474,"end":7476,"said":"not","significant":false},{"start":7649,"end":7659,"said":"activites","significant":false},{"start":7709,"end":7716,"said":"find","significant":false},{"start":8051,"end":8059,"said":"fatigue","significant":false},{"start":8120,"end":8124,"said":"Mmm.","significant":false},{"start":8139,"end":8151,"said":"low","significant":false},{"start":8331,"end":8336,"said":"We're getting","significant":false},{"start":8591,"end":8595,"said":"it would","significant":false},{"start":8766,"end":8771,"said":"can","significant":false},{"start":8797,"end":8797,"said":"we'll","significant":false},{"start":8941,"end":8950,"said":"alright","significant":false},{"start":9005,"end":9016,"said":"it feels","significant":false},{"start":9174,"end":9180,"said":"we've run","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"Reports ~2 months of fatigue/low energy\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","\"difficulty getting up in mornings and reduced ability to manage usual activities\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"reports trouble sleeping rather than early waking\"."],["The note captures: Reduced appetite/not eating much.","yes","\"Reduced appetite\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"Poor concentration/distractibility\" and \"Mood lower recently\"."],["The note captures: Reduced libido/sexual interest.","yes","\"Reduced libido and reduced interest in sex\"."],["The note captures: No thoughts of harming self or others are reported.","yes","\"Denies thoughts of self-harm or harm to others\"."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"father died by suicide ~15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"PMH: hypothyroidism\" correctly recorded."],["The note captures: Currently taking thyroxine.","yes","\"Meds: thyroxine, ongoing\"."],["The note captures: No known medication allergies.","yes","\"no known medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"Exertional SOB during sport, worse than ~2 months ago\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"onset may have coincided with starting new job ~2 months ago\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","The patient's goal of returning to his previous state is not recorded."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"Arrange in-person GP appointment within next few days for clinical examination\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Blood tests discussed as part of investigation for fatigue\"."]],"claims":[],"note":"Subjective\nReports ~2 months of fatigue/low energy, difficulty getting up in mornings and reduced ability to manage usual activities; onset may have coincided with starting new job ~2 months ago.\nSleep difficulty; reports trouble sleeping rather than early waking.\nReduced appetite.\nPoor concentration/distractibility.\nMood lower recently; denies feeling distinctly happy or unhappy initially.\nReduced libido and reduced interest in sex over past few months; married.\nNo reported change in morning erections.\nExertional SOB during sport, worse than ~2 months ago.\nCan sometimes still enjoy usual activities.\nDenies thoughts of self-harm or harm to others.\nPMH: hypothyroidism.\nMeds: thyroxine, ongoing.\nAllergies: no known medication allergies.\nFHx: father died by suicide ~15 years ago; otherwise denies relevant medical/psychiatric FHx. Mother well; only child.\nDenies visual changes.\nObjective\nNo physical examination or investigations completed during this remote consultation.\nAssessment\nFatigue, insomnia, reduced appetite, impaired concentration, low mood and reduced libido for ~2 months, with functional impact.\nExertional SOB during exercise.\nSymptoms may be multifactorial; medical contributors require assessment given known hypothyroidism treated with thyroxine. Mood symptoms also present.\nNo current SI/HI reported.\nPlan\nArrange in-person GP appointment within next few days for clinical examination and further assessment.\nBlood tests discussed as part of investigation for fatigue and associated symptoms.","review":88.44736842105263,"saved":209.05263157894737,"clean":false,"effort":6.25,"sig":[],"mb":12.470612,"latency":16.228,"signable":104.67536842105264},{"label":"Run 3","wer":13.093196112064037,"text":"I need one second.\n\n  Hello?\n\n  Hi there.\n\n  Hi, hi there. Uh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\n\n  Hi there, yeah. Uh, my name's Joe.\n\n  So what— sorry, your name was?\n\n  My name was Brian.\n\n  Brian, hi Brian. Nice to meet you.\n\n  Hi.\n\n  Um, uh, and your date of birth?\n\n  Yeah, my date of birth is the 8th of August 1982.\n\n  Great. And, uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n  Yeah. No, no one else can hear me.\n\n  Great. And you're happy to continue with your consultation?\n\n  Yes.\n\n  Marvelous. Okay, so, um, how can I help today?\n\n  Yeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\n\n  Okay. So things have become quite difficult for you?\n\n  Yeah.\n\n  Is there anything else?\n\n  Um, I don't know. It's quite hard to say. Like, things like I'm not, not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n  Okay. Um, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\n\n  Roughly. Now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\n\n  When did you start your new job? Two months ago, did you say?\n\n  Yeah.\n\n  Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so?\n\n  More like two, two months, I would say. Yeah.\n\n  Okay. Okay. All right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\n  Well, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problems sort of, you know, eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state somehow. Um, I'm not sure how that is. Uh, what, what the best way is of doing that are, but, yeah, give some advice or whatever. That'd be really useful.\n\n  Okay. Sure. Okay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\n\n  Okay.\n\n  Okay, great. Can you— so you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n\n  Um, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n\n  Does difficulty sleeping as well?\n\n  Yeah.\n\n  Um, and have you— and how, how has your mood been over this period? Have you been—\n\n  Um, feeling—\n\n  Your usual—\n\n  Distracted. I, I'd say. Uh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say. Um, not unhappy or happy, but just, uh, quite just not focused.\n\n  Okay. So difficulty focusing, quite distracted, and would you say you've been in good spirits, or is your mood low?\n\n  Um, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well.\n\n  All right.\n\n  So, yeah.\n\n  Okay. And, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you— is that something that you've noticed?\n\n  Yeah.\n\n  In recent—\n\n  Um, I have noticed anything like that specifically, no.\n\n  So you've not— so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings.\n\n  Yes.\n\n  With something, but you have not noticed those recently?\n\n  I have not noticed those recently.\n\n  Okay. So and that's been a change, has it?\n\n  Um, Important one, I don't think. Um.\n\n  Sorry?\n\n  Yeah. Not I don't think it's an important change, no.\n\n  I, I sorry. Are you you don't think there's been a change there?\n\n  No, there hasn't been a change there.\n\n  Oh, okay. Sorry. Right. Sorry. Okay. So just. Going back to the mood symptoms as well, uh, knowing you've had, uh, difficulty focusing, easily distracted, your mood has been slightly lower, with lower sex drive.\n\n  Yeah.\n\n  Um, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment?\n\n  Yeah, I— I'm married. Um, I've been for many years.\n\n  Mm-hmm.\n\n  And, uh, yeah, just, um, over the last few months, just, uh, been decent.\n\n  Disinterested. Sorry. Okay. Sorry, you froze there for a moment. Um, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems, you know?\n\n  Um, so in the past, um, I have a history of hypothyroidism, uh.\n\n  Hypo.\n\n  Hypothyroidism.\n\n  Hypothyroidism.\n\n  Yeah.\n\n  Okay. So that's—\n\n  Um.\n\n  High thyroid, just to sort of confirm that.\n\n  Sorry, can you say that again, please?\n\n  Hyper as in high. Hyperthyroid.\n\n  Hypo.\n\n  Hypo? Okay, hypothyroid. Thank you.\n\n  Thank you. Um, yeah.\n\n  Okay.\n\n  And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\n\n  Okay. Okay. And, um, uh. Do you take any medications?\n\n  I have a drug history of thyroxine.\n\n  Mm-hmm.\n\n  So maybe, yes.\n\n  Do you do you continue to take thyroxine now?\n\n  Yes.\n\n  You do?\n\n  Yeah.\n\n  You're so you're taking thyroxine at the moment?\n\n  Um, Yes.\n\n  Cool. And any drug allergies? Are you allergic to any medications?\n\n  No, I have no, uh, medication allergies, no.\n\n  No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions?\n\n  No.\n\n  No depression or anything like that running in the family, or?\n\n  No.\n\n  Nothing, nothing at all?\n\n  No.\n\n  Okay. And your mother is, is well? Any brothers or sisters?\n\n  Yeah, she's fine. Um, and I'm an only child.\n\n  Um, okay. Um, okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision?\n\n  No, no, nothing like that.\n\n  No change in your vision? Okay. And just to go back to your you're saying you had low mood. Some people who are who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n  No.\n\n  No?\n\n  No, no, not really, no.\n\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\n  Sometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago.\n\n  Okay. So you, you've become more short of breath over the last few months?\n\n  Yeah.\n\n  Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months?\n\n  Hmm.\n\n  Um, with a sli low, lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about?\n\n  Um, no, nothing specific, no.\n\n  So, um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can.\n\n  Yes.\n\n  We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more.\n\n  That makes sense, yeah.\n\n  Is that all right?\n\n  Yeah, that's very useful. Thank you, um.\n\n  Okay.\n\n  Better to have some kind of plan, um.\n\n  Yeah, yeah, yeah. I think we I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that.\n\n  Mm-hmm.\n\n  Um, and you're.\n\n  Yes.\n\n  Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms.\n\n  Mm-hmm.\n\n  And we'll see you. Okay?\n\n  Thank you very much for taking the time.\n\n  Okay.\n\n  Thank you.\n\n  Thank you. Thanks.","marks":[{"start":0,"end":18,"said":"","significant":false},{"start":104,"end":112,"said":"Babylon.","significant":false},{"start":157,"end":165,"said":"","significant":false},{"start":187,"end":191,"said":". Makes sense. 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OK.","significant":false},{"start":5580,"end":5588,"said":"","significant":false},{"start":5688,"end":5703,"said":"Hyperthyroid.","significant":false},{"start":5716,"end":5721,"said":"K","significant":false},{"start":6068,"end":6075,"said":"the","significant":false},{"start":6142,"end":6151,"said":"commited","significant":false},{"start":6247,"end":6251,"said":"had a","significant":false},{"start":6344,"end":6353,"said":"Thyrocsin","significant":false},{"start":6414,"end":6423,"said":"Thyrocsin","significant":false},{"start":6563,"end":6563,"said":"no.","significant":false},{"start":6840,"end":6843,"said":"your","significant":false},{"start":6859,"end":6862,"said":"uh Uh","significant":false},{"start":6883,"end":6906,"said":"that sort. 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Yeah it feels","significant":false},{"start":9131,"end":9137,"said":"we've run","significant":false},{"start":9559,"end":9579,"said":"when we","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"~2 months of fatigue/low energy.\""],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Fatigue, difficulty getting up and \"reduced ability to manage usual activities.\""],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"insomnia.\""],["The note captures: Reduced appetite/not eating much.","yes","\"reduced appetite.\""],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"poor concentration/distractibility, mildly low mood.\""],["The note captures: Reduced libido/sexual interest.","yes","\"reduced libido... less interest in sex with wife.\""],["The note captures: No thoughts of harming self or others are reported.","yes","\"Denies SI, self-harm thoughts or thoughts of harming others.\""],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"father died by suicide ~15 years ago.\""],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"PMH: hypothyroidism.\""],["The note captures: Currently taking thyroxine.","yes","\"Medications: thyroxine, ongoing.\""],["The note captures: No known medication allergies.","yes","\"Drug allergies: none known.\""],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"exertional SOB during sport, worse than ~2 months ago.\""],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"onset possibly coincided with starting new job.\""],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Wish to return to previous state not documented."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"Arrange in-person GP review within next few days. Perform clinical examination.\""],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Arrange blood tests/investigations.\""]],"claims":[],"note":"Subjective\n44-year-old male reports ~2 months of fatigue/low energy, difficulty getting up, reduced appetite, insomnia and reduced ability to manage usual activities; onset possibly coincided with starting new job.\nReports poor concentration/distractibility, mildly low mood and reduced libido over past few months; less interest in sex with wife.\nReports exertional SOB during sport, worse than ~2 months ago.\nDenies SI, self-harm thoughts or thoughts of harming others.\nReports able to enjoy usual activities at times.\nPMH: hypothyroidism.\nMedications: thyroxine, ongoing.\nDrug allergies: none known.\nFHx: father died by suicide ~15 years ago. No other reported psychiatric/medical FHx. Mother well; only child.\nDenies visual changes.\nNo change in morning erections reported.\nObjective\nNo physical examination or investigations completed during this consultation.\nAssessment\nFatigue, insomnia, reduced appetite, impaired concentration, low mood and reduced libido for ~2 months, with functional impact.\nExertional SOB reported.\nSymptoms may be multifactorial; thyroid status and other physical causes require assessment given known hypothyroidism and ongoing thyroxine.\nLow mood present; denies SI/HI.\nPlan\nArrange in-person GP review within next few days.\nPerform clinical examination.\nArrange blood tests/investigations to assess fatigue and associated symptoms.","review":82.76315789473685,"saved":214.73684210526315,"clean":false,"effort":6.25,"sig":[],"mb":12.496377,"latency":20.3,"signable":103.06315789473685},{"label":"Run 4","wer":13.20754716981132,"text":"Actually, sorry.\n\n  Hello?\n\n  Hi there.\n\n  Hi, hi there. Uh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\n\n  Hi there, yeah. Uh, my name's Joe.\n\n  So what— sorry, your name was?\n\n  My name was Brian.\n\n  Brian, hi Brian. Nice to meet you.\n\n  Hi.\n\n  Um, uh, and your date of birth?\n\n  Yeah, my date of birth is the 8th of August 1982.\n\n  Great. And, uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n  Yeah. No, no one else can hear me.\n\n  Great. And you're happy to continue with your consultation?\n\n  Yes.\n\n  Marvelous. Okay, so, um, how can I help today?\n\n  Yeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\n\n  Okay. So things have become quite difficult for you?\n\n  Yeah.\n\n  Is there anything else?\n\n  Um, I wouldn't know. It's quite hard to say. Like, things like I'm not, not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n  Okay. Um, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\n\n  Roughly.\n\n  Now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\n\n  When did you start your new job? Two months ago, did you say?\n\n  Yeah.\n\n  Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so?\n\n  More like two, two months, I would say. Yeah.\n\n  Okay. Okay. All right. So, um, it— Is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\n  Well, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of, you know, eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is. Uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\n\n  Okay. Sure. Okay. Um, well, what— what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\n\n  Okay.\n\n  Okay, great. So you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n\n  Um, actually, I'm just, uh, not— not really wakeing up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n\n  Do you have difficulty sleeping as well?\n\n  Yeah.\n\n  Um, and have you— and how, how is your mood been over this period? Have you been—\n\n  Um, distracted?\n\n  Feeling distracted? I, I'd say. Uh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say. Um, not unhappy or happy, but just, uh, quite just not focused.\n\n  Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low?\n\n  Um, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well.\n\n  All right.\n\n  So yeah.\n\n  Okay. And, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these. Do you tend to, to have morning erections like you— is that something that you've noticed?\n\n  Um, I have noticed anything like that specifically, no.\n\n  So you've not— so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings.\n\n  Yes.\n\n  With something, but you have not noticed those recently?\n\n  I have not noticed those recently.\n\n  Okay. So and that's been a change, has it?\n\n  Um, Important one, I don't think. Um.\n\n  Sorry?\n\n  Yeah.\n\n  Not I don't think it's an important change, no.\n\n  I, I sorry. Are you— you don't think there's been a change there?\n\n  No, there hasn't been a change there.\n\n  Oh, okay. Sorry. Right. Sorry. Okay. So um, just going back to the mood symptoms as well.\n\n  Yeah.\n\n  Uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been um, slightly lower, with lower sex drive.\n\n  Yeah.\n\n  Um, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment?\n\n  Yeah, I— I'm married. Um, I've been for, for many years.\n\n  Mm-hmm.\n\n  And, uh, yeah, just, um, over the last few months, just, uh, been decent.\n\n  Disinterested.\n\n  Okay.\n\n  Okay. So are you phrased there for a moment? Um, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems? No?\n\n  Um, so in the past, um, I have a history of hypothyroidism, uh.\n\n  Hypo.\n\n  Hypothyroidism.\n\n  Hypothyroidism.\n\n  Yeah.\n\n  Okay. So that's.\n\n  Um.\n\n  High thyroid, just to sort of confirm that.\n\n  Sorry, can you say that again, please?\n\n  Hyper, as in high. Hyperthyroid.\n\n  Hypo.\n\n  Hypo? Okay, hypothyroid. Thank you.\n\n  Thank you. Um, yeah.\n\n  Okay.\n\n  And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there are suspicions that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\n\n  Okay. Okay. And, um, uh. Do you take any medications?\n\n  I have a drug history of thyroxine.\n\n  Mm-hmm.\n\n  So maybe, yes.\n\n  Do you— do you continue to take thyroxine now?\n\n  Yes.\n\n  You do? You're so you're taking thyroxine at the moment?\n\n  Um, Yes.\n\n  Cool. And any drug allergies? Are you allergic to any medications?\n\n  No, I have no, uh, medication allergies, no.\n\n  No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions?\n\n  No.\n\n  No depression or anything like that running in the family, or?\n\n  No.\n\n  Nothing. Nothing at all. Okay. And your mother is, is well? Any brothers or sisters?\n\n  Yeah, she's fine. Um, and I'm an only child. Um, okay.\n\n  Um, so I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision?\n\n  No, no, nothing like that.\n\n  No change in vision? Okay. And just to go back to your— you were saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n  No.\n\n  No?\n\n  No, not re not really, no.\n\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\n  Sometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I— I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago.\n\n  Okay. So you— you've become more short of breath over the last few months?\n\n  Yeah.\n\n  Um, and you've had, uh, okay. So, uh, any, uh, other things around this? Are you more fatigued, more shortness of breath, um, over the last few months?\n\n  Mm-hmm.\n\n  Um, with a sli low, lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about?\n\n  Um, no, nothing specific, no.\n\n  Okay. So um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can.\n\n  Yes.\n\n  We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more.\n\n  That makes sense, yeah.\n\n  Is that all right?\n\n  Yeah, that's very useful. Thank you. Um, yeah.\n\n  Okay. Good.\n\n  Better to have some kind of plan, um.\n\n  Yeah. Yeah, yeah. I think we I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that.\n\n  Mm-hmm.\n\n  Um, and you're.\n\n  Yes.\n\n  Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms.\n\n  Mm-hmm.\n\n  When we see you. Okay?\n\n  Thank you very much for taking the time.\n\n  Okay.\n\n  Thank you.\n\n  Thank you. Thanks.","marks":[{"start":0,"end":16,"said":"","significant":false},{"start":102,"end":110,"said":"Babylon.","significant":false},{"start":155,"end":163,"said":"","significant":false},{"start":185,"end":189,"said":". Makes sense. 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Consented to remote consultation; confirmed privacy.\nApprox. 2-month hx fatigue/low energy, difficulty getting up, reduced appetite and reduced ability to complete usual daily tasks; onset may have coincided with starting new job.\nReports insomnia/difficulty sleeping.\nReports poor concentration/distractibility.\nMood slightly lower; reduced libido and decreased interest in sex over recent months.\nReports exertional SOB during sport, worse than a few months ago.\nUsually able to enjoy most activities, though symptoms affect functioning.\nDenies thoughts of self-harm or harm to others.\nDenies visual change.\nPMH: hypothyroidism.\nMeds: thyroxine, ongoing.\nDrug allergies: none reported.\nFHx: father died by suicide approx. 15 years ago. No other reported psychiatric/medical FHx. Mother well; only child.\nMarried.\nReports no change in morning erections from usual.\nObjective\nRemote consultation; no physical examination or investigations completed.\nAssessment\nFatigue, insomnia, reduced appetite, impaired concentration and low mood for approx. 2 months, with functional impact.\nDepressive symptoms present, including low mood, reduced libido and sleep/concentration disturbance; denies SI/HI.\nKnown hypothyroidism on thyroxine may contribute to fatigue and low mood; requires clinical review and investigations.\nNew/worsening exertional SOB reported; requires in-person assessment.\nPlan\nArrange GP/in-person review within next few days for physical examination and blood tests.\nPatient agreeable to plan.","review":91.28947368421053,"saved":206.21052631578948,"clean":false,"effort":6.25,"sig":[],"mb":12.510627,"latency":52.698,"signable":143.98747368421053},{"label":"Run 5","wer":16.123499142367066,"text":"Actually, sorry.\n\n  Hello?\n\n  Hi there.\n\n  Hi, hi there. Uh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\n\n  Hi there, yeah. Uh, my name's Joe.\n\n  So what— sorry, your name was?\n\n  My name was Brian.\n\n  Brian, hi Brian. Nice name.\n\n  Brian.\n\n  Um, and your date of birth?\n\n  Yeah, my date of birth is the 8th of August 1982.\n\n  Great. And, uh, are you in a sort of, uh, confidential place where you can speak freely?\n\n  Yeah. No, no one else can hear me.\n\n  Great. And you're happy to continue with your consultation?\n\n  Yes.\n\n  Marvelous. Okay, so, um, how can I help today?\n\n  Yeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\n\n  Okay. So things have become quite difficult for you?\n\n  Yeah.\n\n  Is there anything else?\n\n  Um, I wouldn't know. It's quite hard to say. Like, things like I'm not, not eating very much at the moment. I just don't feel like I have a lot of energy.\n\n  Okay. I'm sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\n\n  Roughly. Now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\n\n  When did you start your new job? Two months ago, did you say?\n\n  Yeah.\n\n  Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so?\n\n  More like two, two months, I would say. Yeah.\n\n  Okay. Okay. All right. So, um, it— Is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\n  Well, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of, you know, eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is. Uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\n\n  Okay. Sure. Okay. Um, well, what— what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\n\n  Okay.\n\n  Okay, great. So you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n\n  Um, actually, I'm just, uh, not— not really wakeing up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n\n  Do you have difficulty sleeping as well?\n\n  Yeah.\n\n  Um, and have you— and how, how has your mood been over this period? Have you been—\n\n  Um, feeling—\n\n  Your usual— I, I'd say. Uh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say. Um, not unhappy or happy, but just, uh, quite just not focused.\n\n  Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low?\n\n  Um, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well.\n\n  All right.\n\n  So yeah.\n\n  Okay. And, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these. Do you tend to, to have morning erections like you— is that something that you've noticed?\n\n  Yeah.\n\n  In recent—\n\n  Um, I have noticed anything like that specifically. No.\n\n  So you've not— so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings.\n\n  Yes.\n\n  With something. But you have not noticed those recently?\n\n  I have not noticed those recently.\n\n  Okay. So and that's been a change, has it?\n\n  Um, Important one, I don't think. Um.\n\n  Sorry?\n\n  Yeah. Not— I don't think it's an important change. No.\n\n  I, I— sorry. Are you— you don't think there's been a change there?\n\n  No, there hasn't been a change there.\n\n  Oh, okay. Sorry. Right. Sorry. Okay. So um, just going back to the mood symptoms as well, uh.\n\n  Yeah.\n\n  You're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been slightly lower, with lower sex drive.\n\n  Yeah.\n\n  Um, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment?\n\n  Yeah, I— I'm married. Um, I've been for many years.\n\n  Mm-hmm.\n\n  And, uh, yeah, just, um, over the last few months, just, uh, been decent.\n\n  Disinterested. Okay. So are you phrased there for a moment? Um, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems? No?\n\n  Um, so in the past, um, I have a history of hypothyroidism, uh.\n\n  Hypo?\n\n  Hyperthyroidism.\n\n  Hyperthyroidism.\n\n  Yeah.\n\n  Okay. So that's—\n\n  Um.\n\n  High thyroid, just to sort of confirm that.\n\n  Sorry, can you say that again, please?\n\n  Hyper as in high. Hyperthyroid.\n\n  Hypo.\n\n  Hypo? Okay. Hypothyroid. Thank you.\n\n  Thank you. Um, yeah.\n\n  Okay.\n\n  And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\n\n  Okay. Okay. And, um, uh. Do you take any medications?\n\n  I have a drug history of thyroxine.\n\n  Mm-hmm.\n\n  So maybe, yes.\n\n  Do you— do you continue to take thyroxine now?\n\n  Yes.\n\n  You do?\n\n  Yeah.\n\n  You're— so you're taking thyroxine at the moment?\n\n  Um, Yes.\n\n  Cool. And any drug allergies? Are you allergic to any medications?\n\n  No, I have no, uh, medication allergies. No.\n\n  No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions?\n\n  No.\n\n  No depression or anything like that running in the family, or?\n\n  No.\n\n  No?\n\n  Nothing. Nothing at all.\n\n  Okay. And your mother is, is well? Any brothers or sisters?\n\n  Yeah, she's fine. Um, and I'm an only child. Um, okay.\n\n  Okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision?\n\n  No, no, nothing like that.\n\n  No change in vision? Okay. And just to go back to your— you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n\n  No.\n\n  No?\n\n  No, not re not really. No.\n\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\n  Sometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, uh, my— I found sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago.\n\n  Okay. So you— you've become more short of breath over the last few months?\n\n  Yeah.\n\n  Um, and you've had, uh, uh.\n\n Um, no, nothing specific. No.\n\n So, um, we're getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and— and also we'd probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days?\n\n With your GP or— That would be ideal, I think, here. And then we can— yes, we can probably do some more— do an examination and do some investigations, really, to see what's going on here a little bit more.\n\n That makes sense. Yeah.\n\n Is that all right?\n\n Yeah, that's very useful. Thank you.\n\n Okay.\n\n Better to have some kind of plan.\n\n Yeah. Yeah, yeah. I think we— I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started.\n\n Part of the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're— although you have a low mood and you're not feeling suicidal, just to confirm that.\n\n Mm-hm.\n\n And you're— and we'll hopefully get to the bottom of some of your tiredness and your other symptoms when we see you. Okay?\n\n Thank you very much for taking the time. 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And","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","'~2 months of fatigue/low energy'."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Fatigue, difficulty getting up, 'reduced ability to manage usual tasks'."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","'poor sleep'; assessment 'insomnia'."],["The note captures: Reduced appetite/not eating much.","yes","'reduced appetite'."],["The note captures: Low mood with distractibility and impaired concentration.","yes","'reduced concentration/distractibility, mildly low mood'."],["The note captures: Reduced libido/sexual interest.","yes","'reduced libido/interest in sex'."],["The note captures: No thoughts of harming self or others are reported.","yes","'Denies thoughts of self-harm or harm to others.'"],["The note captures: Father died by suicide approximately fifteen years ago.","yes","'father died by suicide ~15 years ago'."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","'PMH: hypothyroidism' recorded correctly (not hyper)."],["The note captures: Currently taking thyroxine.","yes","'Meds: thyroxine, ongoing.'"],["The note captures: No known medication allergies.","yes","'no known medication allergies'."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","'exertional SOB during sport, worse than a few months ago'."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","'possibly coincided with starting new job ~2 months ago'."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Patient's wish to return to his previous state/usual function is not documented."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","'Arrange in-person appointment within the next few days/with GP' with examination."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","'Arrange blood tests to investigate fatigue'."]],"claims":[],"note":"Subjective\nReports ~2 months of fatigue/low energy, difficulty getting up in mornings, poor sleep, reduced appetite and reduced ability to manage usual tasks.\nSymptoms possibly coincided with starting new job ~2 months ago.\nReports reduced concentration/distractibility, mildly low mood and reduced libido/interest in sex.\nReports exertional SOB during sport, worse than a few months ago.\nReports able to enjoy most usual activities at times.\nDenies change in vision.\nDenies thoughts of self-harm or harm to others.\nPMH: hypothyroidism.\nMeds: thyroxine, ongoing.\nAllergies: no known medication allergies.\nFHx: father died by suicide ~15 years ago; otherwise denies FHx psychiatric or significant medical illness. Mother well; only child.\nMarried.\nObjective\nNo physical examination or investigations documented during this remote consultation.\nAssessment\nFatigue, insomnia, reduced appetite, impaired concentration, low mood and reduced libido x ~2 months; symptoms may be temporally associated with new job.\nHypothyroidism on thyroxine may be relevant to fatigue/low mood; requires clinical review and blood tests.\nExertional SOB reported, requiring further assessment.\nNo reported SI/HI despite low mood and paternal history of suicide.\nPlan\nArrange in-person appointment within the next few days/with GP.\nPerform clinical examination at in-person review.\nArrange blood tests to investigate fatigue and associated symptoms.","review":86.86842105263159,"saved":210.6315789473684,"clean":false,"effort":6.25,"sig":[],"mb":12.212826,"latency":42.027,"signable":128.8954210526316}],"heidi":[{"label":"Run 1","wer":13.150371640937678,"text":"Hello? Hey, there. Hi. Hi there. Uh, my name's Joe. I'm one of the doctors at Bavaria. I just-- Can I confirm your name, please?\n\nYeah. My name is David. Brian. So what so your name was? Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth? Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like, getting up in the morning's really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, is become quite difficult.\n\nOkay. So things have become quite difficult for you? Yeah. Is there anything else? It's quite hard to say, like, things like I'm not I'm not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How long? Last week? Now I kinda think about it, maybe maybe even longer.\n\nI guess, uh, it might be related to, so I also started the new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say. Yeah. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but, you know, give some advice or whatever. That'd be really useful. Okay, sure. Okay. Um, well, what what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that all right?\n\nOkay. Okay, great. So you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings? Um, actually, I'm just, uh, not not really waking, you know, early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Do you have difficulty sleeping as well? Yeah. Um, and have you... And how, how has your mood been over this period? Have you been- Um--feeling.\n\nUsually distract, I I'd say. I I kind of, yeah, finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently, and so I've noticed, like,\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to it may be slightly personal questions, but if you're okay to answer this, do you tend to to have morning erections? Like, you is that something that you've noticed in recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have\n\nWaking up in the middle with something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important. One, I don't think. Sorry? Yeah. Not I don't think it's important to change it. No. I sorry. You don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, saying you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive.\n\nYeah. Um, and in what way has your sex drive been lower? Are you in a relationship at the moment? Yeah, I, I'm married. Um, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been disinterested. Disinterested. Frozen. Okay. Sorry, you froze there for a moment. Um, so less interested as well. Okay. And just to ask you a few questions before we, uh, corre- uh, uh, wrap up is, uh, any significant past medical history? Um, so do you suffer from any-\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hypothyroidism. Hyperthyroidism. Yeah. High thyroid just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high. Hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. Okay. And also in the past, I mean\n\nI haven't had any kind of specific, uh, medical diagnoses along these lines, um, but there are suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay, and, um, uh, uh, do you take any medications? I have a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now?\n\nYes. You do? You're so you're taking thyroxine at the moment? Yes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or No. Nothing of that sort.\n\nOkay. And your mother is as well? Any brothers or sisters? Yeah, she's fine. Um, and no, I'm an only child. Um. Okay. Um, okay. So I just, uh, uh, sorry, it might have been my slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision. Okay. And just to go back to your... you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, not really, not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you've become more short of breath over the last few months. Yeah. Um, and you've had, uh. Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months, um, with a sl- lower, lower mood, decreased sex drive. Um, is there... Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\n\nIs that right? Yeah, that's very useful. Thank you. Um, okay. Better to have some kind of plan. Um, yeah, yeah, yeah, I think we're- I definitely think we need a plan here. Um, it's been nice talking to you. 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Hey there. Hi. Hi there. My name's Joe. I'm one of the doctors at Bavaria. I just can I confirm your name, please?\n\nHi. Yeah. My name is David. Brian. So what so your name was Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth? Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, is become quite difficult.\n\nOkay, so things have become quite difficult for you? Yeah. Is there anything else? Um, I don't know. It's quite hard to say, like, things like I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? Uh, how's that? Well, now I kind of think about it, maybe, maybe even longer, um-\n\nI guess, uh, m- might be related to, so I also started the new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say. Yeah. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but, you know, give some advice or whatever. That'd be really useful. Okay, sure. Okay. Um, well, what what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that right?\n\nOkay. Okay, great. You, so you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings? Um, actually, I'm just, uh, not, not really wake- waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well? Yeah. Um, and have you... And how, how has your mood been over this period? Have you been- Um--feeling-\n\nDistract, I I'd say. I I kind of yeah. Finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently, and so I've noticed, like,\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. K. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these, do you tend to to have morning erections? Like, you is that something that you've noticed recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have\n\nWaking up in the midst with something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important one, I don't think. Sorry? Yeah. Not I don't think it's important to change. No. I sorry. You don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, saying you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive.\n\nYeah. And in what way has your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, yeah, just over the last few months, just been disinterested. Disinterested. Okay. Sorry. You froze there for a moment. So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hypothyroidism. Hyperthyroidism. Yeah. But that's high thyroid, just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high. Hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. Okay. And also in the past, I mean\n\nI haven't had any kind of specific, uh, medical diagnoses along these lines, um, but there are suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay, and, um, uh, do you take any medications? I have a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now?\n\nYes. You do? You're so you're taking thyroxine at the moment? Yes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or nothing of that sort.\n\nOkay. And your mother is as well. Any brothers or sisters? Yeah. She's fine. And no. I'm an only child. K. Okay. So I just sorry. It might have been my slightly random question, but any change in your vision? No. No. Nothing like that. No change in vision. Okay. And just to go back to your you're saying you had low mood. Some people who are who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you, you've become more short of breath over the last few months. Yeah. Um, and you've had, uh... Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months? Mm. Um, with a sl- lower, lower mood, decreased sex drive. Um, is there-- Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we'd probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that all right?\n\nYeah, that's very useful. Thank you. Um, okay. Better to have some kind of plan. Um, yeah, yeah, yeah. I think we're-- I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we run out of time now, uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you'll, you're-- although you have a low mood, um, you're, you're, um, you're not feeling suicidal, just to confirm that. Mm-hmm. And you'll, uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms when we see you. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":73,"end":81,"said":"Babylon.","significant":false},{"start":123,"end":126,"said":"","significant":false},{"start":136,"end":157,"said":"name's . Makes sense. Yeah.","significant":false},{"start":161,"end":168,"said":". Sorry","significant":false},{"start":225,"end":234,"said":"Hi. 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Mother well. Only child. No family history of depression or other psychiatric conditions.\n\n- Social History: Married. Started new job two months ago, coinciding with symptom onset.\n\n- Review of Systems:\n\n  - Vision: no changes.\n\n\n\n\nObjective\n\n\n\n\n- Not examined (telehealth consultation).\n\n\n\n\nAssessment\n\n\n\n\n- Fatigue and low energy over two months, with associated sleep disturbance, reduced appetite, lower mood, decreased libido and exertional SOB. Background hypothyroidism on thyroxine.\n\n\n\n\nPlan\n\n\n\n\n- Blood tests.\n\n- Book appointment with GP for in-person review and physical examination.\n\n- Discuss further investigations.","review":88.27631578947368,"saved":209.2236842105263,"clean":false,"effort":9.375,"sig":[],"mb":46.788586,"latency":27.642,"signable":115.91831578947368},{"label":"Run 3","wer":13.436249285305891,"text":"Hello? Hey there. Hi. Hi there. My name's Joe. I'm one of the doctors at Bavar. I just can I confirm your name, please?\n\nHi. Yeah. My name is Dana. Brian. So what so your name was Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth? Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, has become quite difficult.\n\nOkay. So things have become quite difficult for you? Yeah. Is there anything else? Um, it's quite hard to say, like, things like I'm not, I'm not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? Uh, how long? Well, now I kind of think about it, maybe, maybe even longer. Um-\n\nI guess, uh, it might be related to, so I also started a new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but, you know, give some advice or whatever. That'd be really useful. Okay, sure. Okay. Um, well, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that right?\n\nOkay. Okay, great. So you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings? Um, actually, I'm just, uh, not, not really wake- waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well. Yeah. Um, and have you... And how, how has your mood been over this period? Have you been- Um--feeling-\n\nUsually distracted, I I'd say. I I kind of, yeah, finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently, and so I've noticed, like,\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to it may be slightly personal questions, but if you're okay to answer these, do you tend to to have morning erections? Like, you is that something that you've noticed in recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have\n\nWaking up in the middle with something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important one, I don't think. Sorry? Yeah. Not I don't think it's an important change. No. Sorry. You don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, saying you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive.\n\nYeah. Um, and in what way has your sex drive been lower? Are you in a relationship at the moment? Yeah, I, I'm married. Um, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been disinterested. Disinterested? Frozen. Okay. Sorry, you phrased that for a moment. Um, so less interested as well. Okay. And just to ask you a few questions before we, uh, current, uh, uh, wrap up is, uh, any significant past medical history? Um, so do you suffer from any-\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. But that's high thyroid, just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high. Hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. Okay. And also in the past, I mean\n\nI haven't had any kind of specific, uh, medical diagnoses along these lines, um, but the suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay, and, um, uh, do you take any medications? I have a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now?\n\nYes. You do? You're so you're taking thyroxine at the moment? Yes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in family? Or Nothing. Nothing of that sort.\n\nOkay. And your mother is as well. Any brothers or sisters? Yeah. She's fine. And no. I'm an only child. K. Okay. So I just sorry. Might have been slightly random question, but any change in your vision? No. No. Nothing like that. No change in vision. Okay. And just to go back to your you're saying you had low mood. Some people who are who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I found sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you've become more short of over the last few months. Yeah. Um, and you've had, uh. Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months, um, with a sl- lower, lower mood, decreased sex drive. Um, is there-- Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that all right?\n\nYeah, that's very useful. Thank you. Um, okay. Better to have some kind of plan. Um, yeah, yeah, yeah. I think we're-- I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we run out of time now, uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you'll f- you're-- although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"for ~2 months.\""],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty getting up, low energy, \"Routine tasks now challenging.\""],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"Difficulty sleeping.\""],["The note captures: Reduced appetite/not eating much.","yes","\"Reduced appetite.\""],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"Distracted, difficulty focusing\" and \"Lower mood recently.\""],["The note captures: Reduced libido/sexual interest.","yes","\"Decreased sex drive over past few months; disinterested.\""],["The note captures: No thoughts of harming self or others are reported.","yes","\"No suicidal ideation or thoughts of harming self/others.\""],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"father died by suicide 15 years ago.\""],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"PMHx: hypothyroidism.\""],["The note captures: Currently taking thyroxine.","yes","\"Meds: thyroxine.\""],["The note captures: No known medication allergies.","yes","\"Allergies: NKDA.\""],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"SOB on exertion, worsened over past few months.\""],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"started new job 2 months ago.\""],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"Wishes to return to previous baseline.\""],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","In-person consultation for examination; GP appointment within next few days."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Blood tests\" for further investigation."]],"claims":[],"note":"Subjective\n\n- Difficulty getting up in the mornings and low energy throughout the day for ~2 months\n\n- Routine tasks now challenging\n\n- Reduced appetite secondary to low energy\n\n- Difficulty sleeping\n\n- Distracted, difficulty focusing\n\n- Lower mood recently\n\n- Decreased sex drive over past few months; disinterested\n\n- Denies change in morning erections\n\n- SOB on exertion, worsened over past few months\n\n- No suicidal ideation or thoughts of harming self/others\n\n- No change in vision\n\n- Wishes to return to previous baseline\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- 2-month history of fatigue, low mood, poor sleep, reduced appetite, reduced libido and exertional SOB\n\n- PMHx: hypothyroidism\n\n- Meds: thyroxine\n\n- Allergies: NKDA\n\n- FHx: father died by suicide 15 years ago; mother well; only child\n\n- Social: married; started new job 2 months ago\n\n\n\n\nPlan\n\n- Recommend in-person consultation for examination\n\n- Blood tests\n\n- Book GP appointment within next few days for further investigation","review":44.8421052631579,"saved":252.6578947368421,"clean":true,"effort":0.0,"sig":[],"mb":42.454977,"latency":26.134,"signable":70.9761052631579},{"label":"Run 4","wer":12.69296740994854,"text":"Hello? Hey there. Hi. Hi there. My name's Joe. I'm one of the doctors at Bavar. I just can I confirm your name, please?\n\nFriday. Yeah. My name is Dana. Brian. So what so your name was Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth? Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvellous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like getting up in the morning's really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, has become quite difficult.\n\nOkay. So things have become quite difficult for you? Yeah. Is there anything else? It's quite hard to say, like, things like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How long? Well, now I come to think about it, maybe maybe even longer.\n\nI guess, uh, might be related to, so I also started a new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say. Yeah. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but, you know, give some advice or whatever. That'd be really useful. Okay, sure. Okay. Um, well, what what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that right?\n\nOkay. Okay, great. So you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings? Um, actually, I'm just, uh, not, not really wake- you know early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Diffic- difficulty sleeping as well. Yeah. Um, and have you... And how, how has your mood been over this period? Have you been- Um--feeling-\n\nDistract, I I'd say. I I kind of, yeah, finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently, and so I've noticed, like,\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to it may be slightly personal questions, but if you're okay to answer this, do you tend to to have morning erections? Like, you is that something that you've noticed recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have\n\nWaking up in the midst with something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important one, I don't think. Sorry? Yeah. Not I don't think it's important to change. No. I sorry. You don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive.\n\nYeah. Um, and in what way has your sex drive been lowered? Are you in a relationship at the moment? Yeah, I, I'm married. Um, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been disinterested. Disinterested. Okay. Sorry, you phrased that for a moment. Um, so less interested as well. Okay, and just to ask you a few questions before we, uh, correct, it, uh, wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems? No. Um-\n\nSo in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. But that's high thyroid, just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high. Hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. Okay. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines.\n\nUm, but the suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay. And, um, uh, do you take any medications? I had a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now? Yes. You do? You're-- So you're taking thyroxine at the moment?\n\nUm, yes. Cool. And any drug allergies? Are you allergic to any medications? No, I have never, uh, medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in family or nothing of that sort. Okay. And your mother is is well. Any brothers or sisters? Yeah, she's fine. Um, and no, I'm an only child. Um.\n\nUm, okay. So I just, uh, uh, so it might have been like a slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision. Okay. And just to go back to your-- you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, not really, not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I find sometimes it's quite difficult to breathe. Um, so I have some kind of like shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you've become more short of breath over the last few months. Yeah. Um, and you've had, uh. Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months, um, with a sl- lower, lower mood, decreased sex drive. Um, is there... Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, or do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\n\nIs that all right? Yeah, that's very useful. Thank you. Um, okay. Better to have some kind of plan. Um, yeah, yeah, yeah. I think we're-- I definitely think we need a plan here. Um, it's been nice talking to you. 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Hey, there. Hi. Hi there. Uh, my name's Joe. I'm one of the doctors at Bavar. I just-- Can I confirm your name, please?\n\nFriday. Yeah. My name is David. Brian. So what so your name was? Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth. Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, is become quite difficult.\n\nOkay. So things have become quite difficult for you? Yeah. Is there anything else? It's quite hard to say, like, things like I'm not I'm not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How long? Well, now I think about it, maybe maybe even longer.\n\nI guess, uh, might be related to, so I also started a new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but give some advice or whatever. That'd be really useful. Okay, sure. Okay, um, well, what what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that all right?\n\nOkay. Okay, great. So you say you've been, um, feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings? Um, actually, I'm just, uh, not, not really wake- you know, barely. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well? Yeah. Um, and have you... And how, how has your mood been over this period? Have you been- Um--feeling-\n\nUsually distracted, I I'd say. I I kind of, yeah, finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently, and so I've noticed, like\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. K. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to it may be slightly personal questions, but if you're okay to answer this, do you tend to to have morning erections? Like, you is that something that you've noticed recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have waking up in the middle with something, but you have not noticed those recently.\n\nI have not noticed those recently. Okay. So and that's been a change, has it? Important one, I don't think. Sorry? Yeah. Not I don't think it's important to change. No. I I so you don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, you're saying you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower?\n\nAre you in a relationship at the moment? Yeah, I'm married. Um, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been disinterested. Disinterested. Frozen. Okay. Sorry, you froze there for a moment. Um, so less interested as well. Okay, and just to ask you a few questions before we, uh, correct, it, uh, wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems? No. Um-\n\nSo in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. But that's high thyroid, just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines.\n\nUm, but the suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay. And, um, uh, do you take any medications? I have a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now? Yes. You do? You're-- So you're taking thyroxine at the moment?\n\nUm, yes. Cool. And any drug allergies? Are you allergic to any medications? No, I have never medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family or nothing. Nothing of that sort. Okay. And your mother is is well. Any brothers or sisters? Yeah. She's fine. Um, and no, I'm an only child. Um.\n\nUm, okay. So I just, uh, uh, sorry, mine's been like a slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision. Okay. And just to go back to your-- you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, not really, not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I found sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you've become more short of breath over the last few months. Yeah. Um, and you've had, uh. Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months, um, with a sl- lower, lower mood, decreased sex drive. Um, is there-- Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we'd probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, or do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\n\nIs that all right? Yeah, that's very useful. Thank you. Um, okay. Better to have some kind of plan. Um, yeah. Yeah, yeah, I think we I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we run out of time now, uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, um, you're you're, um, you're not feeling suicidal, just to confirm that. And you'll, uh, and, uh, we'll hopefully get to the bottom of some of your tiredness and your other symptoms when we see you. Okay. Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":78,"end":84,"said":"Babylon.","significant":false},{"start":128,"end":135,"said":"","significant":false},{"start":145,"end":166,"said":"name's . Makes sense. Yeah.","significant":false},{"start":170,"end":177,"said":". Sorry","significant":false},{"start":235,"end":244,"said":"Hi. 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Hey there. Hi. Hi there. My name's Joe. I'm one of the doctors at Bavar. I just can I confirm your name, please?\n\nYeah. My name is David. Brian. So what so your name was Name was Brian. Brian. Hi, Brian. Nice to meet you. And your date of birth? Yeah. My date of birth is the eighth of August nineteen eighty two.\n\nGreat. And, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvellous. Okay, so, um, how can I help today? Yeah, um, so basically it's just been happening over the last few weeks or so, but I don't really feel like, um, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Um, often, yeah, just like doing most things that I would normally find easy, uh, has become quite difficult.\n\nOkay. So things have become quite difficult for you? Yeah. Is there anything else? It's quite hard to say, like, things like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How's that? Now I kinda think about it, maybe maybe even longer.\n\nI guess, uh, m- might be related to, so I also started a new job, um, slightly recently. Um, it might have even coincided, coincided with, uh, with that job a couple of months ago. When did you start your new job? Two months ago, did you say? Yeah. Okay. And, um, so this has been going on perhaps for, um, sort of six weeks or so? More like two, two months, I would say, yeah. Yeah. Okay. All right, so, um, i- is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\n\nWell, um, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have, uh, any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what what the best ways of doing that are, but give some advice or whatever. That'd be really useful. Okay, sure. Okay. Um, well, what what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background health and, um, and things like that. And then we can go on to sort of what what can be done from there. Is that right?\n\nOkay. Okay. Great. You so you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Difficulty difficulty sleeping as well. Yeah. And have you and how how has your mood been over this period? Have you been feeling\n\nUsually distracted, I I'd say. I I kind of yeah. Finding it really hard to quite difficulty focusing, I would say. Not unhappy or happy, but just quite just not focused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it, like, my mood is a bit lower recently. And so I've noticed, like\n\nMy sex drive has kind of decreased a bit over the the past few months as well. So yeah. K. And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to it may be slightly personal questions, but if you're okay to honestly, do you tend to to have morning erections? Like, you is that something that you've noticed recently? I haven't noticed anything like that specifically. No. So you've so you're saying you have not noticed morning erections, and usually you would. It's a normal thing to have waking up in the middle with something, but you have not noticed those recently.\n\nI have not noticed those recently. Okay. So and that's been a change, has it? Important one, I don't think. Sorry? Yeah. Not I don't think it's important to change it. No. I sorry. You don't think there's been a change there? No. There hasn't been a change there. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, you know, you've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower?\n\nAre you in a relationship at the moment? Yeah, I I'm married. I've been for many years. Mhmm. And, yeah, just over the last few months, just been disinterested. Disinteresting. Okay. Sorry. You froze there for a moment. So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems? No.\n\nSo in the past, I have a history of hypothyroidism. Hypo? Hypothyroidism. Hyperthyroid. Yeah. But that's high thyroid, just to sort of confirm it. Sorry. Can you say that again, please? Hyper as in high. Hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. Okay. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines.\n\nUm, but the suspicion that it may have had an impact on me. But my father has committed suicide, um, about fifteen years ago. Okay. Okay. And, um, uh, do you take any medications? I have a drug history of thyroxine. Mm-hmm. So maybe, yes. Do you, do you continue to take thyroxine now? Yes. You do? You're-- So you're taking thyroxine at the moment?\n\nUm, yes. Cool. And any drug allergies? Are you allergic to any medications? No, I have no, uh, medication allergies. No. No allergies. And you mentioned the the suicide of your father fifteen years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in family or nothing that sort. Okay. And your mother is as well. Any brothers or sisters? Yeah, she's fine. Um, and no, I'm an only child. Um.\n\nUm, okay. So, hmm, I just, uh, uh, sorry, it might have been like a slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision. Okay, and just to go back to your-- you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, not really, not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay, so you've become more short of breath over the last few months. Yeah. Um, and you've had, uh. Okay, so, uh, any other things around there? So you've more fatigue, more shortness of breath, um, over the last few months, um, with a sl- lower, lower mood, decreased sex drive. Um, is there-- Just before we wrap up, is there anything else that you would like to talk about?\n\nUm, no, nothing specific. No. So, um, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination, and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few days, uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can- Yes. We could probably do some more, uh, or do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\n\nIs that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. 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Denies recent morning erections.\n\n- Denies any change in vision.\n\n\n\n\nPast Medical History\n\n\n\n\n- Hypothyroidism.\n\n\n\n\nMedications\n\n\n\n\n- Thyroxine (ongoing).\n\n\n\n\nAllergies\n\n\n\n\n- NKDA.\n\n\n\n\nFamily History\n\n\n\n\n- Father committed suicide 15 years ago.\n\n- Denies family history of depression or other psychiatric conditions.\n\n- Mother well.\n\n- Only child.\n\n\n\n\nSocial History\n\n\n\n\n- Married.\n\n\n\n\nObjective\n\n\n\n\n- Not examined (telehealth consultation).\n\n\n\n\nAssessment\n\n\n\n\n- Two-month history of fatigue, low mood, reduced appetite, poor sleep, poor concentration, decreased libido and exertional SOB, on background of hypothyroidism on thyroxine.\n\n\n\n\nPlan\n\n\n\n\n- Review in person for examination.\n\n- Blood tests.\n\n- Book appointment with GP within the next few days for further assessment and investigations.","review":80.23684210526315,"saved":217.26315789473685,"clean":false,"effort":6.25,"sig":[],"mb":48.506425,"latency":23.971,"signable":104.20784210526315}],"freed":[{"label":"Run 1","wer":20.125786163522015,"text":"Hello. Hi, there. My name's Joe. I'm one of the doctors at Babel. Can I confirm your name, please? Sorry, your name was?\n  My name was Brian.\n  Brian. Hi, Brian. Nice name. And your date of birth?\n  Yeah, my date of birth is the 8th of August, nineteen eighty-two. Great.\n  And are you in a sort of confidential place where you can speak freely? Yeah.\n  No, no one else can hear me.\n  Great. And you're happy to continue with the consultation?\n  Yes.\n  Fabulous. Okay. So how can I help today?\n  Yeah. So basically, it's just been happening over the last few weeks or so. But I don't really feel like... Like getting up in the morning is really difficult and I don't have much energy at all during the day. Often, yeah, just like doing most things that I would normally find easy has become quite difficult.\n  Okay, so things have become quite difficult for you.\n  Yeah.\n  Is there anything else?\n  It's quite hard to say. things like I'm not eating very much at the moment, I just don't feel like I have a lot of energy.\n  Okay, I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or five?\n  Now I think about it maybe even longer. I guess it might be related to it, so I also started a new job slightly recently, it might have even coincided with that job a couple of months ago.\n  When did you start your new job, 2 months ago you say? Yeah. Okay, and so this has been going on perhaps for sort of 6 weeks or so?\n  More like 2 months I would say, yeah.\n  Okay, all right, so is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\n  Well, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. What I want to do is to kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but yeah, give some advice or whatever, that'd be really useful.\n  Okay, sure. Okay, well what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that and then we can go on to sort of what can be done from there. Is that all right?\n  Okay, great.\n  So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the morning?\n  Actually, I'm just not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n  Do you have difficulty sleeping as well? Yeah. And have you... How has your mood been over this period? Have you been feeling re-usual?\n  Distracted, I'd say. I kind of... Yeah, finding it really hard to quite difficulty focusing, I would say, not unhappy or happy, but just quite not focused.\n  Okay, so difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\n  Actually, now you mentioned it like my, Mood is a bit lower recently. And so I've noticed like my sex drive has kind of decreased a bit over the past few months as well. So yeah.\n  And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, maybe slightly personal questions but if you're okay to answer these, do you tend to have morning erections like you, is that something that you've noticed recently?\n  I haven't noticed anything like that specifically.\n  So you're saying you have not noticed morning erections and usually you would, it's a normal thing to have waking up in the morning with something but you have not noticed those recently.\n  I have not noticed those recently.\n  Okay, and that's been a change, has it?\n  An important one, I don't think.\n  Sorry?\n  Yeah, I don't think it's an important change, no.\n  Sorry, you don't think there's been a change there?\n  No, there hasn't been a change there.\n  Oh, okay, sorry, right, sorry. Just going back to the mood symptoms as well, when you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower? Are you in a relationship at the moment?\n  Yeah, I'm married. I've been for many years. And yeah, just over the last few months, just been decentralized. Who's interested?\n  Okay, sorry, you froze there for a moment. So less interested as well, okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems?\n  So in the past, I have a history of hypothyroidism.\n  Hypo?\n  Hypothyroidism.\n  Hyperthyroidism.\n  Yeah.\n  But that's high thyroid, just to sort of confirm it.\n  Sorry, can you say that again, please?\n  Hyper, as in high, hyperthyroid. Hypo. Hypo, okay, hypothyroid, thank you.\n  Thank you. Yeah, and also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there's a suspicion that it may have had an impact on me, that my father has committed suicide about 15 years ago.\n  Okay. Okay. Do you take any medications?\n  I had a drug history of thyroxine, so maybe, yes.\n  Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment? Yes. Any drug allergies? Are you allergic to any medications?\n  No, I have no medication allergies.\n  No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No depression or anything like that running in your family? Okay, and your mother is well? Any brothers or sisters?\n  Yeah, she's fine, and I'm an only child.\n  Okay, so I just, sorry, might seem like a slightly random question, but any change in your vision?\n  No, nothing like that.\n  Okay, and just to go back to your saying you had low mood, some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n Unknown: No.\n  No, not really.\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n  Sometimes, I mean, I guess. most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\n  Okay, so you've become more short of breath over the last few months.\n  Yeah.\n  And you've had, okay, so any other things around this, more fatigue, more shortness of breath? over the last few months, with a slower mood, decreased sex drive. Is there, just before we wrap up, is there anything else that you would like to talk about?\n  No, nothing specific, no.\n  So, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination and also we would probably like to do some blood tests as well. So do you think it would be possible to book an appointment in the next few days with your GP? That would be ideal I think here. And then we can probably do some more, do an examination and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\n  Yeah, it's very useful, thank you. Okay. It's better to have some kind of plan.\n  Yeah, yeah, yeah, I definitely think we need a plan here. It's been nice talking to you. I'm sorry we've run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad that, you know, although you have a low mood, you're... You're not feeling suicidal, just to confirm that, and you'll and will hopefully get to the bottom of some of your tiredness and your other symptoms when we see you, okay?\n  Thank you very much for taking the time.\n  Okay, thank you. Thanks.","marks":[{"start":17,"end":17,"said":"Hi Hi there. Uh","significant":false},{"start":59,"end":65,"said":"Babylon. I just","significant":false},{"start":97,"end":97,"said":"yeah. Uh my name's . Makes sense. Yeah. So .","significant":false},{"start":116,"end":125,"said":"is","significant":false},{"start":167,"end":172,"said":"to Hi. 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He reports that over the past approximately 2 months, he has experienced significant difficulty getting up in the morning and has had very low energy throughout the day. He states that doing most things he would normally find easy has become quite difficult. He also reports not eating very much and having trouble sleeping. He notes difficulty focusing and feeling easily distracted. He endorses a lower mood than usual and decreased interest in sex. He is married and reports being less interested in sexual activity with his spouse. He denies any thoughts of self-harm or harming others. He also reports increased shortness of breath with sports and physical activity compared to a couple of months ago.\n\nHe notes that his symptoms may have coincided with starting a new job approximately 2 months ago. He states he is not able to get his usual enjoyment out of daily activities. He denies any changes in vision.\n\nMedical History  \n- Hypothyroidism\n\nMedications and Supplements  \n- Thyroxine\n\nAllergies  \n- No known medication allergies\n\nFamily History  \n- Father: Deceased by suicide approximately 15 years ago  \n- Mother: Well\n\nSocial History  \n- Occupation: Started a new job approximately 2 months ago  \n- Marital Status: Married for many years  \n- Exercise: Engages in sports; reports increased difficulty with exertion\n\nReview of Systems  \n- General: Difficulty sleeping  \n- Respiratory: Shortness of breath with exertion  \n- Genitourinary: Decreased sex drive  \n- Psychiatric: Difficulty focusing and feeling distracted, denies thoughts of self-harm\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and shortness of breath.\n\nFatigue and low mood  \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking in the mornings, decreased appetite, poor concentration, low mood, and decreased libido. Symptoms began around the time he started a new job 2 months ago. He reports difficulty sleeping and shortness of breath with exertion compared to his baseline. Family history is significant for father's suicide 15 years ago. No current suicidal ideation reported. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for possible depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism.  \nPlan:  \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation  \n- Obtain blood tests to evaluate for underlying medical causes\n","review":169.60526315789474,"saved":127.89473684210526,"clean":false,"effort":15.625,"sig":[["fabrication","He states he is not able to get his usual enjoyment out of daily activities.","Patient said he still enjoys most activities; recording anhedonia, a core depression criterion, reverses the history."]],"mb":18.569812,"latency":44.112,"signable":201.64826315789475},{"label":"Run 2","wer":20.35448827901658,"text":"Hello. Hi, there. My name's Joe. I'm one of the doctors at Babel. Can I confirm your name, please? Sorry, your name was?\n  My name was Brian.\n  Brian. Hi, Brian. Nice name. And your date of birth?\n  Yeah, my date of birth is the 8th of August, nineteen eighty-two. Great.\n  And are you in a sort of confidential place where you can speak freely? Yeah.\n  No, no one else can hear me.\n  Great. And you're happy to continue with the consultation?\n  Yes.\n  Fabulous. Okay. So how can I help today?\n  Yeah. So basically, it's just been happening over the last few weeks or so. But I don't really feel like... Like getting up in the morning is really difficult and I don't have much energy at all during the day. Often, yeah, just like doing most things that I would normally find easy has become quite difficult.\n  Okay, so things have become quite difficult for you.\n  Yeah.\n  Is there anything else?\n  It's quite hard to say. things like I'm not eating very much at the moment, I just don't feel like I have a lot of energy.\n  Okay, I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or five?\n  Now I think about it maybe even longer. I guess it might be related to it, so I also started a new job slightly recently, it might have even coincided with that job a couple of months ago.\n  When did you start your new job, 2 months ago you say? Yeah. Okay, and so this has been going on perhaps for sort of 6 weeks or so?\n  More like 2 months I would say, yeah.\n  Okay, all right, so is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\n  Well, I know that it's not really normal for me, so before this phase started happening, I wouldn't have any problems sort of eating what I want to eat or doing standard things in life. What I want to do is to kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but yeah, give some advice or whatever, that'd be really useful.\n  Okay, sure. Okay, well what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that and then we can go on to sort of what can be done from there. Is that all right?\n  Okay, great.\n  So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the morning?\n  Actually, I'm just not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n  Do you have difficulty sleeping as well? Yeah. And have you... How has your mood been over this period? Have you been feeling re-usual?\n  Distracted, I'd say. I kind of... Yeah, finding it really hard to quite difficulty focusing, I would say, not unhappy or happy, but just quite not focused.\n  Okay, so difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\n  Actually, now you mentioned it like my, Mood is a bit lower recently. And so I've noticed like my sex drive has kind of decreased a bit over the past few months as well. So yeah.\n  And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, maybe slightly personal questions but if you're okay to answer these, do you tend to have morning erections like you, is that something that you've noticed recently?\n  I haven't noticed anything like that specifically.\n  So you're saying you have not noticed morning erections and usually you would, it's a normal thing to have waking up in the morning with something but you have not noticed those recently.\n  I have not noticed those recently.\n  Okay, and that's been a change, has it?\n  An important one, I don't think.\n  Sorry?\n  Yeah, I don't think it's an important change, no.\n  Sorry, you don't think there's been a change there?\n  No, there hasn't been a change there.\n  Oh, okay, sorry, right, sorry. Just going back to the mood symptoms as well, when you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower? Are you in a relationship at the moment?\n  Yeah, I'm married. I've been for many years. And yeah, just over the last few months, just been decentralized. Who's interested?\n  Okay, sorry, you froze there for a moment. So less interested as well, okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems?\n  So in the past, I have a history of hypothyroidism.\n  Hypo?\n  Hypothyroidism.\n  Hyperthyroidism?\n  Yeah.\n  But that's high thyroid, just to sort of confirm it.\n  Sorry, can you say that again, please?\n  Hyper, as in high, hyperthyroid? Hypo. Hypo, okay, hypothyroid, thank you.\n  Thank you. Yeah, and also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there's a suspicion that it may have had an impact on me, that my father has committed suicide about 15 years ago.\n  Okay. Okay. Do you take any medications?\n  I had a drug history of thyroxine, so maybe, yes.\n  Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment? Yes. Any drug allergies? Are you allergic to any medications?\n  No, I have no medication allergies.\n  No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No depression or anything like that running in your family? Okay, and your mother is well? Any brothers or sisters?\n  Yeah, she's fine, and I'm an only child.\n  Okay, so I just, sorry, might seem like a slightly random question, but any change in your vision?\n  No, nothing like that.\n  Okay, and just to go back to your saying you had low mood, some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n Unknown: No.\n  No, not really.\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n  Sometimes, I mean, I guess. most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\n  Okay, so you've become more short of breath over the last few months.\n  Yeah.\n  And you've had, okay, so any other things around this, more fatigue, more shortness of breath? over the last few months, with a slower mood, decreased sex drive. Is there, just before we wrap up, is there anything else that you would like to talk about?\n  No, nothing specific, no.\n  So, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination and also we would probably like to do some blood tests as well. So do you think it would be possible to book an appointment in the next few days with your GP? That would be ideal I think here. And then we can probably do some more, do an examination and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\n  Yeah, it's very useful, thank you. Okay. It's better to have some kind of plan.\n  Yeah, yeah, yeah, I definitely think we need a plan here. It's been nice talking to you. I'm sorry we've run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad that, you know, although you have a low mood, you're... You're not feeling suicidal, just to confirm that, and you'll and will hopefully get to the bottom of some of your tiredness and your other symptoms when we see you, okay?\n  Thank you very much for taking the time.\n  Okay, thank you. Thanks.","marks":[{"start":17,"end":17,"said":"Hi Hi there. Uh","significant":false},{"start":59,"end":65,"said":"Babylon. I just","significant":false},{"start":97,"end":97,"said":"yeah. Uh my name's . Makes sense. Yeah. So .","significant":false},{"start":116,"end":125,"said":"is","significant":false},{"start":167,"end":172,"said":"to Hi. Um uh","significant":false},{"start":229,"end":232,"said":"eighth","significant":false},{"start":453,"end":468,"said":"Marvelous. 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He reports that over the past approximately 2 months, he has experienced significant difficulty getting up in the morning and has had very low energy throughout the day. He reports that activities he would normally find easy have become quite difficult. He also notes decreased appetite and is not eating very much. He reports difficulty sleeping, which he believes may be contributing to his fatigue. He describes difficulty focusing and being easily distracted. He reports his mood has been somewhat lower recently and notes a decrease in sex drive over the past few months, describing decreased interest in sexual activity with his wife. He denies any change in morning erections. He also reports increased shortness of breath with physical activity compared to a couple of months ago.\n\nThe patient notes that his symptoms may have coincided with starting a new job approximately 2 months ago. He states that prior to this period, he had no problems with eating or performing his usual daily activities. He expresses a desire to return to his previous baseline functioning. He denies any thoughts of self-harm or harming others. He denies any changes in vision.\n\nMedical History  \n- Hypothyroidism\n\nMedications and Supplements  \n- Thyroxine PO daily\n\nAllergies  \n- No known medication allergies\n\nFamily History  \n- Father: Deceased by suicide approximately 15 years ago  \n- Mother: No known medical conditions, living\n\nSocial History  \n- Occupation: Started a new job approximately 2 months ago  \n- Marital Status: Married for many years\n\nReview of Systems  \n- General: Difficulty sleeping  \n- Respiratory: Exertional shortness of breath  \n- Gastrointestinal: Decreased appetite  \n- Genitourinary: Denies change in morning erections  \n- Psychiatric: Difficulty focusing and distractibility\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and decreased sex drive.\n\nFatigue and low mood  \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking, decreased appetite, low mood, decreased sex drive, and shortness of breath with exertion. Symptoms began around the time he started a new job. History of hypothyroidism currently treated with thyroxine. Family history significant for father's suicide 15 years ago. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism. The shortness of breath with exertion could suggest anemia or other systemic illness. No current suicidal ideation reported.  \nPlan:  \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation  \n- Obtain blood tests to investigate underlying causes  \n- Continue current thyroxine medication\n","review":170.5263157894737,"saved":126.9736842105263,"clean":false,"effort":18.75,"sig":[["fabrication","Thyroxine PO daily","Route and frequency of thyroxine were never stated; invented medication frequency/route in the record."]],"mb":18.814129,"latency":48.939,"signable":205.2983157894737},{"label":"Run 3","wer":20.125786163522015,"text":"Hello. Hi, there. My name's Joe. I'm one of the doctors at Babel. Can I confirm your name, please? Sorry, your name was?\n  My name was Brian.\n  Brian. Hi, Brian. Nice name. And your date of birth?\n  Yeah, my date of birth is the 8th of August, nineteen eighty-two. Great.\n  And are you in a sort of confidential place where you can speak freely? Yeah.\n  No, no one else can hear me.\n  Great. And you're happy to continue with the consultation?\n  Yes.\n  Fabulous. Okay. So how can I help today?\n  Yeah. So basically, it's just been happening over the last few weeks or so. But I don't really feel like... Like getting up in the morning is really difficult and I don't have much energy at all during the day. Often, yeah, just like doing most things that I would normally find easy has become quite difficult.\n  Okay, so things have become quite difficult for you.\n  Yeah.\n  Is there anything else?\n  It's quite hard to say. things like I'm not eating very much at the moment, I just don't feel like I have a lot of energy.\n  Okay, I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or five?\n  Now I think about it maybe even longer. I guess it might be related to it, so I also started a new job slightly recently, it might have even coincided with that job a couple of months ago.\n  When did you start your new job, 2 months ago you say? Yeah. Okay, and so this has been going on perhaps for sort of 6 weeks or so?\n  More like 2 months I would say, yeah.\n  Okay, all right, so is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\n  Well, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. What I want to do is to kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but yeah, give some advice or whatever, that'd be really useful.\n  Okay, sure. Okay, well what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that and then we can go on to sort of what can be done from there. Is that all right?\n  Okay, great.\n  So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the morning?\n  Actually, I'm just not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n  Do you have difficulty sleeping as well? Yeah. And have you... How has your mood been over this period? Have you been feeling re-usual?\n  Distracted, I'd say. I kind of... Yeah, finding it really hard to quite difficulty focusing, I would say, not unhappy or happy, but just quite not focused.\n  Okay, so difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\n  Actually, now you mentioned it like my, Mood is a bit lower recently. And so I've noticed like my sex drive has kind of decreased a bit over the past few months as well. So yeah.\n  And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, maybe slightly personal questions but if you're okay to answer these, do you tend to have morning erections like you, is that something that you've noticed recently?\n  I haven't noticed anything like that specifically.\n  So you're saying you have not noticed morning erections and usually you would, it's a normal thing to have waking up in the morning with something but you have not noticed those recently.\n  I have not noticed those recently.\n  Okay, and that's been a change, has it?\n  An important one, I don't think.\n  Sorry?\n  Yeah, I don't think it's an important change, no.\n  Sorry, you don't think there's been a change there?\n  No, there hasn't been a change there.\n  Oh, okay, sorry, right, sorry. Just going back to the mood symptoms as well, when you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower? Are you in a relationship at the moment?\n  Yeah, I'm married. I've been for many years. And yeah, just over the last few months, just been decentralized. Who's interested?\n  Okay, sorry, you froze there for a moment. So less interested as well, okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems?\n  So in the past, I have a history of hypothyroidism.\n  Hypo?\n  Hypothyroidism.\n  Hyperthyroidism.\n  Yeah.\n  But that's high thyroid, just to sort of confirm it.\n  Sorry, can you say that again, please?\n  Hyper, as in high, hyperthyroid. Hypo. Hypo, okay, hypothyroid, thank you.\n  Thank you. Yeah, and also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there's a suspicion that it may have had an impact on me, that my father has committed suicide about 15 years ago.\n  Okay. Okay. Do you take any medications?\n  I had a drug history of thyroxine, so maybe, yes.\n  Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment? Yes. Any drug allergies? Are you allergic to any medications?\n  No, I have no medication allergies.\n  No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No depression or anything like that running in your family? Okay, and your mother is well? Any brothers or sisters?\n  Yeah, she's fine, and I'm an only child.\n  Okay, so I just, sorry, might seem like a slightly random question, but any change in your vision?\n  No, nothing like that.\n  Okay, and just to go back to your saying you had low mood, some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n Unknown: No.\n  No, not really.\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n  Sometimes, I mean, I guess. most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\n  Okay, so you've become more short of breath over the last few months.\n  Yeah.\n  And you've had, okay, so any other things around this, more fatigue, more shortness of breath? over the last few months, with a slower mood, decreased sex drive. Is there, just before we wrap up, is there anything else that you would like to talk about?\n  No, nothing specific, no.\n  So, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination and also we would probably like to do some blood tests as well. So do you think it would be possible to book an appointment in the next few days with your GP? That would be ideal I think here. And then we can probably do some more, do an examination and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\n  Yeah, it's very useful, thank you. Okay. It's better to have some kind of plan.\n  Yeah, yeah, yeah, I definitely think we need a plan here. It's been nice talking to you. I'm sorry we've run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad that, you know, although you have a low mood, you're... You're not feeling suicidal, just to confirm that, and you'll and will hopefully get to the bottom of some of your tiredness and your other symptoms when we see you, okay?\n  Thank you very much for taking the time.\n  Okay, thank you. Thanks.","marks":[{"start":17,"end":17,"said":"Hi Hi there. Uh","significant":false},{"start":59,"end":65,"said":"Babylon. I just","significant":false},{"start":97,"end":97,"said":"yeah. Uh my name's . Makes sense. Yeah. So .","significant":false},{"start":116,"end":125,"said":"is","significant":false},{"start":167,"end":172,"said":"to Hi. Um uh","significant":false},{"start":229,"end":232,"said":"eighth","significant":false},{"start":453,"end":468,"said":"Marvelous. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"approximately 2 months of fatigue\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty waking, very low energy, normally easy activities now difficult."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"reports difficulty sleeping\"; no early-waking claim."],["The note captures: Reduced appetite/not eating much.","yes","\"has not been eating very much. He notes decreased appetite\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Lower mood, \"easily distracted with difficulty focusing\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decrease in sex drive... less interested in sexual activity\"."],["The note captures: No thoughts of harming self or others are reported.","yes","\"denies any thoughts of self-harm or harming others\"."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"Father: Deceased by suicide approximately 15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Hypothyroidism correctly recorded."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine PO\"."],["The note captures: No known medication allergies.","yes","\"No known medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"increased shortness of breath... during sports, compared to a couple of months ago\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","New job ~2 months ago \"may have coincided with the onset\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"goal is to return to his previous baseline functioning\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"in-person appointment with GP in the next few days for physical examination\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Obtain blood tests to investigate symptoms\"."]],"claims":[["Cardiovascular/Respiratory ROS: \"Denies chest pain, palpitations, orthopnea, PND, syncope, edema\"; \"denies cough, wheezing\"","None of these symptoms were asked about or mentioned; only vision change and self-harm were explicitly negated in the transcript."],["GI/Neuro ROS: \"Denies abdominal pain, nausea, vomiting\"; \"Denies dizziness, headaches, focal weakness\"","Invented negations; the transcript never discusses these symptoms."]],"note":"Subjective\nBrian, a 44-year-old male with a history of hypothyroidism, presents with approximately 2 months of fatigue, difficulty waking up in the morning, decreased appetite, and low mood. He reports that over the past 2 months, he has experienced significant difficulty with morning awakenings and has had very low energy throughout the day. He states that activities he would normally find easy have become quite difficult. He also reports difficulty sleeping and has not been eating very much. He notes decreased appetite. He started a new job approximately 2 months ago, which may have coincided with the onset of his symptoms.\n\nHis mood has been lower recently and he has been easily distracted with difficulty focusing. He also reports a decrease in sex drive over the past few months, noting he is less interested in sexual activity. He denies any change in morning erections. He denies any thoughts of self-harm or harming others. He reports increased shortness of breath with physical activity, specifically during sports, compared to a couple of months ago. He denies any changes in vision. He states he is not able to fully enjoy his usual daily activities as he did previously. His goal is to return to his previous baseline functioning.\n\nMedical History  \n- Hypothyroidism\n\nMedications and Supplements  \n- Thyroxine PO\n\nAllergies  \n- No known medication allergies\n\nFamily History  \n- Father: Deceased by suicide approximately 15 years ago  \n- Mother: Well\n\nSocial History  \n- Occupation: Started a new job approximately 2 months ago  \n- Marital Status: Married for many years  \n- Physical Activity: Participates in sports\n\nReview of Systems  \n- General: Sleep disturbance  \n- Cardiovascular: Denies chest pain, palpitations, orthopnea, PND, syncope, edema  \n- Respiratory: Exertional shortness of breath, denies cough, wheezing  \n- Gastrointestinal: Denies abdominal pain, nausea, vomiting  \n- Neurological: Denies dizziness, headaches, focal weakness  \n- Psychiatric: Difficulty focusing and distractibility, denies suicidal ideation  \n- HEENT: Denies vision changes  \n- Genitourinary: Denies change in morning erections\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and decreased libido.\n\nFatigue and low mood  \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking in the mornings, decreased appetite, poor concentration, low mood, and decreased libido. Symptoms began around the time he started a new job 2 months ago. He reports difficulty sleeping and has become more short of breath with exertion compared to his baseline. He has a history of hypothyroidism currently treated with thyroxine. Family history is significant for father's suicide 15 years ago. No current suicidal ideation reported. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for possible depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism.  \nPlan:  \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation  \n- Obtain blood tests to investigate symptoms\n","review":174.6315789473684,"saved":122.86842105263159,"clean":false,"effort":18.75,"sig":[["fabrication","Cardiovascular/Respiratory ROS: \"Denies chest pain, palpitations, orthopnea, PND, syncope, edema\"; \"denies cough, wheezing\"","Cardiorespiratory negatives never asked, in a patient with new exertional dyspnoea."],["fabrication","GI/Neuro ROS: \"Denies abdominal pain, nausea, vomiting\"; \"Denies dizziness, headaches, focal weakness\"","GI and neuro negatives (headache, dizziness, weakness) never covered in the transcript."]],"mb":19.960411,"latency":57.809,"signable":220.3505789473684},{"label":"Run 4","wer":20.125786163522015,"text":"Hello. Hi, there. My name's Joe. I'm one of the doctors at Babel. Can I confirm your name, please? Sorry, your name was?\n  My name was Brian.\n  Brian. Hi, Brian. Nice name. And your date of birth?\n  Yeah, my date of birth is the 8th of August, nineteen eighty-two. Great.\n  And are you in a sort of confidential place where you can speak freely? Yeah.\n  No, no one else can hear me.\n  Great. And you're happy to continue with the consultation?\n  Yes.\n  Fabulous. Okay. So how can I help today?\n  Yeah. So basically, it's just been happening over the last few weeks or so. But I don't really feel like... Like getting up in the morning is really difficult and I don't have much energy at all during the day. Often, yeah, just like doing most things that I would normally find easy has become quite difficult.\n  Okay, so things have become quite difficult for you.\n  Yeah.\n  Is there anything else?\n  It's quite hard to say. things like I'm not eating very much at the moment, I just don't feel like I have a lot of energy.\n  Okay, I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or five?\n  Now I think about it maybe even longer. I guess it might be related to it, so I also started a new job slightly recently, it might have even coincided with that job a couple of months ago.\n  When did you start your new job, 2 months ago you say? Yeah. Okay, and so this has been going on perhaps for sort of 6 weeks or so?\n  More like 2 months I would say, yeah.\n  Okay, all right, so is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\n  Well, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. What I want to do is to kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but yeah, give some advice or whatever, that'd be really useful.\n  Okay, sure. Okay, well what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that and then we can go on to sort of what can be done from there. Is that all right?\n  Okay, great.\n  So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the morning?\n  Actually, I'm just not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n  Do you have difficulty sleeping as well? Yeah. And have you... How has your mood been over this period? Have you been feeling re-usual?\n  Distracted, I'd say. I kind of... Yeah, finding it really hard to quite difficulty focusing, I would say, not unhappy or happy, but just quite not focused.\n  Okay, so difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\n  Actually, now you mentioned it like my, Mood is a bit lower recently. And so I've noticed like my sex drive has kind of decreased a bit over the past few months as well. So yeah.\n  And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, maybe slightly personal questions but if you're okay to answer these, do you tend to have morning erections like you, is that something that you've noticed recently?\n  I haven't noticed anything like that specifically.\n  So you're saying you have not noticed morning erections and usually you would, it's a normal thing to have waking up in the morning with something but you have not noticed those recently.\n  I have not noticed those recently.\n  Okay, and that's been a change, has it?\n  An important one, I don't think.\n  Sorry?\n  Yeah, I don't think it's an important change, no.\n  Sorry, you don't think there's been a change there?\n  No, there hasn't been a change there.\n  Oh, okay, sorry, right, sorry. Just going back to the mood symptoms as well, when you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way has your sex drive been lower? Are you in a relationship at the moment?\n  Yeah, I'm married. I've been for many years. And yeah, just over the last few months, just been decentralized. Who's interested?\n  Okay, sorry, you froze there for a moment. So less interested as well, okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems?\n  So in the past, I have a history of hypothyroidism.\n  Hypo?\n  Hypothyroidism.\n  Hyperthyroidism.\n  Yeah.\n  But that's high thyroid, just to sort of confirm it.\n  Sorry, can you say that again, please?\n  Hyper, as in high, hyperthyroid. Hypo. Hypo, okay, hypothyroid, thank you.\n  Thank you. Yeah, and also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there's a suspicion that it may have had an impact on me, that my father has committed suicide about 15 years ago.\n  Okay. Okay. Do you take any medications?\n  I had a drug history of thyroxine, so maybe, yes.\n  Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment? Yes. Any drug allergies? Are you allergic to any medications?\n  No, I have no medication allergies.\n  No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No depression or anything like that running in your family? Okay, and your mother is well? Any brothers or sisters?\n  Yeah, she's fine, and I'm an only child.\n  Okay, so I just, sorry, might seem like a slightly random question, but any change in your vision?\n  No, nothing like that.\n  Okay, and just to go back to your saying you had low mood, some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else?\n Unknown: No.\n  No, not really.\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n  Sometimes, I mean, I guess. most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\n  Okay, so you've become more short of breath over the last few months.\n  Yeah.\n  And you've had, okay, so any other things around this, more fatigue, more shortness of breath? over the last few months, with a slower mood, decreased sex drive. Is there, just before we wrap up, is there anything else that you would like to talk about?\n  No, nothing specific, no.\n  So, getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination and also we would probably like to do some blood tests as well. So do you think it would be possible to book an appointment in the next few days with your GP? That would be ideal I think here. And then we can probably do some more, do an examination and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\n  Yeah, it's very useful, thank you. Okay. It's better to have some kind of plan.\n  Yeah, yeah, yeah, I definitely think we need a plan here. It's been nice talking to you. I'm sorry we've run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad that, you know, although you have a low mood, you're... You're not feeling suicidal, just to confirm that, and you'll and will hopefully get to the bottom of some of your tiredness and your other symptoms when we see you, okay?\n  Thank you very much for taking the time.\n  Okay, thank you. Thanks.","marks":[{"start":17,"end":17,"said":"Hi Hi there. Uh","significant":false},{"start":59,"end":65,"said":"Babylon. I just","significant":false},{"start":97,"end":97,"said":"yeah. Uh my name's . Makes sense. Yeah. So .","significant":false},{"start":116,"end":125,"said":"is","significant":false},{"start":167,"end":172,"said":"to Hi. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"approximately 2 months of fatigue\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty waking, very low energy, normally easy activities \"have become quite difficult\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"reports difficulty sleeping\"; no early-waking claim."],["The note captures: Reduced appetite/not eating much.","yes","\"decreased appetite with reduced food intake\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Low mood, \"difficulty focusing and feeling easily distracted\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased sex drive over the past few months\"."],["The note captures: No thoughts of harming self or others are reported.","yes","\"denies any thoughts of self-harm or harming others\"."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"Father: Deceased by suicide approximately 15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Hypothyroidism correctly recorded."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine PO\" / \"on thyroxine\"."],["The note captures: No known medication allergies.","yes","\"No known medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"new-onset shortness of breath with physical activity, such as sports, compared to a couple of months ago\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","Onset \"may have coincided with starting a new job approximately 2 months ago\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"seeking advice on how to return to his previous baseline functioning\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"in-person appointment with GP in the next few days for physical examination\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Obtain blood tests to investigate underlying causes\"."]],"claims":[],"note":"Subjective\nBrian, a 44-year-old male with a history of hypothyroidism, presents with approximately 2 months of fatigue, difficulty waking up in the morning, decreased appetite, and low mood. He reports that over the past 2 months, he has been experiencing significant difficulty with morning awakenings and has had very low energy throughout the day. He states that activities he would normally find easy have become quite difficult. He also reports difficulty sleeping and decreased appetite with reduced food intake. He describes difficulty focusing and feeling easily distracted. He endorses a low mood and decreased sex drive over the past few months. He denies any thoughts of self-harm or harming others. He also reports new-onset shortness of breath with physical activity, such as sports, compared to a couple of months ago. He denies any changes in vision.\n\nThe patient notes that the onset of his symptoms may have coincided with starting a new job approximately 2 months ago. He reports that prior to this period, he had no problems with eating or performing daily activities. He is seeking advice on how to return to his previous baseline functioning.\n\nMedical History  \n- Hypothyroidism\n\nMedications and Supplements  \n- Thyroxine PO\n\nAllergies  \n- No known medication allergies\n\nFamily History  \n- Father: Deceased by suicide approximately 15 years ago  \n- Mother: Living, well\n\nSocial History  \n- Marital Status: Married for many years  \n- Occupation: Started a new job approximately 2 months ago  \n- Physical Activity: Participates in sports\n\nReview of Systems  \n- HEENT: Denies vision changes  \n- Respiratory: Shortness of breath with exertion  \n- Genitourinary: Decreased libido  \n- Psychiatric: Difficulty focusing and distractibility, denies suicidal ideation\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and decreased sex drive.\n\nFatigue and low mood  \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking, decreased appetite, low mood, decreased sex drive, and difficulty concentrating. Symptoms began around the time he started a new job 2 months ago. He has a history of hypothyroidism on thyroxine and a family history of his father committing suicide 15 years ago. He denies suicidal ideation but reports shortness of breath with exertion compared to his baseline a couple of months ago. The constellation of symptoms including fatigue, low mood, decreased libido, and concentration difficulties raises concern for depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism.  \nPlan:  \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation  \n- Obtain blood tests to investigate underlying causes  \n- Continue current thyroxine medication\n","review":136.42105263157896,"saved":161.07894736842104,"clean":true,"effort":0.0,"sig":[],"mb":18.850059,"latency":59.035,"signable":183.22305263157895},{"label":"Run 5","wer":20.35448827901658,"text":"Hello. Hi there. My name's Joe, I'm one of the doctors at Babel. Can I confirm your name please?\n  Yeah, my name is Brian.\n  Sorry, your name was?\n  My name was Brian.\n  Brian, hi Brian, nice to meet you. And your date of birth?\n  Yeah, my date of birth is the 8th of August, nineteen eighty-two. Great.\n  And are you in a sort of confidential place where you can speak freely?\n  Yeah, no one else can hear me.\n  Great. And you're happy to continue with the consultation?\n  Yes.\n  Marvellous. OK, so how can I help today?\n  Yeah, so basically it's just been happening over the last few weeks or so. I don't really feel like... Like getting up in the morning is really difficult and I don't have much energy at all during the day. Often, yeah, just like doing most things that I would normally find easy has become quite difficult.\n  Okay, so things have become quite difficult for you.\n  Yeah.\n  Is there anything else?\n  It's quite hard to say. things like I'm not eating very much at the moment, I just don't feel like I have a lot of energy.\n  Okay, I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or five?\n  Now I think about it maybe even longer. I guess it might be related to it, so I also started a new job slightly recently, it might have even coincided with that job a couple of months ago.\n  When did you start your new job, 2 months ago you say? Yeah. Okay, and so this has been going on perhaps for sort of 6 weeks or so?\n  More like 2 months I would say, yeah.\n  Okay, all right, so is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\n  Well, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. What I want to do is to kind of return to that previous state somehow. I'm not sure how that is, what the best way is of doing that are, but yeah, give some advice or whatever, that'd be really useful.\n  Okay, sure. Okay, well what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that.\n  And then we can go on to sort of what can be done from there. Is that all right? Okay, great.\n  So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to, just on that note, do you tend to wake up early and then stay in bed in the mornings?\n  Actually, I'm just not really waking up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close.\n  Difficulty sleeping as well? Yeah. And have you... How has your mood been over this period? Have you been feeling re-strict, I'd say?\n  I kind of... Yeah, finding it really hard to quite difficulty focusing, I would say, not unhappy or happy, but just quite not focused.\n  OK, so difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\n  Actually, now you mention it, like, Mood is a bit lower recently and so I've noticed like my sex drive has kind of decreased a bit over the past few months as well. So yeah.\n  And so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, maybe slightly personal questions but if you're okay to answer these, do you tend to have morning erections like you, is that something that you've noticed recently?\n  I haven't noticed anything like that specifically.\n  So you're saying you have not noticed morning erections and usually you would, it's a normal thing to have waking up in the morning with something but you have not noticed those recently.\n  I have not noticed those recently.\n  Okay, and that's been a change, has it?\n  An important one, I don't think.\n  Sorry?\n  Yeah, I don't think it's an important change, no.\n  Sorry, you don't think there's been a change there?\n  No, there hasn't been a change there.\n  Oh, okay, sorry, right, sorry. Just going back to the mood symptoms as well, you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what ways has your sex drive been lower? Are you in a relationship at the moment?\n  Yeah, I'm married. I've been for many years. And yeah, just over the last few months, just been disinterested. Who's interested?\n  Okay, sorry, you froze there for a moment. So less interested as well, okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any mental health problems in the past or any physical health problems?\n  So in the past, then, I have a history of hypothyroidism. Hypo? Hypothyroidism.\n  Hyperthyroidism.\n  Yeah.\n  But that's hythyroid, just to sort of confirm it.\n  Sorry, can you say that again, please?\n  Hyper, as in high, hyperthyroid. Hypo. Hypo. OK, hypothyroid. Thank you.\n  Thank you. Yeah, and also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there's a suspicion that it may have had an impact on me, that my father has committed suicide about 15 years ago.\n  Okay. Okay. Do you take any medications?\n  I have a drug history of thyroxine, so maybe, yes.\n  Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment?\n  Yes.\n  Any drug allergies? Are you allergic to any medications?\n  No, I have no medication allergies.\n  No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No depression or anything like that running in your family? Okay, and your mother is well? Any brothers or sisters?\n  Yeah, she's fine, and I'm an only child.\n  Okay, so I just, sorry, might seem like a slightly random question, but any change in your vision?\n  No, nothing like that.\n  Okay, and just to go back to your saying you had low mood, some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No.\n  No, not really.\n  And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\n  Sometimes, I mean, I guess. most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\n  Okay, so you've become more short of breath over the last few months.\n  Yeah.\n  And you've had, okay, so any other things around this, more fatigue, more shortness of breath? over the last few months with a slower mood, decreased sex drive. Just before we wrap up, is there anything else that you would like to talk about?\n  No, nothing specific.\n  Getting a little bit towards the end now but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination and also we would probably like to do some blood tests as well. So do you think it would be possible to book an appointment in the next few days with your GP or that would be ideal I think here. And then we can probably do some more, do an examination and do some investigations really to see what's going on here a little bit more. That makes sense, yeah. Yeah, it's very useful, thank you. Okay. It's better to have some kind of plan. Yeah, yeah, yeah. I definitely think we need a plan here. It's been nice talking to you. I'm sorry we've run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad, you know, although you have a low mood, you're... You're not feeling suicidal, just to confirm that, and you'll and will hopefully get to the bottom of some of your tiredness and your other symptoms when we see you, okay? Thank you very much for taking the time. Okay, thank you. Thanks.","marks":[{"start":16,"end":16,"said":"Hi Hi there. Uh","significant":false},{"start":58,"end":64,"said":"Babylon. I just","significant":false},{"start":108,"end":122,"said":"name's . Makes sense. Yeah. So .","significant":false},{"start":142,"end":151,"said":"is","significant":false},{"start":195,"end":204,"said":"Hi. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"approximately 2 months of progressive fatigue\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty getting up, very low energy, and \"activities he would normally find easy have become quite difficult\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"reports difficulty sleeping at night\"; no claim of early waking."],["The note captures: Reduced appetite/not eating much.","yes","\"is not eating very much\" / decreased appetite."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Low mood with \"difficulty focusing and feeling distracted\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased sex drive... disinterest in sexual activity\"."],["The note captures: No thoughts of harming self or others are reported.","yes","\"denies any thoughts of self-harm or harming others\"."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"Father: Deceased by suicide approximately 15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Medical history correctly listed as hypothyroidism."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine PO\" listed as current medication."],["The note captures: No known medication allergies.","yes","\"No known medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"new-onset shortness of breath with physical exertion compared to a couple of months ago\" with sports noted."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","Onset \"may have coincided with starting a new job approximately 2 months ago\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"wishes to return to his previous baseline\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"in-person appointment with GP in the next few days for physical examination\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Obtain blood tests to evaluate for medical causes of symptoms\"."]],"claims":[],"note":"Subjective\nBrian, a married male with a history of hypothyroidism, presents with approximately 2 months of progressive fatigue, difficulty waking up in the morning, decreased appetite, difficulty sleeping, difficulty focusing, low mood, decreased sex drive, and exertional shortness of breath.\n\nHe reports that over the past approximately 2 months, he has experienced significant difficulty getting up in the morning and has had very low energy throughout the day. He states that activities he would normally find easy have become quite difficult. He also reports difficulty sleeping at night and is not eating very much. He notes his mood has been lower recently and he has had difficulty focusing and feeling distracted. He reports decreased sex drive over the past few months, describing disinterest in sexual activity with his wife. He denies any change in morning erections. He also reports new-onset shortness of breath with physical exertion compared to a couple of months ago. He denies any thoughts of self-harm or harming others. He denies any changes in vision.\n\nHe notes that the onset of his symptoms may have coincided with starting a new job approximately 2 months ago. He states that prior to this period, he had no problems with eating or performing daily activities and wishes to return to his previous baseline.\n\nMedical History  \n- Hypothyroidism\n\nMedications and Supplements  \n- Thyroxine PO\n\nAllergies  \n- No known medication allergies\n\nFamily History  \n- Father: Deceased by suicide approximately 15 years ago  \n- Mother: No known depression or psychiatric conditions, living\n\nSocial History  \n- Occupation: Started a new job approximately 2 months ago  \n- Marital Status: Married for many years  \n- Exercise: Engages in sports\n\nReview of Systems  \n- Cardiovascular: Shortness of breath with exertion  \n- Gastrointestinal: Decreased appetite  \n- Genitourinary: Denies change in morning erections  \n- Psychiatric: Denies suicidal ideation or thoughts of harming others, denies vision changes\n\nObjective\nN/A\n\nAssessment & Plan\n44-year-old male with history of hypothyroidism, presenting with 2 months of fatigue, difficulty waking, decreased appetite, low mood, and decreased libido.\n\nFatigue and low mood  \nAssessment: Patient presents with a 2-month history of fatigue, difficulty waking in the mornings, decreased appetite, low mood, decreased libido, difficulty focusing, and shortness of breath with exertion. Symptoms began around the time he started a new job 2 months ago. History of hypothyroidism currently treated with thyroxine. Family history is significant for father's suicide 15 years ago. The constellation of symptoms including fatigue, low mood, decreased libido, and cognitive difficulties raises concern for depression, though medical causes including thyroid dysfunction must be ruled out given his history of hypothyroidism. The shortness of breath with exertion could be related to deconditioning from decreased activity or may indicate an underlying medical condition. Patient denies suicidal ideation and maintains some ability to enjoy usual activities.  \nPlan:  \n- Schedule in-person appointment with GP in the next few days for physical examination and further evaluation  \n- Obtain blood tests to evaluate for medical causes of symptoms\n","review":152.21052631578948,"saved":145.28947368421052,"clean":true,"effort":0.0,"sig":[],"mb":18.899799,"latency":56.354,"signable":196.33652631578948}],"cliniscripts":[{"label":"Run 1","wer":13.264722698684963,"text":"Yeah, I think you said— Hello?\nHi there.\nHi, hi there.\nUh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\nUh, yeah. My name's Zoe.\nSo what— sorry, your name was? My name was Brian. Brian. Hi, Brian. Nice to meet you. Hi. Um, uh, and your date of birth? Yeah. My date of birth is the 8th of August 1982.\nGreat.\nAnd, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation?\nYes. Marvelous. Okay, so, um, how can I help today?\nYeah, um, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day.\nUm, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\nOkay. So things have become quite difficult for you. Yeah. Is there anything else?\nUm, I don't know. It's quite hard to say. Like, things like I— not, not eating very much at the moment.\nI just don't feel like I have a lot of energy.\nOkay. Um, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How, how long? Roughly? Well, now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah.\nOkay.\nAnd, um, so this has been going on perhaps for, um, sort of six weeks or so?\nMore like two, two months, I would say. Yeah. Okay.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\nWell, um, I, I know that it's not really normal for me, so. But for this phase, so it happening, you know, I wouldn't have any problem sort of eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\nOkay. Sure. Okay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\nOkay. Okay, great.\nSo you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings?\nUm, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well?\nYeah. Um, and have you and how, how is your mood been over this period?\nHave you been? Um, feeling your usual? Distract? I, I'd say.\nUh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say.\nUm, not unhappy or happy, but just, uh, quite just not focused.\nOkay. So difficulty focusing, quite distracted.\nAnd would you say you've been in good spirits, or is your mood low?\nUm, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well. All right. So yeah.\nOkay.\nAnd, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you is that something that you've noticed recently? Um, I have noticed anything like that specifically, no. So you've not so you're saying you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings with som\nething. Yes. But you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it?\nUm, important one, I don't think. Um. Sorry? Yeah.\nNot I don't think it's an important change, no. I, I sorry, are y-y-you don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry. Okay. So um, just going back to the mood symptoms as well, uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been um, slightly lower with lower sex drive. Yeah.\nUm, and in what way is your sex drive been lower? Uh, are you in a relationship at the moment? Yeah, I, I'm married.\nUm, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been decent. Disinterested.\nSorry. Okay. Sorry, you froze there for a moment.\nUm, so less interested as well. Okay. And just to ask you a few questions before we it, uh, wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems?\nNo? Um, so in the past, um, I have, uh, a history of hypothyroidism. Um. Hypo?\nHyperthyroidism. Hyperthyroidism.\nYeah. Okay.\nSo that's. Um. High thyroid, just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high, hyperthyroid.\nHyper? Hypo okay, hypothyroid. Thank you. Thank you.\nUm, yeah. Okay. And, uh, also, in the past I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me. But my father has committed suicide, um, about 15 years ago.\nOkay.\nOkay. And, um, uh, do you take any medications?\nI have a drug history of thyroxine.\nMm-hmm. So maybe, yes.\nDo you do you continue to take thyroxine now?\nYes.\nYou do? You're so you're taking thyroxine at the moment?\nUm, yes. Cool.\nAnd any drug allergies? Are you allergic to any medications? No, I have no, uh, medication allergies, no. No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in your family or thyroxine? No, nothing at all. Okay. And your mother is, is well? Any brothers or sisters? Yeah, she's fine. Um, and I'm an only child. Um,\nokay. Okay. So I just, uh, uh sorry, mine seemed like slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision? Okay. And just to go back to your you're saying you had low mood. Some people who are who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, no, not really, no. And are you able to get the usual enjoyment out of your daily activities that you have\ndone in the past?\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, uh, my I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay. So you, you've become more short of breath over the last few months? Yeah. Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months? Hmm. U\nm, with a sli lower, lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about? Um, no, nothing specific, no. So um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few d\nays? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can. Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\nIs that all right? Yeah, that's very useful. Thank you, um. Okay. Uh, better to have some kind of plan, um. Yeah, yeah, yeah. I think we I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. Mm-hmm. Um, and you're.\nYes. Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms. And we'll see you.\nOkay? Thank you very much for taking the time.","marks":[{"start":0,"end":22,"said":"","significant":false},{"start":100,"end":108,"said":"Babylon.","significant":false},{"start":170,"end":174,"said":". Makes sense. 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Thanks.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"2-month history\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty waking, low energy, \"finding normal activities difficult\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"experiencing difficulty sleeping\"."],["The note captures: Reduced appetite/not eating much.","yes","\"reduced appetite\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"lower mood... difficulty focusing, and being easily distracted\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased sex drive\"."],["The note captures: No thoughts of harming self or others are reported.","no","No mention of absence of thoughts of harm to self or others."],["The note captures: Father died by suicide approximately fifteen years ago.","no","Father's suicide not mentioned."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"history of hypothyroidism\" noted in assessment."],["The note captures: Currently taking thyroxine.","no","Thyroxine not mentioned."],["The note captures: No known medication allergies.","no","Allergies not mentioned."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"new onset shortness of breath during sports over the last few months\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","no","New job not mentioned."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"concern is to return to their previous state of well-being\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","partial","In-person examination planned, but the next-few-days timeframe / GP is missing."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Conduct blood tests to investigate the reported symptoms further\"."]],"claims":[["\"not noticing morning erections, which is a change for them\"","Patient explicitly clarified \"there hasn't been a change there\"; the note asserts the opposite."],["\"The patient's affect appears congruent with reported low mood\"","No observation of affect is made anywhere in the transcript; invented objective finding."]],"note":"S (Subjective):\n- Patient presents with a 2-month history of difficulty waking up, low energy, and reduced appetite.\n- They report finding normal activities difficult and experiencing difficulty sleeping.\n- Patient describes lower mood, decreased sex drive, difficulty focusing, and being easily distracted.\n- They report not noticing morning erections, which is a change for them.\n- Patient notes new onset shortness of breath during sports over the last few months.\n\nO (Objective):\n- The patient is cooperative during the consultation.\n- The patient's speech is clear and responsive.\n- The patient's affect appears congruent with reported low mood.\n- No other objective findings were explicitly mentioned or observed via equipment.\n- No vital signs, laboratory results, or imaging studies were discussed.\n\nA (Assessment):\n- Patient presents with symptoms consistent with a depressive episode, including low mood, anhedonia (difficulty enjoying activities), sleep disturbance, reduced energy, and decreased libido.\n- Differential diagnosis includes underlying medical conditions, particularly given the history of hypothyroidism and new-onset shortness of breath.\n- The chronicity of symptoms (2 months) suggests a persistent issue.\n- The patient's concern is to return to their previous state of well-being.\n\nP (Plan):\n- Book an in-person appointment for the patient for a physical examination.\n- Conduct blood tests to investigate the reported symptoms further.\n- Further investigations are planned to understand the underlying cause of the symptoms.\n- No specific medication or dietary changes were discussed or prescribed.\n- Referral to other specialties was not explicitly mentioned at this stage.\n","review":192.90789473684208,"saved":104.59210526315792,"clean":false,"effort":53.125,"sig":[["missing","No thoughts of harming self or others are reported.","Documented absence of self-harm thoughts omitted in a low-mood patient with family suicide history."],["missing","Father died by suicide approximately fifteen years ago.","Father suicide is a key suicide-risk factor for a patient with low mood."],["missing","Currently taking thyroxine.","Current thyroxine omitted from the medication record."],["partial","Plan for an in-person GP appointment in the next few days with physical examination.","Follow-up urgency (GP within next few days) lost, which could delay review of new dyspnoea."],["fabrication","\"not noticing morning erections, which is a change for them\"","Patient said there was no change in morning erections; note states it is a change."],["fabrication","\"The patient's affect appears congruent with reported low mood\"","Affect observation invented; no mental state finding was made."]],"mb":34.590137,"latency":29.153,"signable":202.9158947368421},{"label":"Run 2","wer":13.093196112064037,"text":"And I think you said— Hello?\nHi there.\nHi, hi there.\nUh, my name's Joe, I'm one of the doctors at Babylon. I just— can I confirm your name, please?\nUh, yeah. My name is— So what— sorry, your name was? My name was Brian. Brian. Hi Brian. Nice to meet you. Hi. Um, and your date of birth? Yeah. My date of birth is the 8th of August 1982.\nGreat.\nAnd, uh, are you in a sort of, uh, confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation?\nYes. Marvelous. Okay, so how can I help today?\nYeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day.\nUm, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\nOkay. So things have become quite difficult for you? Yeah. Is there anything else?\nUm, I don't know. It's quite hard to say. Like, things like I— not, not eating very much at the moment.\nI just don't feel like I have a lot of energy.\nOkay.\nI'm sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How, how long? Roughly? Well, now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah.\nOkay.\nAnd, um, so this has been going on perhaps for, um, sort of six weeks or so?\nMore like two, two months, I would say. Yeah. Okay.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\nWell, um, I, I know that it's not really normal for me, so. But for this phase side happening, you know, I wouldn't have any problem sort of eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\nOkay. Sure. Okay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\nOkay. Okay, great.\nSo you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings?\nUm, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Do you have difficulty sleeping as well?\nYeah. Um, and have you and how, how has your mood been over this period?\nHave you been? Um, feeling your usual? Distract? I, I'd say.\nUh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say.\nUm, not unhappy or happy, but just, uh, quite just not focused.\nOkay. So difficulty focusing, quite distracted.\nAnd would you say you've been in good spirits, or is your mood low?\nUm, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well. All right. So, yeah.\nOkay.\nAnd, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you is that something that you've noticed recently? Um, I have noticed anything like that specifically, no. So you've not so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have waking up in the morning with som\nething. Yes. But you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it?\nUm, important one, I don't think. Um. Sorry? Yeah.\nNot I don't think it's an important change, no. I, I sorry. Are you, you don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, uh, when you've had, uh, difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah.\nUm, and in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah, I, I'm married.\nUm, I've been for, for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been decent. Disinterested?\nSorry. Okay. Sorry, you froze there for a moment.\nUm, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems?\nNo? Um, so in the past, um, I have a history of hypothyroidism, uh. Hypo.\nHypothyroidism. Hyperthyroidism.\nYeah. Okay.\nSo that's. Um. High thyroid, just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high, hyperthyroid.\nHypo? Hypo okay, hypo-thyroid. Thank you. Thank you.\nUm, yeah. Okay. And, uh, also, in the past I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me. But my father has committed suicide, um, about 15 years ago.\nOkay.\nOkay. And, um, uh, do you take any medications?\nI have a drug history of thyroxine.\nMm-hmm. So maybe, yes.\nDo you do you continue to take thyroxine now?\nYes.\nYou do? You're so you're taking thyroxine at the moment?\nUm, yes. Cool.\nAnd any drug allergies? Are you allergic to any medications? No, I have no, uh, medication allergies, no. No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family or thyroxine? No, nothing like that at all. Okay. And your mother is, is well? Any brothers or sisters? Yeah, she's fine. U\nm, and I'm an only child. Um, okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision? Okay. And just to go back to your you're saying you had low mood. Some people who are who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, not re not really, no. And are you able to get the usual enjoyment out of y\nour daily activities that you have done in the past?\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay. So you, you've become more short of breath over the last few months? Yeah. Um, and you've had, uh, okay. So, uh, any other things around there? So more fatigue, more shortness of breath, um, over the last few months? Hmm. Um,\nwith a s low lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about? Um, no, nothing specific, no. So going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few d\nays? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can. Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense, yeah.\nIs that all right? Yeah, that's very useful. Thank you. Um, better to have some kind of plan, um. Yeah, yeah, yeah. I think I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. Mm-hmm. And, and you're.\nYes. Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms. And we'll see you.\nOkay? Thank you very much for taking the time. Okay. Thank you. Thank you. Thanks.","marks":[{"start":0,"end":20,"said":"","significant":false},{"start":161,"end":168,"said":"name's . Makes sense. 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Yeah it feels","significant":false},{"start":8697,"end":8703,"said":"we've run","significant":false},{"start":9111,"end":9120,"said":"when we","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","States ~2 months of symptoms."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Captures difficulty getting up, low energy and usual tasks becoming difficult."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","Records difficulty/trouble sleeping without claiming early waking."],["The note captures: Reduced appetite/not eating much.","yes","Records decreased appetite/not eating much."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Records lower mood with difficulty focusing and distractibility."],["The note captures: Reduced libido/sexual interest.","yes","Records decreased sex drive/interest."],["The note captures: No thoughts of harming self or others are reported.","yes","Denies thoughts of harming self or others."],["The note captures: Father died by suicide approximately fifteen years ago.","no","Father's suicide ~15 years ago is not mentioned."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Past history correctly recorded as hypothyroidism."],["The note captures: Currently taking thyroxine.","yes","Thyroxine listed as current medication."],["The note captures: No known medication allergies.","no","Allergy status is not documented."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","Increased shortness of breath with sport/exertion vs a couple of months ago."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","Symptoms coincided with new job ~2 months ago."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Patient's wish to return to his previous self is not captured; plan goal is framed as finding the cause."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","In-person GP appointment in next few days for physical examination."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","Blood tests planned to investigate symptoms."]],"claims":[],"note":"S (Subjective):\n- Patient reports a 2-month history of difficulty waking, low energy, and general difficulty with daily tasks, which coincided with starting a new job.\n- They experience difficulty sleeping, difficulty focusing, and easy distractibility, along with a decreased appetite.\n- Patient notes a lower mood and decreased sex drive over the past few months, expressing disinterest within their marriage.\n- They report an increase in shortness of breath during sports activities compared to a few months ago.\n- Patient denies any thoughts of self-harm or harming others.\n\nO (Objective):\n- The patient is cooperative and communicative, providing direct answers to the doctor's questions.\n- No physical examination findings, vital signs, or laboratory results are documented in the transcript.\n- No unusual patterns in speech, affect, or thought process were explicitly noted by the doctor during the interaction.\n\nA (Assessment):\n- The doctor has not yet made a definitive diagnosis but is considering various possibilities for the patient's reported fatigue, low mood, and other systemic symptoms.\n- Patient's past medical history of hypothyroidism, currently managed with Thyroxine, is noted as a relevant factor.\n- The constellation of symptoms necessitates further investigation to differentiate between potential medical and psychological etiologies.\n\nP (Plan):\n- Schedule an in-person appointment for the patient with their General Practitioner within the next few days.\n- Conduct a comprehensive physical examination during the scheduled follow-up.\n- Order specific blood tests to aid in the investigation of the patient's reported symptoms.\n- The goal is to identify the underlying cause of the patient's persistent tiredness and associated health concerns.\n","review":130.3421052631579,"saved":167.1578947368421,"clean":false,"effort":18.75,"sig":[["missing","Father died by suicide approximately fifteen years ago.","Father's suicide is a key risk factor in a patient presenting with low mood and needs to be in the record."]],"mb":34.892588,"latency":31.882,"signable":148.3601052631579},{"label":"Run 3","wer":13.550600343053173,"text":"And I think— Hello?\nHi there.\nHi, hi there.\nUh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\nHi there, yeah. My name is Joe.\nSo what— sorry, your name was? My name was Brian. Brian, hi Brian. Nice to meet you. Brian. Um, and your date of birth? Yeah, my date of birth is the 8th of August 1982.\nGreat.\nAnd, uh, are you in a sort of confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation?\nYes. Marvelous. Okay, so, um, how can I help today?\nYeah, um, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day.\nUm, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\nThat's okay. So things have become quite difficult for you? Yeah. Is there anything else?\nUm, oh no, it's quite hard to say. Like, things like I— not, not eating very much at the moment.\nI just don't feel like I have a lot of energy.\nOkay.\nUm, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How, how long? Roughly? Well, now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah.\nOkay.\nAnd, um, so this has been going on perhaps for, um, sort of six weeks or so?\nMore like two, two months, I would say. Yeah. Okay.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\nWell, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what, what the best way is of doing that are, but, yeah, give some advice or whatever. That'd be really useful.\nOkay. Sure.\nOkay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\nOkay. Okay, great.\nSo you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings?\nUm, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well?\nYeah. Um, and have you and how, how is your mood been over this period?\nHave you been? Um, feeling your usual?\nDistracted. I, I'd say.\nUh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say.\nUm, not unhappy or happy, but just, uh, quite just not focused.\nOkay. So difficulty focusing, quite distracted.\nAnd would you say you've been in good spirits, or is your mood low?\nUm, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well. All right. So, yeah.\nOkay.\nAnd, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you is that something that you've noticed recently? Um, I have noticed anything like that specifically, no. So you've not so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have waking up in the mornings. Yes. With som\nething, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it?\nUm, important one, I don't think. Um. Sorry? Yeah.\nNo, I don't think it's an important change, no. I, I sorry, are you, you don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. Uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been slightly lower, with lower sex drive. Yeah.\nUm, and in what way has your sex drive been lower? Are you in a relationship at the moment? Yeah, I, I'm married.\nUm, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been decent. Disinterested.\nSorry. Okay. So are you phrased there for a moment?\nUm, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems?\nNo? Um, so in the past, um, I have, uh, a history of hypothyroidism, uh. Hypo.\nHypothyroidism. Hyperthyroidism.\nYeah. Okay.\nSo that's. Um. High thyroid, just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high. Hyperthyroid.\nHypo. Hypo? Okay, hypothyroid. Thank you. Thank you.\nUm, yeah. Okay. And, uh, also, in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me. But my father has committed suicide, um, about 15 years ago.\nOkay.\nOkay. And, um, uh, do you take any medications?\nI have a drug history of thyroxine.\nMm-hmm. So maybe, yes.\nDo you, do you continue to take thyroxine now?\nYes.\nYou do? You're so you're taking thyroxine at the moment?\nUm, yes. Cool.\nAnd any drug allergies? Are you allergic to any medications? No, I have no, uh, medication allergies, no. No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family or thyroxine? No, I think nothing at all. Okay. And your mother is, is well? Any brothers or sisters? Yeah, she's fine. U\nm, and I'm an only child. Um, okay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision? Okay. And just to go back to your you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, no, not really, no. And are you able to get the usual enjoyment out of y\nour daily activities that you have done in the past?\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay. So you, you've become more short of breath over the last few months? Yeah. Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months? Hmm. U\nm, with a slight low, lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about? Um, no, nothing specific, no. So going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few d\nays? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can. Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\nIs that all right? Yeah, that's very useful. Thank you. Um, yeah. Okay.\nBetter to have some kind of plan, um. Yeah. Yeah, yeah. I think I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. Mm-hmm. And, and you're.\nYes. Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms, when we see you. Okay? Thank you very much for taking the time.","marks":[{"start":0,"end":11,"said":"","significant":false},{"start":89,"end":97,"said":"Babylon.","significant":false},{"start":139,"end":147,"said":"","significant":false},{"start":158,"end":170,"said":"name's . Makes sense. 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I just— can I confirm your name, please?\nHi there, yeah. My name is Joe.\nSo what— sorry, your name was? My name was Brian. Brian, hi Brian. Nice to meet you. Brian. Um, and your date of birth? Yeah, my date of birth is the 8th of August 1982.\nGreat.\nAnd, uh, are you in a sort of confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation?\nYes. Marvelous. Okay, so how can I help today?\nYeah, um, so basically it's just been happening over the last few weeks or so. But I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day.\nUm, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\nOkay. So things have become quite difficult for you? Yeah. Is there anything else?\nUm, I don't know. It's quite hard to say. Like, things like I— not, not eating very much at the moment.\nI just don't feel like I have a lot of energy.\nOkay.\nI'm sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How, how long? Roughly? Well, now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincided— coincided with, uh, with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah.\nOkay.\nAnd, um, so this has been going on perhaps for, um, sort of six weeks or so?\nMore like two, two months, I would say. Yeah. Okay.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\nWell, um, I, I know that it's not really normal for me, so. But for this phase side happening, you know, I wouldn't have any problem sort of eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is, uh, what, what the best way is of doing that are, but yeah, give some advice or whatever. That'd be really useful.\nOkay. Sure. Okay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\nOkay. Okay, great.\nSo you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings?\nUm, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well?\nYeah. Um, and have you— and how, how is your mood been over this period?\nHave you been? Um, feeling your usual?\nDistracted. I, I'd say.\nUh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say.\nUm, not unhappy or happy, but just, uh, quite just not focused.\nOkay. So difficulty focusing, quite distracted.\nAnd would you say you've been in good spirits, or is your mood low?\nUm, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well. All right. So, yeah.\nOkay.\nAnd, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you— is that something that you've noticed recently? Um, I have noticed anything like that specifically, no. So you've not— so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the mornings. Yes. With som\nething, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it?\nUm, important one, I don't think. Um. Sorry? Yeah.\nNo, I don't think it's an important change, no. I, I— sorry. You don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. Uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been slightly lower, with lower sex drive. Yeah.\nUm, and in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah, I— I'm married.\nUm, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been decent. Disinterested.\nSorry. Okay. Sorry, you froze there for a moment.\nUm, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems?\nNo? Um, so in the past, um, I have a history of hypothyroidism. Um. Hypo.\nHypothyroidism. Hyperthyroidism.\nYeah. Okay.\nSo that's. Um. High thyroid, just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high. Hyperthyroid.\nHypo. Hypo? Okay, hypo-thyroid. Thank you. Thank you.\nUm, yeah. Okay. And, uh, also in the past, I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me. But my father has committed suicide, um, about 15 years ago.\nOkay.\nOkay. And, um, uh, do you take any medications?\nI have a drug history of thyroxine. Mm-hmm. So maybe, yes.\nDo you— do you continue to take thyroxine now?\nYes.\nYou do? You're— so you're taking thyroxine at the moment?\nUm, yes. Cool.\nAnd any drug allergies? Are you allergic to any medications? No, I have no medication allergies, no. No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family or thyroxine? No, nothing. Nothing at all. Okay. And your mother is, is well? Any brothers or sisters? Yeah, she's fine. Um, and I'm an only child. Um,\nokay. So I just, uh, uh, sorry, mine seemed like slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in vision? Okay. And just to go back to your— you're saying you had low mood. Some people who are, who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, no, not really. No. And are you able to get the usual enjoyment out of your daily activities that you have\ndone in the past?\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I— I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay. So you— you've become more short of breath over the last few months? Yeah. Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months? Hmm. U\nm, with a slight lower, lower mood, decreased sex drive. Um, is there— just before we wrap up, is there anything else that you would like to talk about? Um, no, nothing specific, no. So going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few d\nays? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can. Yes. We could probably do some more, uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\nIs that all right? Yeah, that's very useful. Thank you. Um, yeah. Okay.\nBetter to have some kind of plan, um. Yeah. Yeah, yeah. I think we— I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. Mm-hmm. And, and you're.\nYes. Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms. And we'll see you. Okay? Thank you very much for taking the time.","marks":[{"start":0,"end":11,"said":"","significant":false},{"start":89,"end":97,"said":"Babylon.","significant":false},{"start":139,"end":147,"said":"","significant":false},{"start":158,"end":170,"said":"name's . Makes sense. 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Thanks.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"past few weeks, possibly two months\" captures approx. two months."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Difficulty getting up, lack of energy \"making routine tasks difficult\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"trouble sleeping\"."],["The note captures: Reduced appetite/not eating much.","yes","\"not eating very much\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"feeling distracted, with difficulty focusing and a slightly lower mood\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased sex drive... disinterest in sexual activity\"."],["The note captures: No thoughts of harming self or others are reported.","yes","\"denies suicidal ideation or thoughts of harming others\"."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"family history of suicide (father, 15 years prior)\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"history of hypothyroidism\"."],["The note captures: Currently taking thyroxine.","no","Thyroxine not mentioned."],["The note captures: No known medication allergies.","no","Allergies not mentioned."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"shortness of breath when doing sports... compared to a couple of months ago\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"coinciding with a new job\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Patient's wish to return to previous self not captured."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","partial","In-person physical examination planned, but no next-few-days timeframe / GP."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Order blood tests to investigate potential underlying medical causes\"."]],"claims":[["\"noting a lack of morning erections, which is a change from their norm\"","Patient explicitly clarified \"there hasn't been a change there\"; the note asserts a change."]],"note":"S (Subjective):\n- Patient reports difficulty getting up in the morning and lack of energy throughout the day, making routine tasks difficult for the past few weeks, possibly two months, coinciding with a new job.\n- They report not eating very much and trouble sleeping.\n- Patient describes feeling distracted, with difficulty focusing and a slightly lower mood recently.\n- They report a decreased sex drive for the past few months, expressing disinterest in sexual activity and noting a lack of morning erections, which is a change from their norm.\n- Patient states they have experienced shortness of breath when doing sports, which is a change compared to a couple of months ago, and feels more fatigued.\n- Patient denies suicidal ideation or thoughts of harming others.\n\nO (Objective):\n- Patient is Brian, born August 8, 1982.\n- Patient confirmed they were in a confidential place to speak freely and happy to continue the consultation.\n- Mood described as \"a bit lower\" and \"not focused,\" with difficulty concentrating and being easily distracted.\n- Patient reported a history of hypothyroidism.\n- Patient reported a family history of suicide (father, 15 years prior).\n\nA (Assessment):\n- The patient presents with symptoms consistent with a depressive episode, including low energy, anhedonia (difficulty enjoying activities), sleep disturbance, decreased appetite, and reduced libido.\n- Hypothyroidism is a known past medical history, which could contribute to fatigue and low mood if not optimally managed.\n- The temporal association of symptoms with a new job suggests potential stress-related factors.\n- Shortness of breath during sports and increased fatigue could indicate underlying physical issues or be a somatic symptom of their current presentation.\n\nP (Plan):\n- Schedule an in-person appointment for a physical examination.\n- Order blood tests to investigate potential underlying medical causes for symptoms, including thyroid function.\n- Discuss potential management strategies following examination and investigation results.\n- The doctor confirmed the patient is not feeling suicidal at the end of the conversation.\n","review":168.14473684210526,"saved":129.35526315789474,"clean":false,"effort":31.25,"sig":[["missing","Currently taking thyroxine.","Current thyroxine omitted; only hypothyroidism is mentioned."],["partial","Plan for an in-person GP appointment in the next few days with physical examination.","Follow-up urgency (GP within next few days) lost, which could delay review of new dyspnoea."],["fabrication","\"noting a lack of morning erections, which is a change from their norm\"","Patient said there was no change in morning erections; note states it is a change."]],"mb":34.690906,"latency":24.815,"signable":178.13173684210525},{"label":"Run 5","wer":13.036020583190394,"text":"And I think— Hello?\nHi there.\nHi, hi there.\nUh, my name's Joe, I'm one of the doctors at Bevelor. I just— can I confirm your name, please?\nHi there, yeah. My name is Joe.\nSo what— sorry, your name was? My name was Brian. Brian, hi Brian. Nice to meet you. Brian. Um, and your date of birth? Yeah, my date of birth is the 8th of August 1982.\nGreat.\nAnd, uh, are you in a sort of confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation?\nYes. Marvelous. Okay, so, um, how can I help today?\nYeah, um, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like, um, like getting up in the morning is really difficult, and I don't have much energy at all during the day.\nUm, often— yeah, just, like, doing most things that I would normally find easy has become quite difficult.\nThat's okay. So things have become quite difficult for you? Yeah. Is there anything else?\nUm, I don't know. It's quite hard to say. Like, things like I'm not, not eating very much at the moment.\nI just don't feel like I have a lot of energy.\nOkay.\nUm, sorry to hear that. Um, so you've had difficulty waking up, no energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five? How, how long? Roughly? Well, now I kind of think about it, maybe— maybe even longer. Um, I guess, uh, it might be related to— so I also started a new job, um, slightly recently. Um, it might have even coincid- coincided with, uh, with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah.\nOkay.\nAnd, um, so this has been going on perhaps for, um, sort of six weeks or so?\nMore like two, two months, I would say. Yeah. Okay.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about, um, or hoping to get out of this consultation?\nWell, um, I, I know that it's not really normal for me, so before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or, you know, doing standard things in life. And, and what I want to do is to, like, kind of return to that previous state, uh, somehow. Um, I'm not sure how that is. Uh, what, what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful.\nOkay. Sure.\nOkay. Um, well, what, what I'd like to do is just ask you a few more sort of questions around what's been going on, um, and also around your background, health, and, um, and things like that. And then we can go on to sort of what, what can be done from there. Is that all right?\nOkay. Okay, great.\nSo you say you've been, um, feeling unwell with not a lot of energy. Difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the mornings?\nUm, actually, I'm just, uh, not, not really wake up early. It's more like I'm just having trouble sleeping at all, probably. I think that's probably close. Does difficulty sleeping as well?\nYeah. Um, and have you and how, how is your mood been over this period?\nHave you been? Um, feeling your usual?\nDistracted. I, I'd say.\nUh, I, I kind of, um, yeah, finding it really hard to quite difficult to keep focusing, I would say.\nUm, not unhappy or happy, but just, uh, quite just not focused.\nOkay. So difficulty focusing, quite distracted, and would you say you've been in good spirits, or is your mood low?\nUm, actually, uh, now you, you mentioned it. Like, my mood is a bit lower recently. Um, and so I've noticed, like, uh, my sex drive has kind of decreased. Um, a bit over the, the past few months as well. All right. So, yeah.\nOkay.\nAnd, uh, so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to, uh, maybe slightly personal questions, but if you're okay to answer these, do you tend to, to have morning erections like you is that something that you've noticed recently? Um, I have noticed anything like that specifically, no. So you've not so you're saying that you have not noticed morning erections and usually you would, so it's a normal thing to have, uh, waking up in the morning with som\nething, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it?\nUm, important one, I don't think. Um. Sorry? Yeah.\nNo, I don't think it's an important change, no. I, I sorry. Are y-y-you don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well, uh, you're saying you've had, uh, difficulty focusing, easily distracted. Your mood has been slightly lower, with lower sex drive. Yeah.\nUm, and in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah, I, I'm married.\nUm, I've been for many years. Mm-hmm. And, uh, yeah, just, um, over the last few months, just, uh, been decent. Disinterested.\nSorry. Okay.\nSo are you phrased there for a moment?\nUm, so less interested as well. Okay. And just to ask you a few questions before we wrap up is, uh, any significant past medical history? Um, so do you suffer from any, uh, mental health problems in the past or any, uh, physical health problems?\nNo? Um, so in the past, um, I have a history of hypothyroidism. Um. Hypo?\nHyperthyroidism. Hyperthyroidism.\nYeah. Okay.\nSo that's. Um. High thyroid, just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high, hyperthyroid.\nHypo? Hypo okay, hypo thyroid. Thank you. Thank you.\nUm, yeah. Okay. And, uh, also in the past I mean, I haven't had any kind of specific, uh, medical diagnoses along these lines. Um, but there's suspicion that it may have had an impact on me, but my father has committed suicide. Um, about 15 years ago.\nOkay.\nOkay. And, um, uh, do you take any medications?\nI have a drug history of thyroxine. Mm-hmm. So maybe, yes.\nDo you do you continue to take thyroxine now?\nYes.\nYou do? You're so you're taking thyroxine at the moment?\nUm, yes. Cool.\nAnd any drug allergies? Are you allergic to any medications? No, I have no, uh, medication allergies, no. No allergies. And you mentioned the, the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other, um, uh, significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family or thyroxine? No, nothing like that at all. Okay. And your mother is, is well? Any brothers or sisters? Yeah, she's fine. U\nm, and I'm an only child. Um, okay. Okay. So I just, uh, uh sorry, mine seemed like slightly random question, but any, uh, change in your vision? No, no, nothing like that. No change in your vision? Okay.\nAnd just to go back to your you're saying you had low mood. Some people who are who do have low mood, uh, and low sex drive can sometimes feel, uh, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No, no, not really, no. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\nSometimes. I mean, I guess, um, most of the activities, but when I've been doing sports as well, um, I find sometimes it's quite difficult to breathe. Um, so I have some kind of, like, shortness of breath, um, when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months? Yeah. Um, and you've had, uh, okay. So, uh, any other things around this? Are you more fatigued, more shortness of breath, um, over the last few months? Hmm. Um,\nwith a s low lower mood, decreased sex drive. Um, is there just before we wrap up, is there anything else that you would like to talk about? Um, no, nothing specific, no. So um, going a little bit towards the end now, but I would quite like to make a bit more of a plan for you. Um, I would like to probably see you in person and do an examination and, and also we would probably like to do some blood tests, um, as well. So do you think it'd be possible to see, uh, to book an appointment in the next few d\nays? Uh, with your GP or, or, um, that would be ideal, I think, here. Um, and then we can. Yes. We could probably do some more uh, do an examination and, and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah.\nIs that all right? Yeah, that's very useful. Thank you. Um, yeah. Okay.\nBetter to have some kind of plan, um. Yeah. Yeah, yeah. I think I definitely think we need a plan here. Um, it's been nice talking to you. I'm sorry we ran out of time now. Uh, but we've at least started the ball rolling with, um, some further investigations and tests. I'm glad that you're, you know, you're, you're, you're although you have a low mood, um, you're, you're, uh, you're not feeling suicidal, just to confirm that. Mm-hmm. And, and you're.\nYes. Uh, and, uh, we'll hopefully get to the bottom of some of your tiredness, um, and your other symptoms, when we see you. Okay? Thank you very much for taking the time. Okay. Thank you. Thank you. Thanks.","marks":[{"start":0,"end":11,"said":"","significant":false},{"start":89,"end":97,"said":"Babylon.","significant":false},{"start":139,"end":147,"said":"","significant":false},{"start":158,"end":170,"said":"name's . Makes sense. 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the stated goal is the doctor's plan."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","In-person examination and GP appointment \"within the next few days\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Blood tests will be conducted to investigate the symptoms further\"."]],"claims":[],"note":"S (Subjective):\n- Patient reports difficulty getting up in the morning and lack of energy throughout the day, making normal activities difficult.\n- Symptoms, including reduced eating, have been ongoing for approximately two months, coinciding with the start of a new job.\n- Patient also reports difficulty sleeping and focusing, feeling distracted, and a lower mood recently.\n- Patient notes a decreased sex drive and disinterest in sexual activity over the past few months.\n- Patient reports shortness of breath when doing sports, which is a change compared to a couple of months ago.\n\nO (Objective):\n- Patient confirmed date of birth as August 8, 1982.\n- Patient is able to speak freely in a confidential place.\n- Patient is cooperative and happy to continue with the consultation.\n- Patient denies suicidal ideation or thoughts of harming others.\n- Patient denies noticing morning erections recently, but clarifies this is not a change from their usual state.\n\nA (Assessment):\n- Patient presents with symptoms consistent with a depressive episode, including low energy, anhedonia, sleep disturbance, difficulty concentrating, and decreased libido.\n- Hypothyroidism is a known comorbidity that could contribute to fatigue and mood changes.\n- Differential diagnoses include adjustment disorder with depressed mood or other medical causes for fatigue and shortness of breath.\n\nP (Plan):\n- Doctor plans to see the patient in person for an examination.\n- Blood tests will be conducted to investigate the symptoms further.\n- Patient advised to book an appointment with their GP or the clinic within the next few days.\n- Goal is to establish a comprehensive plan for further investigation and management of symptoms.\n","review":138.89473684210526,"saved":158.60526315789474,"clean":false,"effort":25.0,"sig":[["missing","Father died by suicide approximately fifteen years ago.","Father suicide is a key suicide-risk factor for a patient with low mood."],["missing","Currently taking thyroxine.","Current thyroxine omitted; 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Hi there. Hi. Hi there. My name is Joe. I'm 1 of the doctors at Papua. I just can I confirm your name, please? Yeah. My name is David. Sorry. What sorry. Your name was? Name was Brian. Brian. Hi, Brian. Nice to meet And your date of\n\nBirth. Yeah. My date of birth is the eighth of August 19 82. Right. And are you in a sort of confidential place where you can speak freely? Yeah. No. No 1 else can hear me. Great. And you're happy to continue with the consultation? Yes. Fabulous. Okay. So how can I help today? Yeah. So, basically, it's just been happening over the last few weeks or so, but\n\nI don't really feel like, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often, yeah, just, like, doing most things that I would normally find easy has become quite difficult. Okay. So things have become quite difficult for you. Yeah. Is there anything else? It's quite hard to say. Like,\n\nThings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or 5? Much? Roughly. Now I think about it maybe maybe even longer. I guess, might be related.\n\nSo I also started a new job slightly recently. It might have even coincided with with that job a couple of months ago. When did you start your new job? 2 months ago, you say? Yeah. K. And so this has been going on perhaps for sort of 6 weeks or so? More like 2 2 months, I would say. Yeah. Okay.\n\nAlright. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is, like,\n\nKind of return to that previous state somehow. I'm not sure how that is, what what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful. Okay. Sure. Okay. Well, what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that. And then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Great. So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close. Difficulty sleeping as well. Yeah.\n\nAnd have you and how how has your mood been over this period? Have you been feeling Distract, I I'd say. I I kind of yeah, finding it really hard to quite difficult to keep focusing, I would say. Not unhappy or happy, but just quite just not focused.\n\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it. Like, my mood is a bit lower recently, and so I it's like my sex drive has kind of decreased a bit over the the past few months as well. Right. So yeah. K. And\n\nSo lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to ask these, do you tend to to have morning erections like you is that something that you've noticed? I haven't noticed anything like that specifically. So you've so you're saying\n\nYou have not noticed morning erections, and usually, you would. It's a normal thing to have waking up in the Yes. With something, but you have not noticed those recently? I have not noticed those recently. Okay. So that's been a change, has it? Important 1, I don't think. Sorry? Yeah. No. I don't think it's an important change. No. I I sorry. You don't think there's been a change there? No. There hasn't been a\n\nThat. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. When you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, just\n\nOver the last few months just in Disinterested. Okay. Sorry. You froze there for a moment. So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. So that's I thyroid, just to sort of confirm that. Sorry. Can you say that again, please? Hyper as in high, hyperthyroid. Hypo.\n\nHypo. Okay. Hyposyroid. Thank you. Thank you. Yeah. And, also, in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but the suspicion that it may have had an impact on me. But my father has committed suicide about 15 years ago. Okay. Okay.\n\nAnd do you take any medications? I have a drug history of thyroxine. Mhmm. So maybe. Yes. Do you do you continue to take thyroxine now? Yes. You do? You're so you're taking thyroxine at the moment?\n\nYes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or Nothing. Nothing.\n\nThat's all. Okay. And your mother is is well? Any brothers or sisters? Yeah. She's fine. And I'm an early child. Okay. Okay. So I just sorry. My slightly random question, but any change in your vision? No. No. Nothing like that. No change in your okay. And just to go back to your you're saying you had low mood. So\n\nSome people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not at all. Okay. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months. Yeah. And you've had okay. So any other things around this? More fatigue, more shortness of breath over the last few months with a low lower mood, decreased sex drive. Is there just\n\nBefore we wrap up, is there anything else that you would like to talk about? No. Nothing specific. No. So I'm getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nSee to book an appointment in the next few days with your GP or or that would be ideal, I think, here. And then we can Yes. We could probably do some more do an examination and and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we're I definitely think we need\n\nPlan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with, some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, you're you're you're not feeling suicidal, just to confirm that. And we'll hopefully get to the bottom of some of your tiredness and your other symptoms when we see. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":34,"end":41,"said":"name's","significant":false},{"start":71,"end":77,"said":"Babylon.","significant":false},{"start":127,"end":153,"said":"name's . 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Hi there. Hi. Hi there. My name is Joe. I'm 1 of the doctors at Papua. I just can I confirm your name, please? Yeah. My name is David. Sorry. What sorry. Your name was? Name was Brian. Brian. Hi, Brian. Nice to meet And your date of\n\nBirth. Yeah. My date of birth is the eighth of August 19 82. Right. And are you in a sort of confidential place where you can speak freely? Yeah. No. No 1 else can hear me. Great. And you're happy to continue with the consultation? Yes. Fabulous. Okay. So how can I help today? Yeah. So, basically, it's just been happening over the last few weeks or so, but\n\nI don't really feel like, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often, yeah, just, like, doing most things that I would normally find easy has become quite difficult. Okay. So things have become quite difficult for you. Yeah. Is there anything else? It's quite hard to say. Like,\n\nThings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or 5? Much? Roughly. Now I think about it maybe maybe even longer. I guess, might be related.\n\nSo I also started a new job slightly recently. It might have even coincided with with that job a couple of months ago. When did you start your new job? 2 months ago, you say? Yeah. K. And so this has been going on perhaps for sort of 6 weeks or so? More like 2 2 months, I would say. Yeah. Okay.\n\nAlright. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is, like,\n\nKind of return to that previous state somehow. I'm not sure how that is, what what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful. Okay. Sure. Okay. Well, what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and and things like that. And then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Great. So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close. Difficulty sleeping as well. Yeah.\n\nAnd have you and how how has your mood been over this period? Have you been feeling Distract, I I'd say. I I kind of yeah, finding it really hard to quite difficult to keep focusing, I would say. Not unhappy or happy, but just quite just not focused.\n\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it. Like, my mood is a bit lower recently, and so I it's like my sex drive has kind of decreased a bit over the the past few months as well. Right. So yeah. K. And\n\nLower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to ask these, do you tend to to have morning erections like you is that something that you've noticed? I haven't noticed anything like that specifically. So you've so you're saying\n\nYou have not noticed morning erections, and usually, you would. It's a normal thing to have waking up in the Yes. With something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important 1, I don't think. Sorry? Yeah. No. I don't think it's an important change. No. I sorry. You don't think there's been a change there? No. There hasn't been a\n\nThat. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. When you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, just\n\nOver the last few months just in Disinterested. Okay. Sorry. You froze there for a moment. So So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. So that's I thyroid, just to sort of confirm that. Sorry. Can you say that again, please? Hyper as in high, hyperthyroid. Hypo.\n\nHypo. Okay. Hyposyroid. Thank you. Thank you. Yeah. And, also, in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but the suspicion that it may have had an impact on me. But my father has committed suicide about 15 years ago. Okay. Okay.\n\nAnd do you take any medications? I have a drug history of thyroxine. Mhmm. So maybe. Yes. Do do you continue to take thyroxine now? Yes. You do? You're so you're taking thyroxine at the moment?\n\nYes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or Nothing. Nothing.\n\nThat's all. Okay. And your mother is is well? Any brothers or sisters? Yeah. She's fine. And I'm an early child. Okay. Okay. So I just sorry. My slightly random question, but any change in your vision? No. No. Nothing like that. No change in your mood. Okay. And just to go back to your you're saying you had low mood.\n\nSome people who who do have low mood, and low sex drive can sometimes feel, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months. Yeah. And you've had okay. So any other things around that? So more fatigue, more shortness of breath over the last few months with a low lower mood, decreased sex drive. Is there just\n\nBefore we wrap up, is there anything else that you would like to talk about? No. Nothing specific. No. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and and, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nSee, to book an appointment in the next few days, with your GP or or, that would be ideal, I think, here. And then we can Yes. We could probably do some more, do an examination and and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we're I definitely think we need\n\nDiane here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with, some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, you're you're not feeling suicidal, just to confirm that. And we'll hopefully get to the bottom of some of your tiredness and your other symptoms Let me see. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":34,"end":41,"said":"name's","significant":false},{"start":71,"end":77,"said":"Babylon.","significant":false},{"start":127,"end":153,"said":"name's . Makes sense. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"Fatigue and low mood for approximately 2 months\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","partial","\"Difficulty waking\" and \"Reduced energy\" captured, but the impact on usual daily tasks is not stated."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"Difficulty sleeping\"."],["The note captures: Reduced appetite/not eating much.","yes","\"Reduced appetite\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"Difficulty concentrating, easily distracted\" and \"Low mood\"."],["The note captures: Reduced libido/sexual interest.","yes","\"Decreased libido\"."],["The note captures: No thoughts of harming self or others are reported.","partial","\"Denies suicidal ideation\" but no mention of thoughts of harming others."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"Father: suicide 15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"Hypothyroidism\" recorded correctly."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine (dose not specified)\"."],["The note captures: No known medication allergies.","yes","\"NKDA\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"Exertional dyspnoea for 2 months, worse than previous baseline\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"coinciding with commencement of new employment\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Patient's goal of returning to his previous self is not documented."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"In-person review for physical examination\" with follow-up \"within next few days\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Blood tests to be arranged\"."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nPatient: Brian\n\nDate of Birth: 08/08/1982\n\nConsultation Date: 22/09/2026\n\n\n\n\nSubjective:\n\nFatigue and low mood for approximately 2 months, coinciding with commencement of new employment\n\nDifficulty waking in the morning\n\nReduced energy throughout the day\n\nReduced appetite\n\nDifficulty sleeping\n\nDifficulty concentrating, easily distracted\n\nLow mood\n\nDecreased libido\n\nDenies morning erections (no change from baseline)\n\nReduced enjoyment of usual activities\n\nExertional dyspnoea for 2 months, worse than previous baseline\n\nDenies suicidal ideation\n\nDenies visual changes\n\n\n\n\nObjective:\n\nTelehealth consultation conducted\n\nPatient in confidential location\n\nNo physical examination performed\n\n\n\n\nAssessment:\n\nFatigue and low mood, 2 months duration\n\nPossible contributing factors: new job stress, underlying hypothyroidism\n\nExertional dyspnoea requiring investigation\n\nFamily history of suicide (father, 15 years ago)\n\n\n\n\nPast Medical History:\n\nHypothyroidism\n\n\n\n\nMedications:\n\nThyroxine (dose not specified)\n\n\n\n\nAllergies:\n\nNKDA\n\n\n\n\nFamily History:\n\nFather: suicide 15 years ago\n\nNo family history of depression\n\nMother: well\n\nOnly child\n\n\n\n\nSocial History:\n\nMarried\n\nStarted new job 2 months ago\n\n\n\n\nPlan:\n\nIn-person review for physical examination\n\nBlood tests to be arranged\n\nFollow-up appointment to be scheduled within next few days\n\nFurther investigations pending examination and blood test results","review":104.92105263157896,"saved":192.57894736842104,"clean":false,"effort":12.5,"sig":[],"mb":20.680561,"latency":21.269,"signable":126.19005263157896},{"label":"Run 3","wer":17.781589479702685,"text":"Hello? Hi there. Hi. Hi there. My name is Joe. I'm 1 of the doctors at Papua. I just can I confirm your name, please? Yeah. My name is David. Sorry. What sorry. Your name was? Name was Brian. Brian. Hi, Brian. Nice to meet And your date of\n\nBirth. Yeah. My date of birth is the eighth of August 19 82. Right. And are you in a sort of confidential place where you can speak freely? Yeah. No. No 1 else can hear me. Great. And you're happy to continue with the consultation? Yes. Fabulous. Okay. So how can I help today? Yeah. So, basically, it's just been happening over the last few weeks or so, but\n\nI don't really feel like, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often, yeah, just, like, doing most things that I would normally find easy has become quite difficult. Okay. So things have become quite difficult for you. Yeah. Is there anything else? It's quite hard to say. Like,\n\nThings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or 5? Much? Roughly. Now I think about it maybe maybe even longer. I guess, might be related.\n\nSo I also started a new job slightly recently. It might have even coincided with with that job a couple of months ago. When did you start your new job? 2 months ago, you say? Yeah. K. And so this has been going on perhaps for sort of 6 weeks or so? More like 2 2 months, I would say. Yeah. Okay.\n\nAlright. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is, like,\n\nKind of return to that previous state somehow. I'm not sure how that is, what what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful. Okay. Sure. Okay. Well, what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and and things like that. And then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Great. So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close. Difficulty sleeping as well. Yeah.\n\nAnd have you and how how has your mood been over this period? Have you been feeling Distract, I I'd say. I I kind of yeah, finding it really hard to quite difficult to keep focusing, I would say. Not unhappy or happy, but just quite just not focused.\n\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it. Like, my mood is a bit lower recently, and so I it's like my sex drive has kind of decreased a bit over the the past few months as well. Right. So yeah. K. And\n\nSo lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to ask these, do you tend to to have morning erections like you is that something that you've noticed? I haven't noticed anything like that specifically. So you've so you're saying\n\nYou have not noticed morning erections, and usually, you would. It's a normal thing to have waking up in the Yes. With something, but you have not noticed those recently? I have not noticed those recently. Okay. So that's been a change, has it? Important 1, I don't think. Sorry? Yeah. No. I don't think it's an important change. No. I I sorry. You don't think there's been a change there? No. There hasn't been a\n\nThat. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. When you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, just\n\nOver the last few months just in Disinterested. Okay. Sorry. You froze there for a moment. So So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. K. So that's I thyroid, just to sort of confirm that. Sorry. Can you say that again, please? Hyper as in high, hyperthyroid. Hypo.\n\nHypo. Okay. Hyposyroid. Thank you. Thank you. Yeah. And, also, in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but the suspicion that it may have had an impact on me. But my father has committed suicide about 15 years ago. Okay. Okay.\n\nAnd do you take any medications? I have a drug history of thyroxine. Mhmm. So maybe. Yes. Do you do you continue to take thyroxine now? Yes. You do? You're so you're taking thyroxine at the moment?\n\nYes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or Nothing. Nothing.\n\nThat's all. Okay. And your mother is is well? Any brothers or sisters? Yeah. She's fine. And I'm an early child. Okay. Okay. So I just sorry. My slightly random question, but any change in your vision? No. No. Nothing like that. No change in your okay. And just to go back to your you're saying you had low mood. So\n\nSome people who who do have low mood, and low sex drive can sometimes feel, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months. Yeah. And you've had okay. So any other things around that? So more fatigue, more shortness of breath over the last few months with a low lower mood, decreased sex drive. Is there just\n\nBefore we wrap up, is there anything else that you would like to talk about? No. Nothing specific. No. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and and, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nSee, to book an appointment in the next few days, with your GP or or, that would be ideal, I think, here. And then we can Yes. We could probably do some more, do an examination and and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we're I definitely think we need\n\nDiane here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with, some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, you're you're not feeling suicidal, just to confirm that. And we'll hopefully get to the bottom of some of your tiredness and your other symptoms Let me see. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":34,"end":41,"said":"name's","significant":false},{"start":71,"end":77,"said":"Babylon.","significant":false},{"start":127,"end":153,"said":"name's . Makes sense. 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Hi there. Hi. Hi there. My name is Joe. I'm 1 of the doctors at Papua. I just can I confirm your name, please? Yeah. My name is David. Sorry. What sorry. Your name was? Name was Brian. Brian. Hi, Brian. Nice to meet And your date of\n\nBirth? Yeah. My date of birth is the eighth of August 19 82. Great. And are you in a sort of confidential place where you can speak freely? Yeah. No. No 1 else can hear me. Great. And you're happy to continue with your consultation? Yes. Fabulous. Okay. So how can I help today? Yeah. So, basically, it's just been happening over the last few weeks or so, but I\n\nI don't really feel like, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often, yeah, just, like, doing most things that I would normally find easy has become quite difficult. Okay. So things have become quite difficult for you. Yeah. Is there anything else? It's quite hard to say. Like,\n\nThings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or 5? Much? Roughly. Now I think about it maybe maybe even longer. I guess, might be related\n\nSo I also started a new job, slightly recently. It might have even coincided with, with that job a couple of months ago. When did you start your new job? 2 months ago, you say? Yeah. K. And so this has been going on perhaps for sort of 6 weeks or so? More like 2 2 months, I would say. Yeah. Okay.\n\nAlright. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is to, like\n\nKind of return to that previous state somehow. I'm not sure how that is, what what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful. Okay. Sure. Okay. Well, what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and and things like that. And then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Great. So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close. Difficulty sleeping as well. Yeah.\n\nAnd have you and how how has your mood been over this period? Have you been feeling Distract, I I'd say. I I kind of yeah, finding it really hard to quite difficult to keep focusing, I would say. Not unhappy or happy, but just quite just not focused.\n\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it. Like, my mood is a bit lower recently, and so I've noticed, like, my sex drive has kind of decreased a bit over the the past few months as well. Right. So yeah. K. And\n\nLower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these, do you tend to to have morning erections like you is that something that you've noticed? I haven't noticed anything like that specifically. So you've so you're saying you\n\nYou have not noticed morning erections, and usually, you would. It's a normal thing to have waking up in the Yes. With something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important 1, I don't think. Sorry? Yeah. No. I don't think it's an important change. No. I I so you don't think there's been a change there? No. There hasn't been a\n\nThat. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. When you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, I just\n\nOver the last few months just in Disinterested. Okay. Sorry. You froze there for a moment. So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nHealth problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. So that's I thyroid, just to sort of confirm that. Sorry. Can you say that again, please? Hyper as in high, hyperthyroid. Hypo.\n\nHypo. Okay. Hyposyroid. Thank you. Thank you. Yeah. And, also, in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but the suspicion that it may have had an impact on me. But my father has committed suicide about 15 years ago. Okay. Okay.\n\nAnd do you take any medications? I have a drug history of thyroxine. Mhmm. So maybe. Yes. Do you do you continue to take thyroxine now? Yes. You do? You're so you're taking thyroxine at the moment?\n\nYes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or Nothing. Nothing.\n\nThat's all. Okay. And your mother is is well? Any brothers or sisters? Yeah. She's fine. And now I'm an early child. Okay. Okay. So I just sorry. My slightly random question, but any change in your vision? No. No. Nothing like that. No change in your okay. And just to go back to your you're saying you had low mood. So\n\nPeople who who do have low mood, and low sex drive can sometimes feel, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months. Yeah. And you've had okay. So any other things around that? So more fatigue, more shortness of breath over the last few months with a low lower mood, decreased sex drive. Is there just\n\nBefore we wrap up, is there anything else that you would like to talk about? No. Nothing specific. No. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and and, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nSee, to book an appointment in the next few days, with your GP or or, that would be ideal, I think, here. And then we can, yes, we can probably do some more, do an examination and and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we're I definitely think we need\n\nAnne here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, you're you're you're not feeling suicidal, just to confirm that. And we'll hopefully get to the bottom of some of your tiredness and your other symptoms when we see. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":34,"end":41,"said":"name's","significant":false},{"start":71,"end":77,"said":"Babylon.","significant":false},{"start":127,"end":153,"said":"name's . 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Hi there. Hi. Hi there. My name is Joe. I'm 1 of the doctors at Papua. I just can I confirm your name, please? Yeah. My name is David. Sorry. What sorry. Your name was? Name was Brian. Brian. Hi, Brian. Nice to meet And your date of\n\nBirth. Yeah. My date of birth is the eighth of August 19 82. Right. And are you in a sort of confidential place where you can speak freely? Yeah. No. No 1 else can hear me. Great. And you're happy to continue with the consultation? Yes. Fabulous. Okay. So how can I help today? Yeah. So, basically, it's just been happening over the last few weeks or so, but\n\nI don't really feel like, like, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often, yeah, just, like, doing most things that I would normally find easy has become quite difficult. Okay. So things have become quite difficult for you. Yeah. Is there anything else? It's quite hard to say. Like,\n\nThings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy. Okay. I'm sorry to hear that. So you've had difficulty waking up, no energy, not eating, and that's been going on for a few weeks. When you say a few weeks, do you mean 2 or 3 or 5? Much? Roughly. Now I think about it maybe maybe even longer. I guess, might be related.\n\nSo I also started a new job slightly recently. It might have even coincided with that job a couple of months ago. When did you start your new job? 2 months ago, you say? Yeah. K. And so this has been going on perhaps for sort of 6 weeks or so? More like 2 2 months, I would say. Yeah. Okay.\n\nAlright. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problems sort of eating what I want to eat or, you know, doing standard things in life. And and what I want to do is, like,\n\nKind of return to that previous state somehow. I'm not sure how that is, what what the best ways of doing that are, but, yeah, give some advice or whatever. That'd be really useful. Okay. Sure. Okay. Well, what I'd like to do is just ask you a few more sort of questions around what's been going on and also around your background health and and things like that. And then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Great. So you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning? Actually, I'm just not not really waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close. Difficulty sleeping as well. Yeah.\n\nAnd have you and how how has your mood been over this period? Have you been feeling Distract, I I'd say. I I kind of yeah, finding it really hard to quite difficult to keep focusing, I would say. Not unhappy or happy, but just quite just not focused.\n\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low? Actually, now you you mentioned it. Like, my mood is a bit lower recently, and so I it's like my sex drive has kind of decreased a bit over the the past few months as well. Right. So yeah. K. And\n\nSo lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to ask these, do you tend to to have morning erections like you is that something that you've noticed? I haven't noticed anything like that specifically. So you've so you're saying\n\nYou have not noticed morning erections, and usually, you would. It's a normal thing to have waking up in the Yes. With something, but you have not noticed those recently? I have not noticed those recently. Okay. So and that's been a change, has it? Important 1, I don't think. Sorry? Yeah. No. I don't think it's an important change. No. I sorry. You don't think there's been a change there? No. There hasn't been a\n\nThat. Oh, okay. Sorry. Right. Sorry. Okay. So just going back to the mood symptoms as well. Yeah. When you've had difficulty focusing, easily distracted, your mood has been slightly lower with lower sex drive. Yeah. And in what way is your sex drive been lower? Are you in a relationship at the moment? Yeah. I I'm married. I've been for many years. Mhmm. And, just\n\nOver the last few months just in Disinterested. Okay. Sorry. You froze there for a moment. So So less interested as well. Okay. And just to ask you a few questions before we wrap up is any significant past medical history? So do you suffer from any\n\nMental health problems in the past or any physical health problems? No. So in the past, I have a history of hypothyroidism. Hypo? Hyperthyroidism. Hyperthyroidism. Yeah. K. So that's I thyroid, just to sort of confirm that. Sorry. Can you say that again, please? Hyper as in high, hyperthyroid. Hypo.\n\nHypo. Okay. Hyposyroid. Thank you. Thank you. Yeah. And, also, in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but the suspicion that it may have had an impact on me. But my father has committed suicide about 15 years ago. Okay. Okay.\n\nAnd do you take any medications? I have a drug history of thyroxine. Mhmm. So maybe. Yes. Do do you continue to take thyroxine now? Yes. You do? You're so you're taking thyroxine at the moment?\n\nYes. Cool. And any drug allergies? Are you allergic to any medications? No. I have no medication allergies. No. No allergies. And you mentioned the the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that running in the family? Or Nothing. Nothing.\n\nThat's all. Okay. And your mother is is well? Any brothers or sisters? Yeah. She's fine. And I'm an early child. Okay. Okay. So I just sorry. My slightly random question, but any change in your vision? No. No. Nothing like that. No change in your mood. Okay. And just to go back to your you're saying you had low mood.\n\nSome people who who do have low mood, and low sex drive can sometimes feel, suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No? No. Not really. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been doing sports as well, I find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when doing sports compared to maybe a couple of months ago. Okay. So you you've become more short of breath over the last few months. Yeah. And you've had okay. So any other things around that? So more fatigue, more shortness of breath over the last few months with a low lower mood, decreased sex drive. Is there just\n\nBefore we wrap up, is there anything else that you would like to talk about? No. Nothing specific. No. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination, and and, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nSee, to book an appointment in the next few days, with your GP or or, that would be ideal, I think, here. And then we can Yes. We could probably do some more, We'll do an examination and and do some investigations really to see what's going on here a little bit more. That makes sense. Yeah. Is that alright? Yeah. That's very useful. Thank you. Okay. Better to have some kind of plan. Yeah. Yeah. Yeah. I think we're I definitely think we need\n\nDiane here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with, some further investigations and tests. I'm glad that you're, you know, you're you're you're although you have a low mood, you're you're not feeling suicidal, just to confirm that. And we'll hopefully get to the bottom of some of your tiredness and your other symptoms Let me see. Okay? Thank you very much for taking the time. Okay. Thank you. Thanks.","marks":[{"start":34,"end":41,"said":"name's","significant":false},{"start":71,"end":77,"said":"Babylon.","significant":false},{"start":127,"end":153,"said":"name's . 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","~2 months duration recorded."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","partial","Fatigue and difficulty waking recorded, but impairment of usual daily activities not stated."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","Difficulty sleeping recorded."],["The note captures: Reduced appetite/not eating much.","yes","Reduced appetite recorded."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Low mood with difficulty concentrating/distractibility."],["The note captures: Reduced libido/sexual interest.","yes","Decreased libido recorded."],["The note captures: No thoughts of harming self or others are reported.","yes","Denies thoughts of harming self or others."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","Father suicide ~15 years ago."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Hypothyroidism recorded."],["The note captures: Currently taking thyroxine.","yes","Thyroxine current."],["The note captures: No known medication allergies.","yes","No medication allergies."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","Shortness of breath during sport over recent months."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","Onset coinciding with new job."],["The note captures: Patient wants to return to previous energy/function or usual self.","no","Patient goal of returning to usual self not recorded."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","In-person GP appointment within next few days for examination."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","Blood tests planned."]],"claims":[["Loss of morning erections as a change from baseline","Patient finally clarified \"there hasn't been a change there\"; a change from baseline contradicts the transcript."]],"note":"SOAP Notes\n\n\n\n\nPatient: Brian\n\nDate of Birth: 08/08/1982\n\nConsultation Date: 22/09/2026\n\n\n\n\nSubjective:\n\nFatigue and low mood for approximately 2 months, coinciding with commencement of new employment\n\nDifficulty waking in the morning\n\nLow energy throughout the day\n\nReduced appetite\n\nDifficulty sleeping\n\nDifficulty concentrating, easily distracted\n\nLow mood\n\nDecreased libido\n\nLoss of morning erections (change from baseline)\n\nExertional dyspnoea for 2 months, worse than baseline during sports activities\n\nAble to derive enjoyment from most activities\n\nDenies suicidal ideation\n\nDenies thoughts of harming self or others\n\nDenies visual changes\n\nMarried\n\nStarted new job 2 months ago\n\n\n\n\nObjective:\n\nTelehealth consultation conducted\n\nPatient in confidential location\n\nNo physical examination performed\n\n\n\n\nAssessment:\n\nFatigue and low mood, 2 months duration\n\nPossible depression\n\nExertional dyspnoea\n\nHistory of hypothyroidism on thyroxine replacement\n\n\n\n\nPlan:\n\nArrange in-person review for physical examination\n\nBlood tests to be arranged\n\nFollow-up appointment to be scheduled within next few days\n\n\n\n\nPast Medical History:\n\nHypothyroidism\n\n\n\n\nCurrent Medications:\n\nThyroxine (dose not specified)\n\n\n\n\nAllergies:\n\nNo known drug allergies\n\n\n\n\nFamily History:\n\nFather: suicide 15 years ago\n\nNo family history of depression","review":102.64473684210526,"saved":194.85526315789474,"clean":false,"effort":18.75,"sig":[["fabrication","Loss of morning erections as a change from baseline","Records loss of morning erections as a change from baseline after the patient said there was no change, pointing toward an organic sexual-function cause."]],"mb":20.789503,"latency":21.489,"signable":124.13373684210526}],"preve":[{"label":"Run 1","wer":19.78273299028016,"text":"Hello? Hey there.\n\nHi. Hi there. My name's Joe. I'm one of the doctors at Buffalo. I just can I confirm your name, please?\n\nYeah. My name is Doug.\n\nSo what so your name was?\n\nName was Brian. Brian. Hi, Brian. Nice to you.\n\nAnd your date of birth?\n\nYeah. My date of birth is the 08/08/1982.\n\nGreat. And\n\nare you in a sort of confidential place where you can speak freely?\n\nYeah. No no one else can hear me. Great. And you're happy to continue with the consultation?\n\nYes. Fabulous. Okay. So how can I help today?\n\nYeah. So, basically, it's just been happening over the last\n\nfew weeks or so. But I don't really feel like\n\nlike, getting up in the morning is really difficult, and I don't have much energy at all.\n\nDuring the day.\n\nOften,\n\nyeah. Just, like, doing most things that I would normally find\n\neasy has become quite difficult.\n\nOkay. So things have become quite difficult for you.\n\nYep. Is there anything else?\n\nIt's quite hard to say. Like,\n\nthings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy.\n\nOkay. I'm sorry to hear that.\n\nSo you had difficulty waking up\n\nno energy, not eating, and that's been going on for a few weeks.\n\nWhen you say a few weeks, do you mean two or three or five?\n\nHow much? Roughly.\n\nNow I can think about it maybe\n\nmaybe even longer. I guess, might be related to\n\nSo I also started a new job slightly recently.\n\nIt might have even coincide coincided with with that\n\njob a couple of months ago.\n\nWhen did you start your new job? Two months ago, you say?\n\nYeah. K.\n\nAnd so this has been going on perhaps for sort of\n\nsix weeks or so.\n\nMore like two two months, I would say. Yeah.\n\nOkay.\n\nAlright. So\n\nis\n\nthere anything that you're particularly sort of concerned about\n\nor hoping to get out of this consultation?\n\nWell, I I know that it's not really normal for me. So\n\nbefore this phase started happening, you know, I wouldn't have\n\nany problems sort of easing\n\nwhat I want to eat or, you know, doing standard things in life and and what I want\n\nto do is to, like, kind of return to that previous state somehow.\n\nI'm not sure how that is, what what the best ways of doing that are, but\n\nyou know, give some advice or\n\nwhatever. That'd be really useful.\n\nOkay. Sure. Okay.\n\nWhat I'd like to do is just ask you a few more sort of questions around what's been going on\n\nand also around your background health and and things like that.\n\nAnd then we can go on sort of what what can be done from there. Is that alright?\n\nOkay.\n\nOkay. Great. So you say you've been feeling unwell with\n\na lot of energy, difficult waking up in the mornings. Do you tend to just on that note,\n\ndo you tend to wake up early and then stay in bed in the morning?\n\nActually, I'm just not\n\nreally wake you know, barely. It's more like I'm just having trouble sleeping at all.\n\nProbably. I think that's probably close.\n\nDifficulty sleeping as well.\n\nYeah. And\n\nhave you and\n\nhow how has your mood been over this period?\n\nHave you been\n\nfeeling\n\nunusually distract,\n\nI I'd say. I I kind\n\nof\n\nyeah. Finding it really hard to\n\nquite difficult to keep focusing, I would say.\n\nNot unhappy or happy, but just\n\nquite just not focused.\n\nOkay. So difficulty focusing, quite distracted.\n\nAnd would you say you've been in good spirits, or is your mood low?\n\nActually,\n\nnow you mentioned it. Like, my rate is a bit lower recently.\n\nAnd so I it's like my sex drive has kind of decreased\n\na bit over the the past few months as well. Right. So yeah.\n\nK. And\n\nso lower mood, decreased sex drive recently as well.\n\nAnd just on that note, just a few questions around that.\n\nAre you able to maybe slightly personal questions,\n\nbut\n\nif you're okay to answer this, do you tend to to have morning erection\n\nlike you is that something that you've noticed?\n\nIn recent\n\nI haven't noticed anything like that specifically. No.\n\nSo you've you're saying you have not noticed\n\nmorning actions, and usually, you would. It's just a normal thing to have\n\nwaking up in the\n\nYes.\n\nWith something, but you have not noticed those recently.\n\nI have not noticed those recently.\n\nOkay. So and that's been a change, has it?\n\nImportant one, don't think. Sorry? Yeah.\n\nNo. I don't think it's an important change. No.\n\nI sorry. Are you\n\nYou don't think there's been a change there?\n\nNo. There hasn't been a change there.\n\nOh, okay. Sorry. Right. Sorry. Okay. So\n\njust going back to the mood symptoms as well.\n\nYeah. When you've had difficulty focusing easily\n\ndistracted, your mood has been slightly lower with lower sex drive.\n\nYep. And in what way is your sex drive been lower\n\nAre you in a relationship at the moment?\n\nYeah. I am married.\n\nI've been for many years. Mhmm. And Just\n\nover the last few months, just in descent,\n\nDisinterested.\n\nOkay.\n\nYou phrased that for a moment.\n\nLess interested as well. Okay. And just to ask you a few questions,\n\nbefore we wrap up is any\n\nsignificant past medical history? So do you suffer from any\n\nmental health problems in the past or any physical health problems?\n\nNo.\n\nSo in the past, I\n\nhave a history of hypothyroid\n\nHypo? Hyperthyroidism.\n\nHyperthyroidism. Yeah.\n\nSo that's my thyroid just to sort of confirm it.\n\nSorry. Can you say that again, please?\n\nHyper as in high.\n\nHyper\n\nthyroid.\n\nHypo.\n\nHypo. Okay. Hypothyroid. Thank you.\n\nThank you.\n\nYep. And\n\nalso in the past, I mean, I haven't had any kind of specific\n\nmedical diagnosis along these lines. But\n\nsuspicion that it may have had an impact on me.\n\nBut my father has committed suicide.\n\nAbout fifteen years ago. Okay.\n\nOkay. And\n\ndo you take any medications?\n\nI have a drug history of\n\nthyroxine.\n\nMhmm. So\n\nmaybe. Yes.\n\nDo you do you continue to take thyroxine\n\nnow?\n\nYes.\n\nYou\n\ndo? You're so you're taking thyroxine at the moment?\n\nYes. Cool.\n\nAny drug allergies? Are you allergic to any medications?\n\nNo. I have no\n\nmedication allergies. No.\n\nNo allergies. And you mentioned the the suicide of your\n\nfather fifteen years ago. I'm very sorry to hear that. Is there\n\nany other\n\nsignificant family history of medical conditions or psychiatric conditions?\n\nNo. No depression or anything like that running in the family\n\nor\n\nNothing. Nothing at\n\nall.\n\nOkay.\n\nAnd your mother is is well? Any brothers or sisters?\n\nYeah. She's fine. And I'm an early child.\n\nOkay.\n\nOkay. So\n\nI\n\njust sorry. My slightly random question, but any\n\nchange in your vision?\n\nNo. No. Nothing like that. No\n\nchange in your\n\nOkay. And just to go back to your you're saying you had low mood.\n\nSome people who are who do have low mood and low sex\n\ndrive can sometimes feel suicidal as well. Have you had any thoughts\n\nof harming yourself or harming anyone else? No. No?\n\nNo. Not\n\nat all, really. No.\n\nAnd are you able to get the usual enjoyment out of your\n\ndaily activities that you have done in the past?\n\nSometimes. I mean, I guess,\n\nmost of the activities, but when I've been doing sports as well, my\n\nI find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when\n\nsports compared to maybe a couple of months ago.\n\nOkay.\n\nSo you you've become more short of breath over the last few months.\n\nYeah.\n\nAnd you've had\n\nokay. So any\n\nother things around this? So more fatigue, more shortness of breath,\n\nover the last few\n\nmonths. Mhmm. With\n\na sort of low lower mood, deep\n\nIs there just before we wrap up, is there anything else that you would\n\nlike to talk about?\n\nNo. Nothing specific. No. So\n\ngetting a little bit towards the end now, but I would quite like\n\nto make a bit more of a plan for you.\n\nI would like to probably see you in person and do an examination\n\nAnd and also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nsee to book an appointment in the next\n\nfew days with your GP or or\n\nthat would be ideal, I think, here.\n\nThen we can we can probably do some more do an examination and and\n\ndo some investigations really to see what's going on there a little bit more.\n\nThat makes sense. Yeah.\n\nIs that alright?\n\nYeah.\n\nThat's very useful. Thank you.\n\nOkay.\n\nBetter to have some kind of plan.\n\nYeah.\n\nYeah. Yeah. I think we're I definitely think we need a plan here. It\n\nbeen nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with\n\nsome further investigations and tests. I'm glad that you're, you know, you're you're\n\nyou've although you have a low mood, you're you're\n\nnot feeling suicidal, just to confirm that. Mhmm. And you're\n\nand we'll hopefully get to the bottom of\n\nsome of your tiredness and your other symptoms.\n\nLet me\n\nsee. Okay?\n\nThank you very much for taking the time. Okay. Thank\n\nyou. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":74,"end":82,"said":"Babylon.","significant":false},{"start":133,"end":146,"said":"name's . Makes sense. Yeah.","significant":false},{"start":151,"end":158,"said":". Sorry","significant":false},{"start":217,"end":221,"said":"Hi. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"~2 months of symptoms\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","partial","Fatigue and difficulty getting up recorded; impaired function only implied via goal of returning to normal function."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"Sleep: difficulty sleeping\"."],["The note captures: Reduced appetite/not eating much.","yes","\"Appetite: reduced intake\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"lower mood\" and \"difficulty focusing, easily distracted\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased sex drive over past few months\"."],["The note captures: No thoughts of harming self or others are reported.","yes","Suicidal/self-harm and homicidal thoughts: denies."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"father died by suicide ~15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"Hypothyroidism\"."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine (ongoing)\"."],["The note captures: No known medication allergies.","yes","\"denies medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"increased shortness of breath during sports over last few months\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"coincided with starting a new job 2 months ago\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"Return to previous normal function and energy\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"Book GP review within next few days for physical exam\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"Blood tests to be arranged\"."]],"claims":[],"note":"Presenting Condition\n\nDuration: ~2 months of symptoms\n\nPrimary concerns: marked fatigue/low energy, difficulty getting up in the morning\n\nSleep: difficulty sleeping\n\nAppetite: reduced intake\n\nCognition: difficulty focusing, easily distracted\n\nMood: lower mood\n\nSexual health: decreased sex drive over past few months\n\nExercise tolerance: increased shortness of breath during sports over last few months\n\nContext: symptoms may have coincided with starting a new job 2 months ago\n\nReasons for visit: seek advice and plan to return to prior normal function\n\n\n\n\nPast Medical History\n\nHypothyroidism\n\nFamily history: father died by suicide ~15 years ago\n\nAllergies: denies medication allergies\n\n\n\n\nMedications\n\nThyroxine (ongoing)\n\n\n\n\nRed Flag/Screening Questions\n\nSuicidal or self-harm thoughts: denies\n\nHomicidal thoughts: denies\n\nVision changes: denies\n\n\n\n\nSocial History\n\nMarital status: married\n\nFamily: only child\n\n\n\n\nSport & Exercise History\n\nParticipates in sports; now experiences increased shortness of breath with exertion\n\n\n\n\nGoals\n\nReturn to previous normal function and energy\n\nSeek guidance/plan to achieve this\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nWorking Dx: fatigue with low mood, sleep disturbance, reduced appetite, decreased libido; consider thyroid dysfunction vs mood disorder; exertional dyspnoea requiring assessment\n\nPrognosis: pending examination and investigations\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nNeed in-person examination\n\nArrange blood tests to investigate causes of fatigue, mood change, dyspnoea\n\nPlan to book GP appointment in next few days\n\n// Patient agreeable to plan; reassured by having next steps; confirms no suicidal ideation\n\n\n\n\nPlan\n\nBook GP review within next few days for physical exam\n\nBlood tests to be arranged at GP visit\n\nFollow-up after tests to determine management steps\n","review":92.51315789473685,"saved":204.98684210526315,"clean":false,"effort":3.125,"sig":[],"mb":18.796771,"signable":115.96215789473685},{"label":"Run 2","wer":19.325328759291025,"text":"Hello? Hey there.\n\nHi. Hi there. My name is Joe. I'm one of the doctors at\n\nI just can I confirm your name, please?\n\nAlright. Yeah. My name is.\n\nWhat so your name was? Name was Brian.\n\nBrian. Hi, Brian. Nice to you.\n\nAnd your date of birth?\n\nYeah. My date of birth is the 08/08/1982.\n\nGreat. And\n\nare you in a sort of confidential place where you can speak freely?\n\nYeah. No no one else can hear me.\n\nGreat. And you're happy to continue with the consultation?\n\nYes.\n\nFabulous. Okay. So how can I help today?\n\nYeah. So, basically, it's just been happening over the last\n\nfew weeks or so. But I don't really feel like,\n\nlike, getting up in the morning is really difficult, and I don't have much energy at all.\n\nDuring the day. Often,\n\nyeah. Just, like, doing most things that I would normally find\n\neasy, has become quite difficult.\n\nOkay. So things have become quite difficult for you.\n\nYep.\n\nIs there anything\n\nelse?\n\nIt's quite hard to say. Like,\n\nthings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy.\n\nOkay. I'm sorry to hear that.\n\nSo you had difficulty waking up\n\nno energy, not eating, and that's been going on for a few weeks.\n\nWhen you say a few weeks, do you mean two or three or five?\n\nHow much? Roughly. Now I\n\ncan think about it maybe\n\nmaybe even longer. I guess, might be related to\n\nSo I also started a new job, slightly recently.\n\nIt might have even coincide coincided with, with that\n\njob a couple of months ago.\n\nWhen did you start your new job? Two months ago, you say?\n\nYeah. K.\n\nAnd so this has been going on perhaps for sort of\n\nsix weeks or so.\n\nMore like\n\ntwo two months, I would say. Yeah.\n\nOkay. Alright. So\n\nis there anything that you're particularly sort of\n\nconcerned about or hoping to get out of this consultation?\n\nWell, I I know that it's not really normal for\n\nme. So before this phase started happening, you know, I wouldn't have\n\nany problems sort of easing\n\nwhat I want to eat or, you know, doing standard things in life and and what I want\n\nto do is to, like, kind of return to that previous state somehow.\n\nI'm not sure how that is, what what the best ways of doing that are, but\n\nyeah, give some advice or\n\nwhatever. That'd be really useful.\n\nOkay. Sure.\n\nOkay. Well, what what I'd like to do is just ask you a few more\n\nsort of questions around what's been going on,\n\nand also around your background health and and things like\n\nthat.\n\nAnd then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Okay.\n\nGreat. So you say you've been feeling unwell with\n\nnot a lot of energy, difficult waking up in the mornings. Do you tend to just on that note,\n\ndo you tend to wake up early and then stay in bed in the morning?\n\nActually, I'm\n\njust not not really wait\n\nYeah. But it's more like I'm just having trouble sleeping. That's all, probably. I think that's\n\nprobably close.\n\nDifficulty sleeping as well.\n\nYeah.\n\nAnd have you and\n\nhow how has your mood been over this period?\n\nHave\n\nyou been feeling\n\nunusually Distract,\n\nI I'd say. I I kind of\n\nyeah. Finding it really hard to\n\nquite difficult to keep focusing, I would say.\n\nNot unhappy or happy, but just\n\nquite just not focused.\n\nOkay. So difficulty focusing, quite distracted.\n\nAnd\n\nwould you say you've been in good spirits, or is your mood low?\n\nActually, now you you mentioned it.\n\nLike, my it is a bit lower recently.\n\nAnd so I it's like my sex drive has kind of decreased\n\na bit over the the past few months as well.\n\nRight.\n\nSo\n\nyeah. K.\n\nAnd so\n\nlower mood, decreased sex drive recently as well, and\n\njust on that note, just a few questions around that.\n\nAre you able to maybe slightly personal questions, but\n\nif you're okay to ask these, do you tend to to have morning erections like\n\nyou is that something that you've noticed?\n\nIn recent I haven't noticed anything like that specifically. No.\n\nSo you've so you're saying you have not noticed\n\nmorning actions, and usually, you would. It's just a normal thing to have\n\nwaking up in the Yes. With something, but you have not noticed those recently.\n\nI have not noticed those recently.\n\nOkay. So and that's been a change, has it?\n\nImportant one, I don't think. Sorry? Yeah.\n\nNo. I don't think it's important to change. No.\n\nI sorry. You you think there's\n\nbeen a change there?\n\nNo. There hasn't been a change there.\n\nOh, okay. Sorry. Right. Sorry. Okay. So\n\njust going back to the mood symptoms as well.\n\nYeah. When you've had difficulty focusing, easily\n\ndistracted, your mood has been slightly lower with lower sex drive.\n\nYep.\n\nAnd\n\nin what\n\nway is your sex drive been\n\nlower\n\nAre you in a relationship at the moment?\n\nYeah. I I'm married.\n\nI've been for many years. Mhmm. And, just\n\nover the last few months, just in descent\n\nDisinterested.\n\nOkay.\n\nYou phrased that for a moment.\n\nLess interested as well. Okay. And just to ask you a few questions\n\nbefore we wrap up is any\n\nsignificant past medical history? So do you suffer from any\n\nmental health problems in the past or any physical health problems?\n\nNo. So\n\nin the past, I\n\nhave a history of hypothy\n\nHypo? Hyperthyroidism.\n\nHyperthyroidism. Yeah.\n\nSo that's my thyroid just to sort of confirm it.\n\nSorry. Can you say that again, please?\n\nHyper\n\nas in high. Hyper thyroid.\n\nHypo.\n\nHypo. Okay. Hypo.\n\nThank you.\n\nThank you.\n\nYep. And also in the past, I mean,\n\nI haven't had any kind of specific, medical diagnosis along these lines.\n\nBut the suspicion that it may have had an\n\non me. But my father has committed suicide.\n\nAbout fifteen years ago. Okay.\n\nOkay. And\n\ndo you take any medications?\n\nI have a drug history of\n\nthyroxine.\n\nMhmm.\n\nSo maybe. Yes.\n\nDo do you continue to take thyroxine now?\n\nYes. You do?\n\nYou're so you're taking thyroxine at the moment?\n\nYes. Cool.\n\nAny drug allergies? Are you allergic to any medications?\n\nNo. I have no\n\nmedication allergies. No.\n\nNo allergies. And you mentioned the the suicide of your\n\nfather fifteen years ago. I'm very sorry to hear that. Is there\n\nany other\n\nsignificant family history of medical conditions or psychiatric conditions?\n\nNo. No depression or anything like that running in the family? Or\n\nNothing. Nothing at all.\n\nAnd your mother is is well? Any brothers or sister\n\nYeah. She's fine. And now I'm an early child.\n\nOkay.\n\nOkay.\n\nSo I just\n\nit might seem like slightly random question, but any change in your vision?\n\nNo. No. Nothing like\n\nthat. No\n\nchange in\n\nyour\n\nOkay. And just to go back to your you're saying you had low mood.\n\nSome people who are who do have low mood and low sex\n\ndrive can sometimes feel suicidal as well. Have you had any thoughts\n\nof harming yourself or harming anyone else? No. No?\n\nNo. Not right now, really.\n\nNo.\n\nAnd are you able to get the usual enjoyment out of your\n\ndaily activities that you have done in the past?\n\nSometimes. I mean, I guess,\n\nmost of the activities, but when I've been doing sports as well, my\n\nI find sometimes it's quite difficult to breathe.\n\nSo I\n\nhave some kind of, like, shortness of breath when\n\nsports compared to maybe a couple of months ago.\n\nOkay. So you you become more short of\n\nbreath over the last few months.\n\nYeah.\n\nYou've had\n\nokay. So any\n\nother things around this? So more fatigue, more shortness of breath,\n\nover the last few months with a sort of low lower mood\n\ndecrease sec drive. Is there just before we wrap up, is there anything else that you would\n\nlike to talk about?\n\nNo. Nothing specific. No.\n\nSo\n\ngetting a little bit towards the end now, but I would quite like to make a bit more of a\n\nplan for you. I would like to\n\nprobably see you in person and do an examination and\n\nand, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nsee to book an appointment in the next\n\nfew days, with your GP or\n\nor\n\nthat would be ideal, I think, here.\n\nAnd then we can we can probably do some more do an examination and and\n\ndo some investigations really to see what's going on there a little bit more.\n\nThat makes sense. Yeah.\n\nIs that alright?\n\nYeah. That's very useful. Thank you.\n\nOkay. Better\n\nto have some kind of plan.\n\nYeah. Yeah. Yeah. I think we're I definitely think we need a plan here.\n\nIt's been nice talking to you. I'm sorry we run out of time now, but we've at least\n\nstarted\n\nthe ball rolling with some further investigations and tests.\n\nI'm glad that you're, you know, you're you're although you have a low mood, you're you're\n\nyou're not feeling suicidal, just to confirm that. Mhmm. And you're\n\nand we'll hopefully get to the bottom of some of your tiredness\n\nand your other symptoms. Let me see. Okay?\n\nYou very much for taking the time.\n\nOkay. Thank you. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":36,"end":43,"said":"name's","significant":false},{"start":74,"end":74,"said":"Babylon.","significant":false},{"start":117,"end":125,"said":"","significant":false},{"start":135,"end":149,"said":"name's . Makes sense. Yeah.","significant":false},{"start":152,"end":152,"said":". Sorry","significant":false},{"start":211,"end":215,"said":"Hi. 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OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","\"Onset over ~2 months\"."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Fatigue, difficulty waking, low energy with goal to \"return to previous normal function\"."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","\"Sleep: trouble sleeping\"."],["The note captures: Reduced appetite/not eating much.","yes","\"reduced appetite\"."],["The note captures: Low mood with distractibility and impaired concentration.","yes","\"slightly lower mood\" with \"difficulty focusing, easily distracted\"."],["The note captures: Reduced libido/sexual interest.","yes","\"decreased libido over past few months\"."],["The note captures: No thoughts of harming self or others are reported.","partial","\"Suicidal ideation/self-harm: denies\" but harm to others not documented."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","\"father died by suicide ~15 years ago\"."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","\"Hypothyroidism\"."],["The note captures: Currently taking thyroxine.","yes","\"Thyroxine (current)\"."],["The note captures: No known medication allergies.","yes","\"denies medication allergies\"."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","\"increased shortness of breath during sports over last few months\"."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","\"coinciding with starting a new job\"."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","\"Patient goal: return to previous normal function and energy\"."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","\"Book in-person GP appointment within few days for examination\"."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","\"plan for blood tests to investigate causes of fatigue and dyspnoea\"."]],"claims":[],"note":"Presenting Condition\n\nOnset over ~2 months, coinciding with starting a new job\n\nMain concerns: marked fatigue, difficulty waking, low energy, reduced appetite\n\nSleep: trouble sleeping\n\nCognitive: difficulty focusing, easily distracted\n\nMood: slightly lower mood\n\nSexual health: decreased libido over past few months; no change in morning erections per patient\n\nDyspnoea: increased shortness of breath during sports over last few months\n\nPatient goal: return to previous normal function and energy\n\n\n\n\nPast Medical History\n\nHypothyroidism\n\nFamily history: father died by suicide ~15 years ago\n\nAllergies: denies medication allergies\n\n\n\n\nMedications\n\nThyroxine (current)\n\n\n\n\nRed Flag/Screening Questions\n\nSuicidal ideation/self-harm: denies\n\nVision changes: denies\n\n\n\n\nSocial History\n\nMarried\n\nNew job started ~2 months ago\n\n\n\n\nSport & Exercise History\n\nParticipates in sports; now experiences increased shortness of breath with sport\n\n\n\n\nGoals\n\nShort-term: advice and plan to improve energy and functioning\n\nLong-term: return to prior baseline of daily activities and appetite\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nWorking dx: fatigue with low mood and reduced appetite; differentials to explore include thyroid dysfunction and other medical causes of fatigue and dyspnoea\n\nPrognosis: to be determined after in-person exam and investigations\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nneed for in-person review and physical examination\n\nplan for blood tests to investigate causes of fatigue and dyspnoea\n\n\n\n\nPlan\n\nBook in-person GP appointment within few days for examination\n\nArrange blood tests at that visit\n\nFollow-up after investigations to refine diagnosis and management\n","review":85.01315789473685,"saved":212.48684210526315,"clean":false,"effort":3.125,"sig":[],"mb":18.324858,"signable":107.82515789473685},{"label":"Run 3","wer":19.268153230417383,"text":"Hello? Hey there.\n\nHi. Hi there. My name is Joe. I'm one of the doctors at\n\nI just can I confirm your name, please?\n\nAlright. Yeah. My name is.\n\nWhat so your name was? Name was Brian.\n\nBrian. Hi, Brian. Nice to you.\n\nAnd your date of birth?\n\nYeah. My date of birth is the 08/08/1982.\n\nGreat. And\n\nare you in a sort of confidential place where you can speak freely?\n\nYeah. No no one else can hear me.\n\nGreat. And you're happy to continue with the consultation?\n\nYes.\n\nFabulous. Okay. So how can I help today?\n\nYeah. So, basically, it's just been happening over the last\n\nfew weeks or so. But I don't really feel like,\n\nlike, getting up in the morning is really difficult, and I don't have much energy at all.\n\nDuring the day. Often,\n\nyeah. Just, like, doing most things that I would normally find\n\neasy, has become quite difficult.\n\nOkay. So things have become quite difficult for you.\n\nYep. Is there anything else?\n\nIt's quite hard to say. Like,\n\nthings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy.\n\nOkay. I'm sorry to hear that.\n\nSo you had difficulty waking up\n\nno energy, not eating, and that's been going on for a few weeks.\n\nWhen you say a few weeks, do you mean two or three or five?\n\nHow much? Roughly. Now I\n\ncan think about it maybe\n\nmaybe even longer. I guess, might be related to\n\nSo I also started a new job, slightly recently.\n\nIt might have even coincide coincided with, with that\n\njob a couple of months ago.\n\nWhen did you start your new job? Two months ago, you say?\n\nYeah. K.\n\nAnd so this has been going on perhaps for sort of\n\nsix weeks or so.\n\nMore like\n\ntwo two months, I would say. Yeah.\n\nOkay. Alright. So\n\nis there anything that you're particularly sort of\n\nconcerned about or hoping to get out of this consultation?\n\nWell, I I know that it's not really normal for\n\nme. So before this phase started happening, you know, I wouldn't have\n\nany problems sort of easing\n\nwhat I want to eat or, you know, doing standard things in life and and what I want\n\nto do is to, like, kind of return to that previous state somehow.\n\nI'm not sure how that is, what what the best ways of doing that are, but\n\nyeah, give some advice or\n\nwhatever. That'd be really\n\nuseful. Okay. Sure.\n\nOkay. Well, what what I'd like to do is just ask you a few more\n\nsort of questions around what's been going on,\n\nand also around your background health and\n\nand things like that.\n\nAnd then we can go on to sort of what what can be done from there. Is that alright?\n\nOkay. Okay.\n\nGreat. So you say you've been feeling unwell with\n\nnot a lot of energy, difficult waking up in the mornings. Do you tend to just on that note,\n\ndo you tend to wake up early and then stay in bed in the morning?\n\nActually, I'm\n\njust not not really wait\n\nYep. Early, it's more like I'm just having trouble sleeping. That's all, probably. I think that's\n\nprobably close.\n\nDifficulty sleeping as well.\n\nYeah.\n\nAnd have you and\n\nhow how has your mood been over this period?\n\nHave\n\nyou been feeling\n\nunusually Distract,\n\nI I'd say. I I kind of\n\nyeah. Finding it really hard to\n\nquite difficult to keep focusing, I would say.\n\nNot unhappy or happy, but just\n\nquite just not focused.\n\nOkay. So difficulty focusing, quite distracted.\n\nAnd\n\nwould you say you've been in good spirits, or is your mood low?\n\nActually, now you you mentioned it.\n\nLike, my it is a bit lower recently.\n\nAnd so I it's like my sex drive has kind of decreased\n\na bit over the the past few months as\n\nwell. Right. So\n\nyeah. K.\n\nAnd so\n\nlower mood, decreased sex drive recently as well, and\n\njust on that note, just a few questions around that.\n\nAre you able to maybe slightly personal questions, but\n\nif you're okay to ask these, do you tend to to have morning erections like\n\nyou is that something that you've noticed?\n\nIn recent\n\nI haven't noticed anything like that specifically. No.\n\nSo you've so you're saying you have not noticed\n\nmorning actions, and usually, you would. It's just a normal thing to have\n\nwaking up in\n\nthe Yes.\n\nWith something, but you have not noticed those recently.\n\nI have not noticed those recently.\n\nOkay. So and that's been a change, has it?\n\nImportant one, I don't think. Sorry? Yeah.\n\nNo. I don't think it's important to change. No. I I\n\nsorry. You you think there's\n\nbeen a change there?\n\nNo. There hasn't been a change there.\n\nOh, okay. Sorry. Right. Sorry. Okay. So\n\njust going back to the mood symptoms as well.\n\nYeah. When you've had difficulty focusing, easily\n\ndistracted, your mood has been slightly lower with lower sex drive.\n\nYep. And in what way is your sex drive been lower\n\nAre you in a relationship at the moment?\n\nYeah. I I'm married.\n\nI've been for many years. Mhmm. And, just\n\nover the last few months, just in descent\n\nDisinterested.\n\nOkay.\n\nYou phrased that for a moment.\n\nLess interested as well. Okay. And just to ask you a few questions\n\nbefore we wrap up is any\n\nsignificant past medical history? So do you suffer from any\n\nmental health problems in the past or any physical health problems?\n\nNo. So\n\nin the past, I\n\nhave a history of hypothy\n\nHypo? Hyperthyroidism.\n\nHyperthyroidism. Yeah.\n\nSo that's my thyroid just to sort of confirm it.\n\nSorry. Can you say that again, please?\n\nHyper as in high. Hyper thyroid.\n\nHypo.\n\nHypo. Okay. Hypo.\n\nThank you.\n\nThank you.\n\nYep. And also in the past, I mean,\n\nI haven't had any kind of specific, medical diagnosis along these lines.\n\nBut the suspicion that it may have had an\n\non me. But my father has committed suicide.\n\nAbout fifteen years ago. Okay.\n\nOkay. And\n\ndo you take any medications?\n\nI have a drug history of\n\nthyroxine.\n\nMhmm.\n\nSo maybe. Yes.\n\nDo do you continue to take thyroxine now?\n\nYes. You do?\n\nYou're so you're taking thyroxine at the moment?\n\nYes. Cool.\n\nAny drug allergies? Are you allergic to any medications?\n\nNo. I have no\n\nmedication allergies. No.\n\nNo allergies. And you mentioned the the suicide of your\n\nfather fifteen years ago. I'm very sorry to hear that. Is there\n\nany other\n\nsignificant family history of medical conditions or psychiatric conditions?\n\nNo.\n\nNo depression or anything like that running in the\n\nfamily?\n\nOr\n\nNothing.\n\nNothing at all.\n\nAnd your mother is is well? Any brothers or sister\n\nYeah. She's fine. And now I'm an early\n\nchild.\n\nOkay.\n\nOkay.\n\nSo I just\n\nit might seem like slightly random question, but any change in your vision?\n\nNo.\n\nNo. Nothing like\n\nthat. No\n\nchange in your\n\nOkay. And just to go back to your you're saying you had low mood.\n\nSome people who are who do have low mood and low sex\n\ndrive can sometimes feel suicidal as well. Have you had any thoughts\n\nof harming yourself or harming anyone else? No. No?\n\nNo. Not right now, really.\n\nNo.\n\nAnd are you able to get the usual enjoyment out of your\n\ndaily activities that you have done in the past?\n\nSometimes. I mean, I guess,\n\nmost of the activities, but when I've been doing sports as well, my\n\nI find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when\n\nsports compared to maybe a couple of months ago.\n\nOkay. So you you become more short of\n\nbreath over the last few months.\n\nYeah.\n\nYou've had\n\nokay. So any\n\nother things around this? So more fatigue, more shortness of breath,\n\nover the last few months with a sort of low lower mood\n\ndecrease sec drive. Is there just before we wrap up, is there anything else that you would\n\nlike to talk about?\n\nNo. Nothing specific. No.\n\nSo\n\ngetting a little bit towards the end now, but I would quite like to make a bit more of a\n\nplan for you. I would like to\n\nprobably see you in person and do an examination and\n\nand, also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nsee to book an appointment in the next\n\nfew days, with your GP or or\n\nthat would be ideal, I think, here.\n\nAnd then we can we can probably do some more do an examination and and\n\ndo some investigations really to see what's going on there a little bit more.\n\nThat makes sense. Yeah.\n\nIs that alright?\n\nYeah. That's very useful. Thank you.\n\nOkay.\n\nBetter\n\nto have some kind of plan.\n\nYeah. Yeah. Yeah. 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Hey there.\n\nHi. Hi there. My name's Joe. I'm one of the doctors at Buffalo. I just can I confirm your name, please?\n\nYeah. My name is Doug.\n\nSo what so your name is?\n\nName was Brian. Brian. Hi, Brian. Nice to you.\n\nAnd your date of birth?\n\nYeah. My date of birth is the 08/08/1982.\n\nGreat. And\n\nare you in a sort of confidential place where you can speak freely?\n\nYeah. No no one else can hear me. Great. And you're happy to continue with the consultation?\n\nYes. Fabulous. Okay. So how can I help today?\n\nYeah. So, basically, it's just been happening over the last\n\nfew weeks or so. But I don't really feel like\n\nlike, getting up in the morning is really difficult, and I don't have much energy at all.\n\nDuring the day.\n\nOften,\n\nyeah. Just, like, doing most things that I would normally find\n\neasy has become quite difficult.\n\nOkay. So things have become quite difficult for you.\n\nYep. Is there anything else?\n\nIt's quite hard to say. Like,\n\nthings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy.\n\nOkay. I'm sorry to hear that.\n\nSo you had difficulty waking up\n\nno energy, not eating, and that's been going on for a few weeks.\n\nWhen you say a few weeks, do you mean two or three or five?\n\nHow much? Roughly.\n\nNow I can think about it maybe\n\nmaybe even longer. I guess, might be related to\n\nSo I also started a new job slightly recently.\n\nIt might have even coincide coincided with with that\n\njob a couple of months ago.\n\nWhen did you start your new job? Two months ago, you say?\n\nYeah. K.\n\nAnd so this has been going on perhaps for sort of\n\nsix weeks or so.\n\nMore like two two months, I would say. Yeah.\n\nOkay.\n\nAlright. So\n\nis\n\nthere anything that you're particularly sort of concerned about\n\nor hoping to get out of this consultation?\n\nWell, I I know that it's not really normal for me. So\n\nbefore this phase started happening, you know, I wouldn't have\n\nany problems sort of easing\n\nwhat I want to eat or, you know, doing standard things in life and and what I want\n\nto do is to, like, kind of return to that previous state somehow.\n\nI'm not sure how that is, what what the best ways of doing that are, but\n\nyou know, give some advice or\n\nwhatever. That'd be really useful.\n\nOkay. Sure. Okay.\n\nWhat I'd like to do is just ask you a few more sort of questions around what's been going on\n\nand also around your background health and and things like that.\n\nAnd then we can go on sort of what what can be done from there. Is that alright?\n\nOkay.\n\nOkay. Great. So you say you've been feeling unwell with\n\na lot of energy, difficult waking up in the mornings. Do you tend to just on that note,\n\ndo you tend to wake up early and then stay in bed in the morning?\n\nActually, I'm just not\n\nreally wake you know, barely. It's more like I'm just having trouble sleeping at all.\n\nProbably. I think that's probably close.\n\nDifficulty sleeping as well.\n\nYeah. And\n\nhave you and\n\nhow how has your mood been over this period?\n\nHave you been\n\nfeeling\n\nunusually distract,\n\nI I'd say. I I kind\n\nof\n\nyeah. Finding it really hard to\n\nquite difficult to keep focusing, I would say.\n\nNot unhappy or happy, but just\n\nquite just not focused.\n\nOkay. So difficulty focusing, quite distracted.\n\nAnd would you say you've been in good spirits, or is your mood low?\n\nActually,\n\nnow you mentioned it. Like, my rate is a bit lower recently.\n\nAnd so I it's like my sex drive has kind of decreased\n\na bit over the the past few months as well. Right. So yeah.\n\nK. And\n\nso lower mood, decreased sex drive recently as well.\n\nAnd just on that note, just a few questions around that.\n\nAre you able to maybe slightly personal questions,\n\nbut\n\nif you're okay to answer this, do you tend to to have morning erection\n\nlike you is that something that you've noticed?\n\nIn recent\n\nI haven't noticed anything like that specifically. No.\n\nSo you've you're saying you have not noticed\n\nmorning actions, and usually, you would. It's just a normal thing to have\n\nwaking up in the\n\nYes.\n\nWith something, but you have not noticed those recently.\n\nI have not noticed those recently.\n\nOkay. So and that's been a change, has it?\n\nImportant one, don't think. Sorry? Yeah.\n\nNo. I don't think it's an important change. No.\n\nI sorry. Are you\n\nYou don't think there's been a change there?\n\nNo. There hasn't been a change there.\n\nOh, okay. Sorry. Right. Sorry. Okay. So\n\njust going back to the mood symptoms as well.\n\nYeah. When you've had difficulty focusing easily\n\ndistracted, your mood has been slightly lower with lower sex drive.\n\nYep. And in what way is your sex drive been lower\n\nAre you in a relationship at the moment?\n\nYeah. I am married.\n\nI've been for many years. Mhmm. And Just\n\nover the last few months, just in descent,\n\nDisinterested.\n\nOkay.\n\nYou phrased that for a moment.\n\nLess interested as well. Okay. And just to ask you a few questions,\n\nbefore we wrap up is any\n\nsignificant past medical history? So do you suffer from any\n\nmental health problems in the past or any physical health problems?\n\nNo.\n\nSo in the past, I\n\nhave a history of hypothyroid\n\nHypo? Hyperthyroidism.\n\nHyperthyroidism. Yeah.\n\nSo that's my thyroid just to sort of confirm it.\n\nSorry. Can you say that again, please?\n\nHyper as in high.\n\nHyper\n\nthyroid.\n\nHypo.\n\nHypo. Okay. Hypothyroid. Thank you.\n\nThank you.\n\nYep. And\n\nalso in the past, I mean, I haven't had any kind of specific\n\nmedical diagnosis along these lines. But\n\nsuspicion that it may have had an impact on me.\n\nBut my father has committed suicide.\n\nAbout fifteen years ago. Okay.\n\nOkay. And\n\ndo you take any medications?\n\nI have a drug history of\n\nthyroxine.\n\nMhmm. So\n\nmaybe. Yes.\n\nDo you do you continue to take thyroxine\n\nnow?\n\nYes.\n\nYou\n\ndo? You're so you're taking thyroxine at the moment?\n\nYes. Cool.\n\nAny drug allergies? Are you allergic to any medications?\n\nNo. I have no\n\nmedication allergies. No.\n\nNo allergies. And you mentioned the the suicide of your\n\nfather fifteen years ago. I'm very sorry to hear that. Is there\n\nany other\n\nsignificant family history of medical conditions or psychiatric conditions?\n\nNo. No depression or anything like that running in the family\n\nor\n\nNothing. Nothing at\n\nall.\n\nOkay.\n\nAnd your mother is is well? Any brothers or sisters?\n\nYeah. She's fine. And I'm an early child.\n\nOkay.\n\nOkay. So\n\nI\n\njust sorry. My slightly random question, but any\n\nchange in your vision?\n\nNo. No. Nothing like that. No\n\nchange in your\n\nOkay. And just to go back to your you're saying you had low mood.\n\nSome people who are who do have low mood and low sex\n\ndrive can sometimes feel suicidal as well. Have you had any thoughts\n\nof harming yourself or harming anyone else? No. No?\n\nNo. Not\n\nat all, really. No.\n\nAnd are you able to get the usual enjoyment out of your\n\ndaily activities that you have done in the past?\n\nSometimes. I mean, I guess,\n\nmost of the activities, but when I've been doing sports as well, my\n\nI find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when\n\nsports compared to maybe a couple of months ago.\n\nOkay.\n\nSo you you've become more short of breath over the last few months.\n\nYeah.\n\nAnd you've had\n\nokay. So any\n\nother things around this? So more fatigue, more shortness of breath,\n\nover the last few\n\nmonths. Mhmm. With\n\na sort of low lower mood, deep\n\nIs there just before we wrap up, is there anything else that you would\n\nlike to talk about?\n\nNo. Nothing specific. No. So\n\ngetting a little bit towards the end now, but I would quite like\n\nto make a bit more of a plan for you.\n\nI would like to probably see you in person and do an examination\n\nAnd and also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nsee to book an appointment in the next\n\nfew days with your GP or or\n\nthat would be ideal, I think, here.\n\nThen we can we can probably do some more do an examination and and\n\ndo some investigations really to see what's going on there a little bit more.\n\nThat makes sense. Yeah.\n\nIs that alright?\n\nYeah.\n\nThat's very useful. Thank you.\n\nOkay.\n\nBetter to have some kind of plan.\n\nYeah.\n\nYeah. Yeah. I think we're I definitely think we need a plan here. It\n\nbeen nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with\n\nsome further investigations and tests. I'm glad that you're, you know, you're you're\n\nyou've although you have a low mood, you're you're\n\nnot feeling suicidal, just to confirm that. Mhmm. And you're\n\nand we'll hopefully get to the bottom of\n\nsome of your tiredness and your other symptoms.\n\nLet me\n\nsee. Okay?\n\nThank you very much for taking the time. Okay. Thank\n\nyou. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":74,"end":82,"said":"Babylon.","significant":false},{"start":133,"end":146,"said":"name's . Makes sense. Yeah.","significant":false},{"start":151,"end":158,"said":". Sorry","significant":false},{"start":216,"end":220,"said":"Hi. 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Hey there.\n\nHi. Hi there. My name's Joe. I'm one of the doctors at Buffalo. I just can I confirm your name, please?\n\nYeah. My name is Doug.\n\nSo what so your name was?\n\nName was Brian. Brian. Hi, Brian. Nice to you.\n\nAnd your date of birth?\n\nYeah. My date of birth is the 08/08/1982.\n\nGreat. And\n\nare you in a sort of confidential place where you can speak freely?\n\nYeah. No no one else can hear me. Great. And you're happy to continue with the consultation?\n\nYes. Fabulous. Okay. So how can I help today?\n\nYeah. So, basically, it's just been happening over the last\n\nfew weeks or so. But I don't really feel like\n\nlike, getting up in the morning is really difficult, and I don't have much energy at all.\n\nDuring the day.\n\nOften,\n\nyeah. Just, like, doing most things that I would normally find\n\neasy has become quite difficult.\n\nOkay. So things have become quite difficult for you.\n\nYep. Is there anything else?\n\nIt's quite hard to say. Like,\n\nthings like I'm not not eating very much at the moment. I just don't feel like I have a lot of energy.\n\nOkay. I'm sorry to hear that.\n\nSo you had difficulty waking up\n\nno energy, not eating, and that's been going on for a few weeks.\n\nWhen you say a few weeks, do you mean two or three or five?\n\nHow much? Roughly.\n\nNow I can think about it maybe\n\nmaybe even longer. I guess, might be related to\n\nSo I also started a new job slightly recently.\n\nIt might have even coincide coincided with with that\n\njob a couple of months ago.\n\nWhen did you start your new job? Two months ago, you say?\n\nYeah. K.\n\nAnd so this has been going on perhaps for sort of\n\nsix weeks or so.\n\nMore like two two months, I would say. Yeah.\n\nOkay.\n\nAlright. So\n\nis\n\nthere anything that you're particularly sort of concerned about\n\nor hoping to get out of this consultation?\n\nWell, I I know that it's not really normal for me. So\n\nbefore this phase started happening, you know, I wouldn't have\n\nany problems sort of easing\n\nwhat I want to eat or, you know, doing standard things in life and and what I want\n\nto do is to, like, kind of return to that previous state somehow.\n\nI'm not sure how that is, what what the best ways of doing that are, but\n\nyou know, give some advice or\n\nwhatever. That'd be really useful.\n\nOkay. Sure. Okay.\n\nWhat I'd like to do is just ask you a few more sort of questions around what's been going on\n\nand also around your background health and and things like that.\n\nAnd then we can go on sort of what what can be done from there. Is that alright?\n\nOkay.\n\nOkay. Great. So you say you've been feeling unwell with\n\na lot of energy, difficult waking up in the mornings. Do you tend to just on that note,\n\ndo you tend to wake up early and then stay in bed in the morning?\n\nActually, I'm just not\n\nreally wake you know, barely. It's more like I'm just having trouble sleeping at all.\n\nProbably. I think that's probably close.\n\nDifficulty sleeping as well.\n\nYeah. And\n\nhave you and\n\nhow how has your mood been over this period?\n\nHave you been\n\nfeeling\n\nunusually distract,\n\nI I'd say. I I kind\n\nof\n\nyeah. Finding it really hard to\n\nquite difficult to keep focusing, I would say.\n\nNot unhappy or happy, but just\n\nquite just not focused.\n\nOkay. So difficulty focusing, quite distracted.\n\nAnd would you say you've been in good spirits, or is your mood low?\n\nActually,\n\nnow you mentioned it. Like, my rate is a bit lower recently.\n\nAnd so I it's like my sex drive has kind of decreased\n\na bit over the the past few months as well. Right. So yeah.\n\nK. And\n\nso lower mood, decreased sex drive recently as well.\n\nAnd just on that note, just a few questions around that.\n\nAre you able to maybe slightly personal questions,\n\nbut\n\nif you're okay to answer this, do you tend to to have morning erection\n\nlike you is that something that you've noticed?\n\nIn recent\n\nI haven't noticed anything like that specifically. No.\n\nSo you've you're saying you have not noticed\n\nmorning actions, and usually, you would. It's just a normal thing to have\n\nwaking up in the\n\nYes.\n\nWith something, but you have not noticed those recently.\n\nI have not noticed those recently.\n\nOkay. So and that's been a change, has it?\n\nImportant one, don't think. Sorry? Yeah.\n\nNo. I don't think it's an important change. No.\n\nI sorry. Are you\n\nYou don't think there's been a change there?\n\nNo. There hasn't been a change there.\n\nOh, okay. Sorry. Right. Sorry. Okay. So\n\njust going back to the mood symptoms as well.\n\nYeah. When you've had difficulty focusing easily\n\ndistracted, your mood has been slightly lower with lower sex drive.\n\nYep. And in what way is your sex drive been lower\n\nAre you in a relationship at the moment?\n\nYeah. I am married.\n\nI've been for many years. Mhmm. And Just\n\nover the last few months, just in descent,\n\nDisinterested.\n\nOkay.\n\nYou phrased that for a moment.\n\nLess interested as well. Okay. And just to ask you a few questions,\n\nbefore we wrap up is any\n\nsignificant past medical history? So do you suffer from any\n\nmental health problems in the past or any physical health problems?\n\nNo.\n\nSo in the past, I\n\nhave a history of hypothyroid\n\nHypo? Hyperthyroidism.\n\nHyperthyroidism. Yeah.\n\nSo that's my thyroid just to sort of confirm it.\n\nSorry. Can you say that again, please?\n\nHyper as in high.\n\nHyper\n\nthyroid.\n\nHypo.\n\nHypo. Okay. Hypothyroid. Thank you.\n\nThank you.\n\nYep. And\n\nalso in the past, I mean, I haven't had any kind of specific\n\nmedical diagnosis along these lines. But\n\nsuspicion that it may have had an impact on me.\n\nBut my father has committed suicide.\n\nAbout fifteen years ago. Okay.\n\nOkay. And\n\ndo you take any medications?\n\nI have a drug history of\n\nthyroxine.\n\nMhmm. So\n\nmaybe. Yes.\n\nDo you do you continue to take thyroxine\n\nnow?\n\nYes.\n\nYou\n\ndo? You're so you're taking thyroxine at the moment?\n\nYes. Cool.\n\nAny drug allergies? Are you allergic to any medications?\n\nNo. I have no\n\nmedication allergies. No.\n\nNo allergies. And you mentioned the the suicide of your\n\nfather fifteen years ago. I'm very sorry to hear that. Is there\n\nany other\n\nsignificant family history of medical conditions or psychiatric conditions?\n\nNo. No depression or anything like that running in the family\n\nor\n\nNothing. Nothing at\n\nall.\n\nOkay.\n\nAnd your mother is is well? Any brothers or sisters?\n\nYeah. She's fine. And I'm an early child.\n\nOkay.\n\nOkay. So\n\nI\n\njust sorry. My slightly random question, but any\n\nchange in your vision?\n\nNo. No. Nothing like that. No\n\nchange in your\n\nOkay. And just to go back to your you're saying you had low mood.\n\nSome people who are who do have low mood and low sex\n\ndrive can sometimes feel suicidal as well. Have you had any thoughts\n\nof harming yourself or harming anyone else? No. No?\n\nNo. Not\n\nat all, really. No.\n\nAnd are you able to get the usual enjoyment out of your\n\ndaily activities that you have done in the past?\n\nSometimes. I mean, I guess,\n\nmost of the activities, but when I've been doing sports as well, my\n\nI find sometimes it's quite difficult to breathe.\n\nSo I have some kind of, like, shortness of breath when\n\nsports compared to maybe a couple of months ago.\n\nOkay.\n\nSo you you've become more short of breath over the last few months.\n\nYeah.\n\nAnd you've had\n\nokay. So any\n\nother things around this? So more fatigue, more shortness of breath,\n\nover the last few\n\nmonths. Mhmm. With\n\na sort of low lower mood, deep\n\nIs there just before we wrap up, is there anything else that you would\n\nlike to talk about?\n\nNo. Nothing specific. No. So\n\ngetting a little bit towards the end now, but I would quite like\n\nto make a bit more of a plan for you.\n\nI would like to probably see you in person and do an examination\n\nAnd and also, we'd probably like to do some blood tests as well. So do you think it'd be possible to\n\nsee to book an appointment in the next\n\nfew days with your GP or or\n\nthat would be ideal, I think, here.\n\nThen we can we can probably do some more do an examination and and\n\ndo some investigations really to see what's going on there a little bit more.\n\nThat makes sense. Yeah.\n\nIs that alright?\n\nYeah.\n\nThat's very useful. Thank you.\n\nOkay.\n\nBetter to have some kind of plan.\n\nYeah.\n\nYeah. Yeah. I think we're I definitely think we need a plan here. It\n\nbeen nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with\n\nsome further investigations and tests. I'm glad that you're, you know, you're you're\n\nyou've although you have a low mood, you're you're\n\nnot feeling suicidal, just to confirm that. Mhmm. And you're\n\nand we'll hopefully get to the bottom of\n\nsome of your tiredness and your other symptoms.\n\nLet me\n\nsee. Okay?\n\nThank you very much for taking the time. Okay. Thank\n\nyou. Thanks.","marks":[{"start":7,"end":10,"said":"Hi","significant":false},{"start":74,"end":82,"said":"Babylon.","significant":false},{"start":133,"end":146,"said":"name's . Makes sense. Yeah.","significant":false},{"start":151,"end":158,"said":". Sorry","significant":false},{"start":217,"end":221,"said":"Hi. 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Yeah it feels","significant":false},{"start":8097,"end":8102,"said":"","significant":false},{"start":8143,"end":8145,"said":"Um it's","significant":false},{"start":8183,"end":8185,"said":"we've","significant":false},{"start":8343,"end":8349,"said":"you're","significant":false},{"start":8386,"end":8386,"said":"you're um","significant":false},{"start":8439,"end":8444,"said":"Mm-hmm yes. And","significant":false},{"start":8548,"end":8554,"said":"when we","significant":false},{"start":8609,"end":8614,"said":"Thank you. OK.","significant":false}],"facts":[["The note captures: Symptoms have lasted approximately two months/eight weeks.","yes","~2 months duration recorded."],["The note captures: Low energy/fatigue and difficulty getting up impair usual daily activities.","yes","Fatigue and difficulty waking with impairment of daily tasks."],["The note captures: Difficulty sleeping/insomnia is reported, rather than definite early morning waking.","yes","Difficulty sleeping recorded."],["The note captures: Reduced appetite/not eating much.","yes","Reduced appetite recorded."],["The note captures: Low mood with distractibility and impaired concentration.","yes","Low mood with difficulty concentrating/distractibility."],["The note captures: Reduced libido/sexual interest.","yes","Decreased libido recorded."],["The note captures: No thoughts of harming self or others are reported.","yes","Denies thoughts of harming self or others."],["The note captures: Father died by suicide approximately fifteen years ago.","yes","Father suicide ~15 years ago."],["The note captures: Past history is hypothyroidism, explicitly corrected from the clinician’s initial hyperthyroidism misunderstanding.","yes","Hypothyroidism recorded."],["The note captures: Currently taking thyroxine.","yes","Thyroxine current."],["The note captures: No known medication allergies.","yes","No medication allergies."],["The note captures: Increasing shortness of breath during sport/exertion over the recent months.","yes","Shortness of breath during sport over recent months."],["The note captures: Symptoms coincide with starting a new job about two months earlier.","yes","Onset coinciding with new job."],["The note captures: Patient wants to return to previous energy/function or usual self.","yes","Goal to return to previous state."],["The note captures: Plan for an in-person GP appointment in the next few days with physical examination.","yes","In-person GP appointment within next few days for examination."],["The note captures: Blood tests/further investigations are planned to investigate symptoms; no named panel is required.","yes","Blood tests planned."]],"claims":[],"note":"Presenting Condition\n\nOnset over ~2 months, coinciding with starting a new job\n\nMain concerns: severe fatigue, difficulty waking, poor appetite, difficulty focusing, lower mood, decreased sex drive, insomnia, reduced exercise tolerance with shortness of breath\n\nDuration: ~2 months\n\nProgression: persistent since job change\n\nImpact on daily activities/work: most usual tasks now difficult\n\nAssociated symptoms: shortness of breath during sports; no vision change\n\n24‑hour pain pattern: difficulty waking; trouble sleeping\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPast Medical History\n\nHypothyroidism\n\nFamily history: father died by suicide ~15 years ago\n\nDenies other family psychiatric/medical conditions\n\nNo medication allergies reported\n\n\n\n\nMedications\n\nThyroxine (current)\n\n\n\n\nRed Flag/Screening Questions\n\nSuicidal or self-harm thoughts: denies\n\nHomicidal thoughts: denies\n\nVision change: denies\n\n\n\n\nSocial History\n\nMarried\n\nStarted a new job ~2 months ago\n\nOnly child; mother well\n\n\n\n\nSport & Exercise History\n\nParticipates in sports; now experiences shortness of breath compared with a few months ago\n\n\n\n\nGoals\n\nReturn to previous level of energy, appetite, function; seeking advice/plan\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nWorking dx: fatigue with low mood, insomnia, reduced libido and exertional dyspnoea; differential to rule out thyroid dysfunction and other medical causes\n\nPrognosis: pending in‑person exam and investigations\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nArrange in‑person review and physical examination\n\nPlan for blood tests to investigate causes\n\n\n\n\nPlan\n\nBook GP appointment within next few days for examination and blood tests\n\nFurther management guided by results and assessment\n","review":72.94736842105263,"saved":224.55263157894737,"clean":true,"effort":0.0,"sig":[],"mb":18.80304,"signable":95.56936842105263}],"patientnotes":[{"label":"Run 1","wer":21.269296740994854,"text":"Hello.\nHi. Hi there. My name's Joe. I'm one of the doctors at Babylon. Can I confirm your name, please?\nYeah.\nSorry, your name was. Name was Brian. Brian. Hi, Brian. Nice time. And your date of birth?\nYeah, my date of birth is the 8th of August, 1982. Great.\nAnd are you in a sort of confidential place where you can speak freely? Yeah, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so how can I help today?\nYeah, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like getting up in the morning is really difficult. And I don't have much energy at all during the day. Often. Yeah. Just like doing most things that I would normally find easy. It's become quite difficult.\nOkay, so things have become quite difficult for you? Yeah. Is there anything else? It's quite\nhard to say.\nLike,\nthings like, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\nOkay. I'm sorry to hear that. So you've had difficulty waking up? No energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five now? I\nthink about it maybe even longer, I guess.\nIt might be related. So I also started a new job slightly recently. It might have even coincided with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you\nsay?\nYeah. Okay. And so this has been going on perhaps for sort of six weeks or so?\nMore like two\nmonths, I would say. Yeah. Okay.\nAll right. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\nWell, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or doing standard things in life and what doing I'm.\nWant to do is to like kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but give some advice or whatever that'd be really useful. Okay, sure.\nOkay. Well, what I like to do is just ask you a few more sort of questions around what's been going on and also around your background health and, and things like that and then we can go on to sort of what can be done from there. Is that right?\nOkay, great.\nSo you say you've been feeling unwell with not a lot of energy, difficult waking up in the morning. Do you tend to. Just on that note, do you tend to wake up early and then stay in bed in the morning?\nActually, I'm just not normally waking up apparently. It's more like I'm just having trouble sleeping at all probably. I think that's probably close difficulty sleeping as well.\nAnd have you how has your mood been over this period? Have you been feeling distracted?\nI'd say I kind of, yeah. Finding it really hard to. Quite difficult to keep focusing. I would say not unhappy or happy, but just quite. Not\nfocused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\nActually, now you mentioned it like, my mood is lower recently and so I slight my sex drive has kind of decreased a bit over the past few months as well. So, yeah.\nAnd so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these. Do you tend to have morning erections? Like you. Is that something that you've noticed? I haven't noticed anything like that specifically. So you're saying you have not noticed morning erections, and usually you would such normal thing to have waking up with something, but you have not noticed those recently? I have not noticed those recently. Okay. So. And that's been a change, has it? Important one, I don't think. Sorry? Yeah, I don't think it's an important change. No. So you don't think that.\nBeen a change there? No, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry.\nOkay, so just going back to the mood symptoms as well. You've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. And in what way has your sex drive been lower? Are you in a relationship at the moment?\nYeah, I'm married. I've been for many years. And, yeah, just over the last few months, just been disinterested. Disinterested.\nOkay, sorry, you phrased there for a moment, so less interested as well. Okay. And just to ask you a few questions before we wrap up, is any significant past medical history.\nSo do you suffer from any mental health problems in the past or any physical health problems? So in the past, I have a history of hypothyroidism. Hypo. Hypothyroidism. Hyperthyroidism. Yeah. Thyroid, just to sort of confirm it. Sorry, can you say that again, please? Hyper as in high hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but suspicion that it may have had an impact on me. But my father has committed suicide about 15 years.\nAgo. Okay. Okay. And. Do you take any medications?\nI have a drug history of thyroxine, so maybe yes.\nDo you continue to take thyroxine now? Yes.\nYou do? So you're taking thyroxine at the moment? Yes. Cool.\nAny drug allergies? Are you allergic to any medications?\nNo, I have no allergies.\nNo allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any. Any other significant family history of medical conditions or psychiatric conditions? No.\nNo depression or anything like that? Running in family or. Okay. And your mother is as well? Any brothers or sisters?\nYeah, she's fine. And I'm an early child.\nOkay. So I just. Sorry. Slightly random question, but any change in your vision? No, nothing like that. Okay. And just to go back to you, you're saying you had low mood? Some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\nSometimes. I mean, I guess most of the activities, but when I've been.\nDoing sports as well. I find sometimes it's quite difficult to breathe. So I have some kind of like, shortness of breath when doing sports compared to me, maybe a couple of months ago.\nOkay, so you've become more short of breath over the last few months. Yeah. And you've had. Okay, so any other things around this? More fatigue, more shortness of breath over the last few months with a lower mood, decreased sex drive. Is there. Just before we wrap up, is there anything else that you would like to talk about? No, nothing specific. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination. And also we probably like to do some blood tests.\nAs well. So do you think it'd be possible to see. To book an appointment in the next few days with your gp? That would be ideal. I think here. And then we could probably do some more. Do an examination and do some investigations, really, to see what's going on there. A little bit more\nclimate.\nIs that all right?\nYeah, that's very useful, thank you. Better to have some kind of plan. Yeah,\nyeah, yeah. I think. I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. 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Hi there. My name's Joe. I'm one of the doctors at Babylon. I just. Can I confirm your name, please?\nYeah, my name is\nBrian. Sorry, your name was.\nName was Brian.\nBrian. Hi, Brian. Nice to meet you. And your date of birth?\nYeah, my date of birth is the 8th of August, 1982.\nGreat. And are you in a sort of confidential place where you can speak freely? Yeah, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Okay, so how can I help today?\nYeah, so basically it's just been happening over the last few weeks or so, but I don't really feel like.\nLike, getting up in the morning is really difficult, and I don't have much energy at all during the day. Often. Yeah. Just like doing most things that I would normally find easy. It's become quite difficult.\nOkay, so things have become quite difficult for you? Yeah. Is there anything else? It's quite hard\nto say. Like, things like, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\nOkay. I'm sorry to hear that. So you had difficulty waking up? No energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five?\nNow I think about it maybe even longer, I guess might be related to. So I also started a new job.\nSlightly recently. It might have even coincided with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah. Okay. And so this has been going on perhaps for sort of six weeks or so?\nMore like two months, I would say. Yeah.\nOkay. All right. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\nWell, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or doing standard things in life. And what I want to do is to kind of return to that previous state.\nSomehow I'm not sure how that is, what the best ways of doing that are, but give some advice or whatever. That'd be really useful. Okay, sure.\nOkay. Well, what I like to do is just ask you a few more sort of questions around what's been going on and also around your background, health and things like that, and then we can go on sort of what can be done from there. That. Right.\nOkay, great.\nSo you say you've been feeling unwell with not a lot of energy, difficult waking up in the mornings. Do you tend to just on that note, do you tend to wake up early and then stay in bed in the morning?\nActually, I'm just not normally waking up early. It's more like I'm just having trouble sleeping at all. Probably. I think that's probably close.\nDifficulty\nsleeping as well.\nHow has your mood been over this period? Have you been feeling distracted?\nI'd say I kind of, yeah. Finding it really hard to. Quite difficult to keep focusing. I would say not unhappy or happy, but just quite. Not focused.\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits, or is your mood low?\nActually, now you mentioned it, like, my mood is a bit lower recently, and so I. My sex drive has kind of decreased a bit over the past few months as well, so. Yeah.\nAnd so.\nLower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these, do you tend to have morning erections like you? Is that something that you've noticed?\nI haven't noticed anything like that specifically.\nSo you're saying you have not noticed morning reactions and usually you would such a normal thing to have waking up in the morning with something, but you have not noticed those recently? I have not noticed those recently. Okay, so. And that's been a change, has it?\nImportant one, I don't think.\nSorry?\nYeah, I don't think it's important to change, no.\nSo you don't think there's been a change there?\nNo, there hasn't been a change there.\nOh, okay. Sorry. Right, sorry.\nOkay,\nso.\nJust going back to the mood symptoms as well. You've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. And in what way is your sex drive been lower? Are you in a relationship at the moment?\nYeah, I'm married. I've been for many years. And, yeah, just over the last few months, just been disinterested. Disinterested.\nOkay.\nSorry,\nyou phrased that for a moment, so less interested as well. Okay. And just to ask you a few questions before we wrap up, is any significant past medical history. So, do you suffer from any mental\nhealth problems in the past\nor any physical health problems?\nSo in the past, I have a history of\nhypothyroidism.\nHypo.\nHyperthyroidism.\nHyperthyroidism,\nyeah.\nHigh thyroid. Just to sort of confirm it. Sorry, can you say that again, please? Hyper, as in high hyperthyroidism. Hypothyroidism. Hypo. Okay. Hypo, thyroid. Thank you.\nThank you.\nYeah. And\nalso in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there suspicion that it may have had an impact on me. But my father has committed suicide 15 years ago.\nOkay. Okay. And.\nDo you take any medications? I have a drug history of thyroxine, so maybe yes. Do you continue to take thyroxine now? Yes. You do? So you're taking thyroxine at the moment? Yes. Cool. Any drug? Allergies? Are you allergic to any medications? No, I have never. Allergies? No, no allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any other significant family history of medical conditions or psychiatric conditions? No. No depression or anything like that? Running in family or Nothing. Okay. And your mother is as well? Any brothers or sisters? Yeah.\nFine. And now I'm an early child.\nOkay. So I just. Sorry, mine slightly random question, but any change in your vision? No, nothing like that. Okay. And just to go back to your you're saying you had low mood? Some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harm yourself or harming anyone else? No. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\nSometimes. I mean, I guess most of the activities. But when I've been doing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of, like, shortness of breath when doing sports.\nCompared to maybe a couple of months ago. Okay, so you've become more short of breath over the last few months. Yeah. And you've had. Okay, so any other things around this More fatigue, more shortness of breath over the last few months with a lower mood, decreased sex drive? Is there. Just before we wrap up, is there anything else that you would like to talk about? No, nothing specific. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination. And also we would probably like to do some blood tests as well. So do you think it'd be possible to see to book an appointment in the next few days with your GP or.\nThat would be ideal, I think here. And then we could probably do some more, do an examination and do some investigations, really, to see what's going on there a little bit more. That makes sense. Yeah. Is that all right?\nYeah, that's very useful. Thank you. Better to have some kind of plan.\nYeah, yeah, yeah. 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Hi there. My name's Joe. I'm one of the doctors at Babylon. I just. Can I confirm your name, please?\nYeah.\nSorry, your name was. Name was Brian. Brian. Hi, Brian. Nice time. And your date of birth?\nYeah, my date of birth is the 8th of August, 1982.\nGreat. And are you in a sort of confidential place where you can speak freely? Yeah. No, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Okay, so how can I help today?\nYeah, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like getting up in the morning is really difficult. And I don't have much energy at all during the day? Often. Yeah. Just like doing most things that I would normally find easy. It's become quite difficult.\nOkay, so things have become quite difficult for you? Yeah. Is there anything else?\nIt's quite hard to say. Like, things like, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\nOkay. I'm sorry to hear that. So you've had difficulty waking up? No energy, not eating. That's been going on for a few weeks. When you say a few weeks, do you mean two or three or five now?\nI think about it maybe even longer, I guess.\nIt might be related. So I also started a new job slightly recently. It might have even coincided with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you say? Yeah. Okay. And so this has been going on perhaps for sort of six weeks or so?\nMore like two months, I would say. Yeah.\nOkay.\nAll right. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\nWell, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or doing standard things in life. And what I.\nWant to do is like kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but give some advice or whatever, that'd be really useful. Okay, sure.\nOkay. Well, what I like to do is just ask you a few more sort of questions around what's been going on and also around your background health and things like that and then we can go on to sort of what can be done from there. Is that all right?\nOkay, great.\nSo you say you've been feeling unwell with not a lot of energy, difficult waking up in the morning. Do you tend to. Just on that note, do you tend to wake up early and then stay in bed in the morning?\nActually, I'm just not normally waking up apparently. It's more like I'm just having trouble sleeping at all probably. I think that's probably close difficulty sleeping as well.\nAnd have you how has your mood been over this period? Have you been feeling\ndistracted? I'd say I kind of, yeah. Finding it really hard to. Quite difficult to keep focusing. I would say not unhappy or happy, but just quite. Not\nfocused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\nActually, now you mentioned it, like, my mood is lower recently, and so I my sex drive has kind of decreased a bit over the past few months as well. So, yeah.\nAnd so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these. Do you tend to have morning erections like you. Is that something that you've noticed? I haven't noticed anything like that specifically. So you're saying you have not noticed morning erections, and usually you would such normal thing to have waking up with something, but you have not noticed those recently? I have not noticed those recently. Okay. And that's been a change, has it? Important one, I don't think. Sorry? Yeah, I don't think it's an important change. No. So you don't think that.\nBeen a change there? No,\nthere hasn't been a change there.\nOkay, Sorry. Right, Sorry.\nOkay, so just going back to the mood symptoms as well. You've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. And in what way has your sex drive been lower? Are you in a relationship at the moment?\nYeah, I'm married. I've been for many years. And, yeah, just over the last few months, just been disinterested. Disinterested.\nOkay, sorry, you phrased there for a moment, so less interested as well. Okay. And just to ask you a few questions before we wrap up, is any significant past medical history.\nSo do you suffer from any mental health problems in the past or any physical health problems? So in the past, I have a history of hypothyroidism. Hypo. Hypothyroidism. Hyperthyroidism. Yeah, it's just to sort of confirm it. Sorry, can you say that again, please? Hyper as in high hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but there suspicion that it may have had an impact on me. But my father has committed suicide about 15 years.\nAgo. Okay. Okay. And. Do you take any medications? I have\na drug history\nof thyroxine, so maybe yes. Do you continue to take thyroxine now?\nYes.\nYou do?\nSo you're taking thyroxine at the moment? Yes. Cool.\nAny drug allergies? Are you allergic to any medications? No, I have no medication. Allergies? No. No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any. Any other significant family history of medical conditions or psychiatric conditions? No.\nNo depression or anything like that, Running in family or. Okay. And your mother is\nas\nwell? Any brothers or sisters?\nYeah, she's fine. And I'm an early child.\nOkay. So I just. Sorry. Slightly random question, but any change in your vision? No, nothing like that. Okay. And just to go back to your you're saying you had low mood? Some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\nSometimes. I mean, I guess most of the activities, but when I've been.\nDoing sports as well, I find sometimes it's quite difficult to breathe. So I have some kind of like, shortness of breath when doing what was compared to maybe a couple of months ago.\nOkay, so you've become more short of breath over the last few months. Yeah. And you've had. Okay, so any other things around this? More fatigue, more shortness of breath over the last few months with a lower mood, decreased sex drive. Is there. Just before we wrap up, is there anything else that you would like to talk about? No, nothing specific. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination. And also we probably like to do some blood tests.\nAs well. So do you think it'd be possible to see. To book an appointment in the next few days with your gp? That would be ideal. I think here. And then we could probably do some more. Do an examination and do some investigations, really, to see what's going on here. A little bit more\nclimate than.\nIs that all right?\nYeah, that's very useful, thank you. Better to have some kind of plan.\nYeah, yeah, yeah. I think. I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. 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Hi there. My name's Joe. I'm one of the doctors at Babylon. I just. Can I confirm your name, please?\nYeah.\nSorry, your name was. Name was Brian. Brian. Hi, Brian. Nice time. And your date of birth?\nYeah, my date of birth is the 8th of August, 1982.\nGreat. And are you in a sort of confidential place where you can speak freely? Yeah, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Okay, so how can I help today?\nYeah, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like getting up in the morning is really difficult. And I don't have much energy at all during the day. Often. Yeah. Just like doing most things that I would normally find easy. It's become quite difficult.\nOkay, so things have become quite difficult for you? Yeah. Is there anything else?\nIt's quite hard to say. Like, things like, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\nOkay. I'm sorry to hear that. So you've had difficulty waking up? No energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five\nnow? I think about it maybe. Maybe even longer, I guess.\nIt might be related. So I also started a new job slightly recently. It might have even coincided with that job a couple of months ago. When did you start your new job? Two months ago. Yeah. Okay. And so this has been going on perhaps for sort of six weeks or so? More like two months, I would say. Yeah. Okay. All right. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation? Well, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or doing standard things in life and what doing. I'm.\nWant to do is to like kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but give some advice or whatever that'd be really useful. Okay, sure.\nOkay. Well what I like to do is just ask you a few more sort of questions around what's been going on and also around your background health and, and things like that and then we can go on sort of what can be done from there. Is that right?\nOkay, great.\nSo you say you've been feeling unwell with not a lot of energy, difficult waking up in the morning. Do you tend to. Just on that note, do you tend to wake up early and then stay in bed in the morning?\nActually I'm just not normally waking up apparently. It's more like I'm just having trouble sleeping at all probably. I think that's probably close\ndifficulty\nsleeping as well.\nAnd have you how has your mood been over this period? Have you been feeling distract?\nI'd say I kind of, yeah. Finding it really hard to. Quite difficult to keep focusing. I would say not unhappy or happy, but just quite. Not focused.\nOkay. So difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\nActually, now you mentioned it, like, my mood is lower recently and so I slight my sex drive has kind of decreased a bit over the past few months as well. So, yeah.\nAnd so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these. Do you tend to have morning erections? Like you. Is that something that you've noticed? I haven't noticed anything like that specifically. So you're saying you have not noticed morning erections, and usually you would such normal thing to have waking up with something, but you have not noticed those recently? I have not noticed those recently. Okay. And that's been a change, has it? Important one, I don't think. Sorry? Yeah, I don't think it's an important change. No. So you don't think that.\nBeen a change there? No,\nthere hasn't been a\nchange there. Okay, Sorry. Right, Sorry.\nOkay, so just going back to the mood symptoms as well. You've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. And in what way has your sex drive been lower? Are you in a relationship at the moment?\nYeah, I'm married. I've been for many years. And, yeah, just over the last few months, just been disinterested. Disinterested.\nOkay, sorry, you phrased there for a moment, so less interested as well. Okay. And just to ask you a few questions before we wrap up, is any significant past medical history.\nSo do you suffer from any mental health problems in the past or any physical health problems? So in the past, I have a history of hypothyroidism. Hypo. Hypothyroidism. Hyperthyroidism. Yeah, it's just to sort of confirm that. Sorry, can you say that again, please? Hyper as in high hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but suspicion that it may have had an impact on me. But my father has committed suicide about 15 years.\nAgo. Okay. Okay. And. Do you take any medications?\nI have a drug history of thyroxine, so\nmaybe yes. Do you continue to take thyroxine now? Yes.\nYou do? So you're taking thyroxine at the moment? Yes. Cool.\nAny drug allergies? Are you allergic to any\nmedications? No,\nI have no allergies. No. No allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any. Any other significant family history of medical conditions or psychiatric conditions? No.\nNo depression or anything like that, Running in family or. Okay. And your mother is as well? Any brothers or sisters? Yeah, she's fine. And I'm an early child. Okay. So I just. Sorry. Slightly random question, but any change in your vision? No, nothing like that. Okay. And just to go back to your you're saying you had low mood? Some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past? Sometimes. I mean, I guess most of the activities, but when I've been.\nDoing sports as well. I find sometimes it's quite difficult to breathe. So I have some kind of shortness of breath when doing sports compared to maybe a couple of months ago.\nOkay, so you've become more short of breath over the last few months. Yeah. And you've had. Okay. Any other things around this? More fatigue, more shortness of breath over the last few months with a lower mood, decreased sex drive. Is there. Just before we wrap up, is there anything else that you would like to talk about? No, nothing specific. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination. And also we probably like to do some blood tests.\nAs well. So do you think it'd be possible to see. To book an appointment in the next few days with your gp? That would be ideal. I think here. And then we could probably do some more, do an examination and do some investigations, really, to see what's going on here a little bit more.\nDoes that make sense? Yeah.\nIs that right?\nYeah, that's very useful. Thank you. Better to have some kind of plan. Yeah,\nyeah, yeah. I think. I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. 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No vital signs recorded.\n\nAssessment:\n\nFatigue likely multifactorial: possible thyroid imbalance, adjustment disorder, depressive symptoms, possible anemia or metabolic issue.\n\nNeed to rule out thyroid dysfunction, anemia, vitamin deficiencies.\n\nPlan:\n\nArrange in‑person GP review and full physical exam.\n\nOrder blood tests: TSH, free T4, CBC, ferritin, vitamin B12, metabolic panel.\n\nConsider mental health referral if mood does not improve.\n\nFollow‑up after results.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nNot discussed\n\nPlan\n\nMedications::\n\nPatient is currently taking thyroxine for hypothyroidism.\n\nThe clinician recommended an in‑person examination and blood tests to investigate the fatigue and associated symptoms. The patient was advised to book an appointment with their GP within the next few days for further assessment.","review":146.55263157894737,"saved":150.94736842105263,"clean":false,"effort":37.5,"sig":[["fabrication","Order blood tests: TSH, free T4, CBC, ferritin, vitamin B12, metabolic panel","Lists six specific blood tests as ordered when only unspecified blood tests were mentioned."],["fabrication","Consider mental health referral if mood does not improve","Invents a conditional mental health referral plan never discussed."]],"mb":32.946331,"latency":67.224,"signable":213.7766315789474},{"label":"Run 5","wer":21.269296740994854,"text":"Hello.\nHi. Hi there. My name's Joe. I'm one of the doctors at Babylon. Can I confirm your name, please?\nYeah.\nSorry, your name was. Name was Brian. Brian. Hi, Brian. Nice time. And your date of birth?\nYeah, my date of birth is the 8th of August, 1982. Great.\nAnd are you in a sort of confidential place where you can speak freely? Yeah, no one else can hear me. Great. And you're happy to continue with the consultation? Yes. Marvelous. Okay, so how can I help today?\nYeah, so basically it's just been happening over the last few weeks or so.\nBut I don't really feel like getting up in the morning is really difficult. And I don't have much energy at all during the day. Often. Yeah. Just like doing most things that I would normally find easy. It's become quite difficult.\nOkay, so things have become quite difficult for you? Yeah. Is there anything else? It's quite\nhard to say.\nLike,\nthings like, I'm not eating very much at the moment. I just don't feel like I have a lot of energy.\nOkay. I'm sorry to hear that. So you've had difficulty waking up? No energy, not eating. And that's been going on for a few weeks. When you say a few weeks, do you mean two or three or five now? I\nthink about it maybe even longer, I guess.\nIt might be related. So I also started a new job slightly recently. It might have even coincided with that job a couple of months ago.\nWhen did you start your new job? Two months ago, did you\nsay?\nYeah. Okay. And so this has been going on perhaps for sort of six weeks or so?\nMore like two\nmonths, I would say. Yeah. Okay.\nAll right. So is there anything that you're particularly sort of concerned about or hoping to get out of this consultation?\nWell, I know that it's not really normal for me. So before this phase started happening, you know, I wouldn't have any problem sort of eating what I want to eat or doing standard things in life and what doing I'm.\nWant to do is to like kind of return to that previous state somehow. I'm not sure how that is, what the best ways of doing that are, but give some advice or whatever that'd be really useful. Okay, sure.\nOkay. Well, what I like to do is just ask you a few more sort of questions around what's been going on and also around your background health and, and things like that and then we can go on to sort of what can be done from there. Is that right?\nOkay, great.\nSo you say you've been feeling unwell with not a lot of energy, difficult waking up in the morning. Do you tend to. Just on that note, do you tend to wake up early and then stay in bed in the morning?\nActually, I'm just not normally waking up apparently. It's more like I'm just having trouble sleeping at all probably. I think that's probably close difficulty sleeping as well.\nAnd have you how has your mood been over this period? Have you been feeling distracted?\nI'd say I kind of, yeah. Finding it really hard to. Quite difficult to keep focusing. I would say not unhappy or happy, but just quite. Not\nfocused. Okay. So difficulty focusing, quite distracted. And would you say you've been in good spirits or is your mood low?\nActually, now you mentioned it like, my mood is lower recently and so I slight my sex drive has kind of decreased a bit over the past few months as well. So, yeah.\nAnd so lower mood, decreased sex drive recently as well. And just on that note, just a few questions around that. Are you able to maybe slightly personal questions, but if you're okay to answer these. Do you tend to have morning erections? Like you. Is that something that you've noticed? I haven't noticed anything like that specifically. So you're saying you have not noticed morning erections, and usually you would such normal thing to have waking up with something, but you have not noticed those recently? I have not noticed those recently. Okay. So. And that's been a change, has it? Important one, I don't think. Sorry? Yeah, I don't think it's an important change. No. So you don't think that.\nBeen a change there? No, there hasn't been a change there.\nOh, okay. Sorry. Right. Sorry.\nOkay, so just going back to the mood symptoms as well. You've had difficulty focusing, easily distracted. Your mood has been slightly lower with lower sex drive. And in what way has your sex drive been lower? Are you in a relationship at the moment?\nYeah, I'm married. I've been for many years. And, yeah, just over the last few months, just been disinterested. Disinterested.\nOkay, sorry, you phrased there for a moment, so less interested as well. Okay. And just to ask you a few questions before we wrap up, is any significant past medical history.\nSo do you suffer from any mental health problems in the past or any physical health problems? So in the past, I have a history of hypothyroidism. Hypo. Hypothyroidism. Hyperthyroidism. Yeah. Thyroid, just to sort of confirm it. Sorry, can you say that again, please? Hyper as in high hyperthyroid. Hypo. Hypo. Okay. Hypothyroid. Thank you. Thank you. Yeah. And also in the past, I mean, I haven't had any kind of specific medical diagnoses along these lines, but suspicion that it may have had an impact on me. But my father has committed suicide about 15 years.\nAgo. Okay. Okay. And. Do you take any medications?\nI have a drug history of thyroxine, so maybe yes.\nDo you continue to take thyroxine now? Yes.\nYou do? So you're taking thyroxine at the moment? Yes. Cool.\nAny drug allergies? Are you allergic to any medications?\nNo, I have no allergies.\nNo allergies. And you mentioned the suicide of your father 15 years ago. I'm very sorry to hear that. Is there any. Any other significant family history of medical conditions or psychiatric conditions? No.\nNo depression or anything like that? Running in family or. Okay. And your mother is as well? Any brothers or sisters?\nYeah, she's fine. And I'm an early child.\nOkay. So I just. Sorry. Slightly random question, but any change in your vision? No, nothing like that. Okay. And just to go back to you, you're saying you had low mood? Some people who do have low mood and low sex drive can sometimes feel suicidal as well. Have you had any thoughts of harming yourself or harming anyone else? No. No. No. And are you able to get the usual enjoyment out of your daily activities that you have done in the past?\nSometimes. I mean, I guess most of the activities, but when I've been.\nDoing sports as well. I find sometimes it's quite difficult to breathe. So I have some kind of like, shortness of breath when doing sports compared to me, maybe a couple of months ago.\nOkay, so you've become more short of breath over the last few months. Yeah. And you've had. Okay, so any other things around this? More fatigue, more shortness of breath over the last few months with a lower mood, decreased sex drive. Is there. Just before we wrap up, is there anything else that you would like to talk about? No, nothing specific. So getting a little bit towards the end now, but I would quite like to make a bit more of a plan for you. I would like to probably see you in person and do an examination. And also we probably like to do some blood tests.\nAs well. So do you think it'd be possible to see. To book an appointment in the next few days with your gp? That would be ideal. I think here. And then we could probably do some more. Do an examination and do some investigations, really, to see what's going on there. A little bit more\nclimate.\nIs that all right?\nYeah, that's very useful, thank you. Better to have some kind of plan. Yeah,\nyeah, yeah. I think. I definitely think we need a plan here. It's been nice talking to you. I'm sorry we run out of time now, but we've at least started the ball rolling with some further investigations and tests. 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I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address please?\n\n Hi. My name is Susan. Um, thirty, Redbridge Street, SW two two HZ.\n\n Hello.\n\n And your date of birth?\n\n forty, oh two, nineteen seventy four.\n\n OK. Are you in a private place so you can have a consultation today?\n\n Yes I am.\n\n OK. What can I do for you?\n\n It hurts when I pee.\n\n OK, and how long has that been going on for?\n\n It stays now.\n\n Pardon?\n\n Uh, six days.\n\n Six days, OK. And just tell me a bit more about that. How did it start?\n\n Um, I've got this thing when I pee, and it hurts when I go to the loo, and I've got this very unpleasant smell that comes out.\n\n OK. And, have you had any other symptoms along with that? Have you had any abdominal pain, or back, lower back pain at all?\n\n I've got, pain in my tummy.\n\n Uh, whereabouts?\n\n In my lower tummy.\n\n OK. Is it one-sided, or in the middle?\n\n In the middle.\n\n And how bad would you say that is on a scale of one to ten? With ten being the worst pain.\n\n Seven.\n\n Seven.\n\n And is it, constant, or does it come and go?\n\n Comes and goes.\n\n OK. And have you actually been able to pass water OK?\n\n Yes, but I've had spotted, uh, blood in my urine. Spots.\n\n OK. And is that just over the last, six days?\n\n Yes.\n\n Right. And have you been able to eat and drink OK?\n\n Yes.\n\n Um, and, have you had a temperature? Do you feel like you've been feverish, or had a temperature with this?\n\n No, not at all.\n\n Um, and any, did you , you said you didn't have any lower back pain?\n\n No, I've got.\n\n Um, and no loin pain as well.\n\n OK. And, have you had these symptoms before?\n\n No.\n\n Never.\n\n No.\n\n And was there anything you were doing recently, which you think may have contributed to it? Have you , have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?\n\n No.\n\n No, OK. And, any, any other symptoms, any vaginal discharge or, anything like that?\n\n No, just the blood spot, in my.\n\n No. Do you have regular periods?\n\n Yes I do.\n\n OK.\n\n Um, and , in the past, have you had any medical problems at all?\n\n No medical, no.\n\n Have you had any problems with your kidneys, or any urine infections?\n\n I had IBS before.\n\n OK.\n\n And how's that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n Yeah, I've had spotting in my urine.\n\n In your, OK. Um, any change in your bowel habit? Any weight loss or anything?\n\n No.\n\n No.\n\n Any other medical problems, or surgery in the past?\n\n No.\n\n Do you take regular medications?\n\n I've had Mebeverine, Mebeverine. I've had Mebeverine.\n\n Pardon? No birth .\n\n Do you take that regularly?\n\n Yes.\n\n OK. And it, do you take it three times a day?\n\n Yes I do.\n\n Two hundred milligrams?\n\n Yes.\n\n Any allergies?\n\n Any allergies?\n\n Clindamycin.\n\n You're allergic to Clindamycin, OK.\n\n And anyone in your family had any medical problems?\n\n No.\n\n That's fine. And whereabouts, do you live? Do you live with friends, family?\n\n I live with friends.\n\n OK. And where do you work? What's your job?\n\n I'm a support worker.\n\n OK. Do you drink alcohol at all?\n\n Occasionally.\n\n So how much in a average week?\n\n One glass of wine a week.\n\n OK. And do you smoke?\n\n No.\n\n OK. Um, it sounds very much like you, might have an infection in your urine. Did you say, you haven't felt feverish?\n\n No fever at all.\n\n Have you got a thermometer at home?\n\n No.\n\n OK. It would be helpful if you could get a thermometer from the pharmacy and, do check your temperature, just to make sure that it isn't, going up and down.\n\n OK.\n\n Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n OK.\n\n Um, how do you feel about that? Are you happy to take a course of antibiotics?\n\n Yes I would be.\n\n It would just be for three days.\n\n OK.\n\n Um.\n\n , get my prescription.\n\n Yes, so I can send a prescription through to your requested pharmacy for that. If you take them, as soon as you can, get them, pick them up as soon as you can, and start taking them.\n\n The other thing which is important to do is to drink, lots of water. So, two and a half to three litres a day.\n\n Um, you can get some cranberry juice and take, drink that as well, that sometimes helps. And also some, sachets um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n Yeah.\n\n OK then.\n\n Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine. Then it's very important that we speak to you again.\n\n OK.\n\n Um, the other thing is that if it becomes a, common, thing or a recurrent problem. Then we need to talk to you again about it.\n\n So, do I have to call after I finish my course of antibiotics.\n\n No, not if you're better. If you're, if you feel like your symptoms get worse at any point, or they're not resolving with the treatment. Or you keep getting a similar, um, you keep getting a similar, problem, reccurently. Then it's important for us to talk, talk to you in more detail about that.\n\n OK.\n\n Yeah.\n\n OK then.\n\n Um, have you got any other questions?\n\n Uh, no. Uh, where will be the pharmacy I'll be picking up, my medication from?\n\n Um, so have you already requested a pharmacy through Babylon?\n\n Yes I did.\n\n Can I just check that with you?\n\n Knightsbridge, Practice.\n\n OK, that's fine. So the antibiotics, that I'm gonna prescribe, um, will go through to that, pharmacy.\n\n How soon?\n\n And then , you'll be able to pick them up from there.\n\n How soon is that gonna be, at the practice? In five minutes?\n\n Um, I would give it longer than that. Give it a, an hour or so.\n\n All right then. Thank you, I'll pick that at lunchtime.\n\n OK. All right then. Take care. Bye.\n\n Thank you.\n\n . Bye.\n\n Sorry, I 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I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\n  Hi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ.\n\n  And your date of birth?\n\n  14/02/1974.\n\n  Okay. Are you in a private place so you can have a consultation today?\n\n  Yes, I am.\n\n  Okay. What can I do for you?\n\n  It hurts when I pee.\n\n  Okay. And how long has that been going on for?\n\n  6 days now.\n\n  Pardon?\n\n  For 6 days.\n\n  6 days. Okay. And just tell me a bit more about that. How did it start?\n\n  Um, I've got this thing when I pee, and it hurts when I go to the loo.\n\n  Okay.\n\n  And I've got this very unpleasant smell that comes out.\n\n  Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\n\n  I've got pain in my tummy.\n\n  Whereabouts?\n\n  In my lower tummy.\n\n  Okay. Is it one-sided, or in the middle?\n\n  In the middle.\n\n  And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain.\n\n  7.\n\n  And is it constant, or does it come and go?\n\n  Comes and goes.\n\n  Okay. And have you actually been able to pass water okay?\n\n  Yes, but I've had spotted, uh, blood in my urine.\n\n  Okay. And is that just over the last 6 days?\n\n  Yes.\n\n  Right. And have you been able to eat and drink okay?\n\n  Yes.\n\n  Um, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\n  No. Not at all.\n\n  Um, and any did you you said you didn't have any low back pain?\n\n  No. I've got um, and no loin pain as well.\n\n  Okay. And have you had these symptoms before?\n\n  No.\n\n  Never.\n\n  No.\n\n  And was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\n\n  No.\n\n  No. Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\n\n  No. Just the blood spot in my.\n\n  Okay. Do you have regular periods?\n\n  Yes, I do.\n\n  Okay. Um, and in the past, have you had any medical problems at all?\n\n  No medical. No.\n\n  Have you had any problems with your kidneys or any urine infections?\n\n  I had IBS before.\n\n  Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n  Yeah, I've had spotting in my urine.\n\n  In your okay. Um, any change in your bowel habit?\n\n  No.\n\n  Any weight loss or anything?\n\n  No.\n\n  Any other medical problems or surgery in the past?\n\n  No.\n\n  Do you take regular medications?\n\n  I've had Mebevine.\n\n  Pardon?\n\n  Mebeverine.\n\n  Mebe.\n\n  I've had Mebeverine.\n\n  Do you take that regularly?\n\n  Yes.\n\n  Okay. And it do you take it 3 times a day?\n\n  Yes, I do.\n\n  200 milligrams?\n\n  Yes.\n\n  Any allergies? Any allergies?\n\n  Clindamycin.\n\n  You're allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\n  No.\n\n  That's fine. And whereabouts do you live? Do you live with friends, family?\n\n  I live with friends.\n\n  Okay. And where do you work? What's your job?\n\n  I'm a support worker.\n\n  Okay. Do you drink alcohol at all?\n\n  Occasionally.\n\n  So how much in average week?\n\n  One glass of wine a week.\n\n  Okay. Do you smoke?\n\n  No.\n\n  Okay. Um, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish?\n\n  No fever at all.\n\n  Have you got a thermometer at home?\n\n  No.\n\n  Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down.\n\n  Okay.\n\n  Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n  Okay.\n\n  Um, how would you feel about that? Are you happy to take a course of antibiotics?\n\n  Yes, I would be.\n\n  It would just be for 3 days.\n\n  Okay.\n\n  Um.\n\n  Perhaps get my prescription?\n\n  Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 liters a day.\n\n  Yeah.\n\n  Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n  Okay then.\n\n  Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\n  Okay.\n\n  Um, the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\n  So do I have to call after I finish my course of antibiotics?\n\n  No, not if you're better.\n\n  Okay.\n\n  If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\n\n  Okay then.\n\n  Um, have you got any other questions?\n\n  Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from?\n\n  Um, so have you already requested a pharmacy through Babylon?\n\n  Yes, I did.\n\n  Can I just check that with you?\n\n  Knightsbridge.\n\n  Okay.\n\n  Practice.\n\n  Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\n\n  Okay.\n\n  And.\n\n  Also?\n\n  You'll be able to pick them up from there.\n\n  How soon is that going to be at the practice? In 5 minutes?\n\n  Um, I would give it longer than that.\n\n  Okay.\n\n  Give it.\n\n  Okay.\n\n  An hour or so.\n\n  All right then. Thank you. I'll pick that at lunchtime.\n\n  Okay. All right then.\n\n  Thank you.\n\n  Take care. Bye.\n\n  Bye.\n\n  Sorry, I didn't keep.","marks":[{"start":183,"end":191,"said":"SW two two HZ. Hello.","significant":false},{"start":222,"end":242,"said":"forty oh two nineteen seventy four. 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Meds: mebeverine 200 mg TDS\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Suspected lower UTI/cystitis\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribe 3-day course of antibiotics; patient agreeable\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer from pharmacy and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Encourage fluids 2.5–3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Review if worsening/non-settling pain, fever, low back pain, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"recurrent similar episodes\" and \"No follow-up required if symptoms resolve\"."]],"claims":[],"note":"Subjective\nDysuria x6 days with unpleasant urine odour.\nIntermittent central lower abdominal pain, 7/10.\nVisible blood spotting in urine x6 days.\nPassing urine adequately; eating/drinking normally.\nDenies fever, low back pain/loin pain, vaginal discharge, change in bowel habit, weight loss.\nNo previous similar episodes, UTIs or kidney problems.\nNo recent dehydration, increased exercise or regular sexual intercourse identified as trigger.\nRegular periods.\nPMH: IBS.\nMeds: mebeverine 200 mg TDS.\nAllergy: clindamycin.\nSocial: lives with friends; support worker; non-smoker; alcohol ~1 glass wine/week.\nRequested information on prescription collection timing/pharmacy.\nObjective\nRemote consultation; no examination or observations recorded.\nNo home thermometer available.\nAssessment\nSuspected lower UTI/cystitis: dysuria, malodorous urine, suprapubic pain and haematuria x6 days.\nNo reported fever or loin/back pain to suggest upper UTI currently.\nPlan\nPrescribe 3-day course of antibiotics; patient agreeable. Send prescription to requested Knightsbridge pharmacy.\nCollect/start antibiotics as soon as possible; advised pharmacy processing may take ~1 hour.\nEncourage fluids 2.5–3 L/day.\nMay try cranberry juice and OTC urinary alkalinising sachets; details to be added to notes.\nObtain thermometer from pharmacy and monitor temperature.\nSeek review urgently if worsening/non-settling pain, fever, low back pain, difficulty passing urine, symptoms not resolving after treatment, or recurrent similar episodes.\nNo follow-up required if symptoms resolve after antibiotics.","review":70.42105263157896,"saved":234.07894736842104,"clean":true,"effort":0.0,"sig":[]},{"label":"Run 2","wer":8.623853211009175,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\n  Hi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ.\n\n  And your date of birth?\n\n  14/02/1974.\n\n  Okay. Are you in a private place so you can have a consultation today?\n\n  Yes, I am.\n\n  Okay. What can I do for you?\n\n  It hurts when I pee.\n\n  Okay. And how long has that been going on for?\n\n  6 days now.\n\n  Pardon?\n\n  For 6 days.\n\n  6 days. Okay. And just tell me a bit more about that. How did it start?\n\n  Um, I've got this thing when I pee, and it hurts when I go to the loo.\n\n  Okay.\n\n  And I've got this very unpleasant smell that comes out.\n\n  Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\n\n  I've got pain in my tummy.\n\n  Whereabouts?\n\n  In my lower tummy.\n\n  Okay. Is it one-sided or in the middle?\n\n  In the middle.\n\n  And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain.\n\n  7.\n\n  And is it constant, or does it come and go?\n\n  Comes and goes.\n\n  Okay. And have you actually been able to pass water okay?\n\n  Yes, but I've had spotted, uh, blood in my urine.\n\n  Okay. And is that just over the last 6 days?\n\n  Yes.\n\n  Right. And have you been able to eat and drink okay?\n\n  Yes.\n\n  Um, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\n  No.\n\n  Not at all? Um, and any did you you said you didn't have any low back pain?\n\n  No. I've got um, and no loin pain as well.\n\n  Okay. And have you had these symptoms before?\n\n  No.\n\n  Never?\n\n  No.\n\n  And was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\n\n  No.\n\n  No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\n\n  No. Just the blood spot in my.\n\n  Okay. Do you have regular periods?\n\n  Yes, I do.\n\n  Okay. Um, and in the past, have you had any medical problems at all?\n\n  No medical. No.\n\n  Have you had any problems with your kidneys or any urine infections?\n\n  I had IBS before.\n\n  Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n  Yeah, I've had spotting in my urine.\n\n  In your okay. Um, any change in your bowel habit?\n\n  No.\n\n  Any weight loss or anything?\n\n  No.\n\n  Any other medical problems or surgery in the past?\n\n  No.\n\n  Do you take regular medications?\n\n  I've had Mebevine.\n\n  Pardon?\n\n  Mebeverine.\n\n  Meb.\n\n  I've had Mebeverine.\n\n  Do you take that regularly?\n\n  Yes.\n\n  Okay. And it do you take it 3 times a day?\n\n  Yes, I do.\n\n  200 milligrams?\n\n  Yes.\n\n  Any allergies? Any allergies?\n\n  Clindamycin.\n\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems?\n\n  No.\n\n  That's fine. And whereabouts do you live? Do you live with friends, family?\n\n  I live with friends.\n\n  Okay. And where do you work? What's your job?\n\n  I'm a support worker.\n\n  Okay. Do you drink alcohol at all?\n\n  Occasionally.\n\n  So how much in average week?\n\n  One glass of wine a week.\n\n  Okay. Do you smoke?\n\n  No.\n\n  Okay. Um, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish?\n\n  No fever at all.\n\n  Have you got a thermometer at home?\n\n  No.\n\n  Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down.\n\n  Okay.\n\n  Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n  Okay.\n\n  Um, how would you feel about that? Are you happy to take a course of antibiotics?\n\n  Yes, I would be.\n\n  It would just be for 3 days.\n\n  Okay.\n\n  Um.\n\n  So how do I get my prescription?\n\n  Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 liters a day.\n\n  Yeah.\n\n  Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n  Okay then.\n\n  Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\n  Okay.\n\n  Um, the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\n  So do I have to call after I finish my course of antibiotics?\n\n  No, not if you're better.\n\n  Okay.\n\n  If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\n\n  Okay then.\n\n  Um, have you got any other questions?\n\n  Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from?\n\n  Um, so have you already requested a pharmacy through Babylon?\n\n  Yes, I did.\n\n  Can I just check that with you?\n\n  Knightsbridge. Practice.\n\n  Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\n\n  Okay.\n\n  And.\n\n  Also.\n\n  You'll be able to pick them up from there.\n\n  How soon is that going to be at the practice? In 5 minutes?\n\n  Um, I would give it longer than that.\n\n  Okay.\n\n  Give it.\n\n  Okay.\n\n  An hour or so.\n\n  All right then. Thank you. I'll pick that at lunchtime.\n\n  Okay. All right then.\n\n  Thank you.\n\n  Take care. Bye.\n\n  Bye.\n\n  Sorry, I didn't keep.","marks":[{"start":183,"end":191,"said":"SW two two HZ. Hello.","significant":false},{"start":222,"end":242,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":431,"end":437,"said":"It stays","significant":false},{"start":1036,"end":1036,"said":"Seven.","significant":false},{"start":1220,"end":1225,"said":"Spots. OK.","significant":false},{"start":1517,"end":1520,"said":"lower","significant":false},{"start":1998,"end":2003,"said":"No.","significant":false},{"start":2244,"end":2251,"said":"how's","significant":false},{"start":2431,"end":2434,"said":"","significant":false},{"start":2465,"end":2465,"said":"No.","significant":false},{"start":2583,"end":2602,"said":"","significant":false},{"start":2622,"end":2626,"said":"Mebeverine.","significant":false},{"start":2650,"end":2650,"said":"Pardon No birth .","significant":false},{"start":3743,"end":3748,"said":"do","significant":false},{"start":3888,"end":3899,"said":"","significant":false},{"start":4194,"end":4200,"said":"litres","significant":false},{"start":4286,"end":4292,"said":"that","significant":false},{"start":5156,"end":5167,"said":"reccurently.","significant":false},{"start":5204,"end":5206,"said":"","significant":false},{"start":5316,"end":5326,"said":"where will","significant":false},{"start":5576,"end":5584,"said":"gonna","significant":false},{"start":5637,"end":5642,"said":"How soon","significant":false},{"start":5654,"end":5659,"said":"then","significant":false},{"start":5726,"end":5734,"said":"gonna","significant":false},{"start":5945,"end":5955,"said":"","significant":false},{"start":5974,"end":5974,"said":"Thank you. .","significant":false},{"start":5995,"end":6007,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Six days of dysuria recorded."],["The note captures: Unpleasant or strong urine odour.","yes","Unpleasant/malodorous urine recorded."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Central, intermittent lower abdominal pain 7/10."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Blood spotting in urine recorded."],["The note captures: Able to pass urine and maintain oral intake.","yes","Able to pass urine and eating/drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","No fever and no loin/lower back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","UTI is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","Three-day antibiotic course prescribed."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain a thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluids 2.5-3 L/day."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Recontact for worsening/persistent pain, fever, back pain or difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Review if recurrent; no routine follow-up if resolved."]],"claims":[],"note":"Subjective\nDysuria x6 days.\nMalodorous urine.\nIntermittent central lower abdominal pain, severity 7/10.\nReports visible blood spotting in urine x6 days.\nAble to pass urine; eating and drinking adequately.\nDenies fever, low back pain, loin pain, vaginal discharge, bowel habit change, weight loss.\nNo prior similar urinary symptoms/UTIs reported.\nDenies recent dehydration, increased exercise or regular sexual intercourse as potential triggers.\nRegular menses.\nPMH: IBS.\nMedications: mebeverine 200 mg TDS.\nAllergy: clindamycin.\nSocial: lives with friends; support worker. Non-smoker. Alcohol ~1 glass wine/week.\nObjective\nRemote consultation; no examination or observations documented.\nNo home thermometer available.\nAssessment\nSuspected uncomplicated lower UTI/cystitis, based on 6 days of dysuria, malodorous urine, suprapubic pain and reported haematuria.\nNo reported fever, flank/loin pain or inability to pass urine to suggest upper UTI/pyelonephritis at present.\nPlan\nPrescribe 3-day course of antibiotics; patient agreeable. Prescription to requested Knightsbridge Practice pharmacy.\nAdvise collection/start as soon as possible; allow approximately 1 hour for prescription processing.\nEncourage fluids 2.5–3 L/day.\nAdvise cranberry juice and OTC urinary alkalinising sachets; details to be included in notes.\nAdvise obtaining thermometer from pharmacy and monitoring temperature.\nSafety-net: seek further review if worsening/non-settling pain, lower back pain, fever, difficulty passing urine, symptoms fail to resolve with treatment, or recurrent similar episodes.\nNo routine follow-up required if symptoms resolve after antibiotics.","review":72.94736842105263,"saved":231.55263157894737,"clean":true,"effort":0.0,"sig":[],"mb":8.963789,"latency":11.454,"signable":84.40136842105264},{"label":"Run 3","wer":8.990825688073395,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\n  Hi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ.\n\n  And your date of birth?\n\n  14/02/1974.\n\n  Okay. Are you in a private place so you can have a consultation today?\n\n  Yes, I am.\n\n  Okay. What can I do for you?\n\n  It hurts when I pee.\n\n  Okay. And how long has that been going on for?\n\n  6 days now.\n\n  Pardon?\n\n  For 6 days.\n\n  6 days. Okay. And just tell me a bit more about that. How did it start?\n\n  Um, I've got this thing when I pee, and it hurts when I go to the loo.\n\n  Okay.\n\n  And I've got this very unpleasant smell that comes out.\n\n  Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\n\n  I've got pain in my tummy.\n\n  Whereabouts?\n\n  In my lower tummy.\n\n  Okay. Is it one-sided, or in the middle?\n\n  In the middle.\n\n  And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain.\n\n  7.\n\n  And is it constant, or does it come and go?\n\n  Comes and goes.\n\n  Okay. And have you actually been able to pass water okay?\n\n  Yes, but I've had spotted, uh, blood in my urine.\n\n  Okay. And is that just over the last 6 days?\n\n  Yes.\n\n  Right. And have you been able to eat and drink okay?\n\n  Yes.\n\n  Um, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\n  No. Not at all.\n\n  Um, and any did you you said you didn't have any low back pain?\n\n  No. I've got um, and no loin pain as well.\n\n  Okay. And have you had these symptoms before?\n\n  No.\n\n  Never.\n\n  No.\n\n  And was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\n\n  No.\n\n  No. Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\n\n  No. Just the blood spot in my.\n\n  Okay. Do you have regular periods?\n\n  Yes, I do.\n\n  Okay. Um, and in the past, have you had any medical problems at all?\n\n  No medical. No.\n\n  Have you had any problems with your kidneys or any urine infections?\n\n  I had IBS before.\n\n  Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n  Yeah, I've had spotting in my urine.\n\n  In your okay. Um, any change in your bowel habit?\n\n  No.\n\n  Any weight loss or anything?\n\n  No.\n\n  Any other medical problems or surgery in the past?\n\n  No.\n\n  Do you take regular medications?\n\n  I've had Mebevine.\n\n  Pardon?\n\n  Mebeverine.\n\n  Mebe.\n\n  I've had Mebeverine.\n\n  Do you take that regularly?\n\n  Yes.\n\n  Okay. And it do you take it 3 times a day?\n\n  Yes, I do.\n\n  200 milligrams?\n\n  Yes.\n\n  Any allergies? Any allergies?\n\n  Clindamycin.\n\n  You're allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\n  No.\n\n  That's fine. And whereabouts do you live? Do you live with friends, family?\n\n  I live with friends.\n\n  Okay. And where do you work? What's your job?\n\n  I'm a support worker.\n\n  Okay. Do you drink alcohol at all?\n\n  Occasionally.\n\n  So how much on average a week?\n\n  One glass of wine a week.\n\n  Okay. Do you smoke?\n\n  No.\n\n  Okay. Um, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish?\n\n  No fever at all.\n\n  Have you got a thermometer at home?\n\n  No.\n\n  Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down.\n\n  Okay.\n\n  Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n  Okay.\n\n  Um, how would you feel about that? Are you happy to take a course of antibiotics?\n\n  Yes, I would be.\n\n  It would just be for 3 days.\n\n  Okay.\n\n  Um.\n\n  So how do I get my prescription?\n\n  Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing, which is important to do, is to drink lots of water. So 2 and a half to 3 liters a day.\n\n  Yeah.\n\n  Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets. Um, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n  Okay then.\n\n  Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\n  Okay.\n\n  Um, the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\n  So do I have to call after I finish my course of antibiotics?\n\n  No, not if you're better.\n\n  Okay.\n\n  If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\n\n  Okay then.\n\n  Um, have you got any other questions?\n\n  Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from?\n\n  Um, so have you already requested a pharmacy through Babylon?\n\n  Yes, I did.\n\n  Can I just check that with you?\n\n  Knightsbridge.\n\n  Okay.\n\n  Practice.\n\n  Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\n\n  Okay.\n\n  And.\n\n  Also.\n\n  You'll be able to pick them up from there.\n\n  How soon is that going to be at the practice? In 5 minutes?\n\n  Um, I would give it longer than that.\n\n  Okay.\n\n  Give it.\n\n  Okay.\n\n  An hour or so.\n\n  All right then. Thank you. I'll pick that at lunchtime.\n\n  Okay.\n\n  Okay.\n\n  All right then.\n\n  Thank you.\n\n  Take care. Bye.\n\n  Bye.\n\n  Sorry, I didn't keep.","marks":[{"start":183,"end":191,"said":"SW two two HZ. Hello.","significant":false},{"start":222,"end":242,"said":"forty oh two nineteen seventy four. 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Non-smoker. Alcohol approx. 1 glass wine/week.\nObjective\nRemote consultation; no physical examination, observations, temperature, or urinalysis documented.\nAssessment\nSuspected lower UTI/cystitis.\nDysuria, malodorous urine, suprapubic pain and reported haematuria support urinary infection.\nNo reported fever, flank/loin pain, or low back pain to suggest upper UTI at present.\nPlan\nPrescribe 3-day course of antibiotics; prescription to be sent to requested Knightsbridge Practice pharmacy.\nAdvise collection and commencement of antibiotics as soon as possible.\nEncourage oral fluids 2.5–3 L/day.\nMay try cranberry juice and OTC urinary alkalinising sachets.\nAdvise purchase of thermometer and monitor temperature.\nSafety-net: seek further review urgently if worsening/non-settling pain, low back pain, high temperature, inability to pass urine, worsening symptoms, or symptoms not resolving with treatment.\nReview if recurrent similar episodes. No routine follow-up needed if symptoms resolve.","review":68.21052631578948,"saved":236.28947368421052,"clean":true,"effort":0.0,"sig":[],"mb":8.96565,"latency":11.468,"signable":79.67852631578948},{"label":"Run 4","wer":8.89908256880734,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name and date of birth, and the first line of your address, please?\n\n  Hi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ.\n\n  And your date of birth?\n\n  14/02/1974.\n\n  Okay. Are you in a private place so you can have a consultation today?\n\n  Yes, I am.\n\n  Okay. What can I do for you?\n\n  It hurts when I pee.\n\n  Okay. And how long has that been going on for?\n\n  6 days now.\n\n  Pardon?\n\n  For 6 days.\n\n  6 days. Okay. And just tell me a bit more about that. How did it start?\n\n  Um, I've got this thing when I pee, and it hurts when I go to the loo.\n\n  Okay.\n\n  And I've got this very unpleasant smell that comes out.\n\n  Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\n\n  I've got pain in my tummy.\n\n  Whereabouts?\n\n  In my lower tummy.\n\n  Okay. Is it one-sided or in the middle?\n\n  In the middle.\n\n  And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain.\n\n  7.\n\n  And is it constant, or does it come and go?\n\n  Comes and goes.\n\n  Okay. And have you actually been able to pass water okay?\n\n  Yes, but I've had spotted, uh, blood in my urine.\n\n  Okay. And is that just over the last 6 days?\n\n  Yes.\n\n  Right. And have you been able to eat and drink okay?\n\n  Yes.\n\n  Um, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\n  No.\n\n  Not at all? Um, and any did you you said you didn't have any low back pain?\n\n  No. I've got um, and no loin pain as well.\n\n  Okay. And have you had these symptoms before?\n\n  No.\n\n  Never?\n\n  No.\n\n  And was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\n\n  No.\n\n  No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\n\n  No. Just the blood spot in my.\n\n  Okay. Do you have regular periods?\n\n  Yes, I do.\n\n  Okay. Um, and in the past, have you had any medical problems at all?\n\n  No medical. No.\n\n  Have you had any problems with your kidneys or any urine infections?\n\n  I had IBS before.\n\n  Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n  Yeah, I've had spotting in my urine.\n\n  In your okay. Um, any change in your bowel habit?\n\n  No.\n\n  Any weight loss or anything?\n\n  No.\n\n  Any other medical problems or surgery in the past?\n\n  No.\n\n  Do you take regular medications?\n\n  I've had Mebevine.\n\n  Pardon?\n\n  Mebeverine.\n\n  Meb.\n\n  I've had Mebeverine.\n\n  Do you take that regularly?\n\n  Yes.\n\n  Okay. And it do you take it 3 times a day?\n\n  Yes, I do.\n\n  200 milligrams?\n\n  Yes.\n\n  Any allergies? Any allergies?\n\n  Clindamycin.\n\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems?\n\n  No.\n\n  That's fine. And whereabouts do you live? Do you live with friends, family?\n\n  I live with friends.\n\n  Okay. And where do you work? What's your job?\n\n  I'm a support worker.\n\n  Okay. Do you drink alcohol at all?\n\n  Occasionally.\n\n  So how much in average week?\n\n  One glass of wine a week.\n\n  Okay. Do you smoke?\n\n  No.\n\n  Okay. Um, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish?\n\n  No fever at all.\n\n  Have you got a thermometer at home?\n\n  No.\n\n  Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down.\n\n  Okay.\n\n  Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n  Okay.\n\n  Um, how would you feel about that? Are you happy to take a course of antibiotics?\n\n  Yes, I would be.\n\n  It would just be for 3 days.\n\n  Okay.\n\n  Um.\n\n  So how do I get my prescription?\n\n  Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing, which is important to do, is to drink lots of water. So 2 and a half to 3 liters a day.\n\n  Yeah.\n\n  Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some, some sachets. Um, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n  Okay then.\n\n  Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\n  Okay.\n\n  Um, the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\n  So do I have to call after I finish my course of antibiotics?\n\n  No, not if you're better.\n\n  Okay.\n\n  If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\n\n  Okay then.\n\n  Um, have you got any other questions?\n\n  Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from?\n\n  Um, so have you already requested a pharmacy through Babylon?\n\n  Yes, I did.\n\n  Can I just check that with you?\n\n  Knightsbridge.\n\n  Okay.\n\n  Practice.\n\n  Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\n\n  Okay.\n\n  And.\n\n  Also?\n\n  You'll be able to pick them up from there.\n\n  How soon is that going to be at the practice? In 5 minutes?\n\n  Um, I would give it longer than that.\n\n  Okay.\n\n  Give it an hour or so.\n\n  All right then. Thank you. I'll pick that at lunchtime.\n\n  Okay. All right then.\n\n  Thank you.\n\n  Take care.\n\n  Bye.\n\n  Bye.\n\n  Bye.\n\n  Sorry, I didn't keep.","marks":[{"start":186,"end":194,"said":"SW two two HZ. Hello.","significant":false},{"start":225,"end":245,"said":"forty oh two nineteen seventy four. 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do not report no known drug allergies.","yes","\"Allergy: clindamycin\" recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Suspected UTI/cystitis as working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day antibiotic course prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluids 2.5-3 L/day captured."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening/non-settling pain, fever, back pain, difficulty passing urine, non-resolution."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Recurrent episodes review and no routine follow-up if resolved both captured."]],"claims":[],"note":"Subjective\n52F with 6-day hx dysuria and malodorous urine.\nReports intermittent central lower abdominal pain, severity 7/10.\nReports spotting of blood in urine for same duration.\nAble to pass urine; eating and drinking normally.\nDenies fever, low back pain, loin pain, vaginal discharge, bowel habit change, weight loss, or blood in stool.\nNo previous similar episodes or known renal/UTI hx.\nNo reported recent dehydration, increased exercise, or regular sexual intercourse.\nPMH: IBS.\nRegular medication: mebeverine 200 mg TDS.\nAllergy: clindamycin.\nSocial: non-smoker; alcohol approx. 1 glass wine/week.\nObjective\nNo examination findings, vital signs, temperature, or urine testing documented.\nAssessment\nSuspected uncomplicated lower UTI/cystitis, based on 6-day dysuria, malodorous urine, suprapubic/lower central abdominal pain, and reported haematuria.\nNo reported fever, flank/loin pain, low back pain, or impaired urine output to suggest upper UTI at present.\nPlan\nAgreed empirical 3-day course of antibiotics; prescription to be sent to requested Knightsbridge Practice pharmacy.\nAdvise collect prescription and start treatment as soon as available.\nEncourage oral fluids 2.5–3 L/day.\nMay use cranberry juice and OTC urinary alkalinising sachets from pharmacy.\nAdvise obtain thermometer and monitor temperature.\nSafety-net: seek further review if worsening/non-settling pain, new lower back pain, fever/high temperature, difficulty passing urine, symptoms not resolving after treatment, or recurrent similar symptoms.\nNo routine follow-up needed if symptoms resolve.","review":73.26315789473685,"saved":231.23684210526315,"clean":true,"effort":0.0,"sig":[],"mb":8.959198,"latency":24.26,"signable":97.52315789473685},{"label":"Run 5","wer":8.89908256880734,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name and date of birth, and the first line of your address, please?\n\n  Hi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ.\n\n  And your date of birth?\n\n  14/02/1974.\n\n  Okay. Are you in a private place so you can have a consultation today?\n\n  Yes, I am.\n\n  Okay. What can I do for you?\n\n  It hurts when I pee.\n\n  Okay. And how long has that been going on for?\n\n  6 days now.\n\n  Pardon?\n\n  For 6 days.\n\n  6 days. Okay. And just tell me a bit more about that. How did it start?\n\n  Um, I've got this thing when I pee, and it hurts when I go to the loo.\n\n  Okay.\n\n  And I've got this very unpleasant smell that comes out.\n\n  Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\n\n  I've got pain in my tummy.\n\n  Whereabouts?\n\n  In my lower tummy.\n\n  Okay. Is it one-sided or in the middle?\n\n  In the middle.\n\n  And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain.\n\n  7.\n\n  And is it constant, or does it come and go?\n\n  Comes and goes.\n\n  Okay. And have you actually been able to pass water okay?\n\n  Yes, but I've had spotted, uh, blood in my urine.\n\n  Okay. And is that just over the last 6 days?\n\n  Yes.\n\n  Right. And have you been able to eat and drink okay?\n\n  Yes.\n\n  Um, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\n  No.\n\n  Not at all? Um, and any did you you said you didn't have any low back pain?\n\n  No. I've got um, and no loin pain as well.\n\n  Okay. And have you had these symptoms before?\n\n  No.\n\n  Never?\n\n  No.\n\n  And was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\n\n  No.\n\n  No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\n\n  No. Just the blood spot in my.\n\n  Okay. Do you have regular periods?\n\n  Yes, I do.\n\n  Okay. Um, and in the past, have you had any medical problems at all?\n\n  No medical. No.\n\n  Have you had any problems with your kidneys or any urine infections?\n\n  I had IBS before.\n\n  Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\n\n  Yeah, I've had spotting in my urine.\n\n  In your okay. Um, any change in your bowel habit?\n\n  No.\n\n  Any weight loss or anything?\n\n  No.\n\n  Any other medical problems or surgery in the past?\n\n  No.\n\n  Do you take regular medications?\n\n  I've had Mebevine.\n\n  Pardon?\n\n  Mebeverine.\n\n  Meb.\n\n  I've had Mebeverine.\n\n  Do you take that regularly?\n\n  Yes.\n\n  Okay. And it do you take it 3 times a day?\n\n  Yes, I do.\n\n  200 milligrams?\n\n  Yes.\n\n  Any allergies? Any allergies?\n\n  Clindamycin.\n\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems?\n\n  No.\n\n  That's fine. And whereabouts do you live? Do you live with friends, family?\n\n  I live with friends.\n\n  Okay. And where do you work? What's your job?\n\n  I'm a support worker.\n\n  Okay. Do you drink alcohol at all?\n\n  Occasionally.\n\n  So how much in average week?\n\n  One glass of wine a week.\n\n  Okay. Do you smoke?\n\n  No.\n\n  Okay. Um, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish?\n\n  No fever at all.\n\n  Have you got a thermometer at home?\n\n  No.\n\n  Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down.\n\n  Okay.\n\n  Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\n\n  Okay.\n\n  Um, how would you feel about that? Are you happy to take a course of antibiotics?\n\n  Yes, I would be.\n\n  It would just be for 3 days.\n\n  Okay.\n\n  Um.\n\n  So how do I get my prescription?\n\n  Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing, which is important to do, is to drink lots of water. So 2 and a half to 3 liters a day.\n\n  Yeah.\n\n  Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some, some sachets, um, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I, I can put the details of that on your notes.\n\n  Okay then.\n\n  Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\n  Okay.\n\n  Um, the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\n  So do I have to call after I finish my course of antibiotics?\n\n  No, not if you're better.\n\n  Okay.\n\n  If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\n\n  Okay then.\n\n  Um, have you got any other questions?\n\n  Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from?\n\n  Um, so have you already requested a pharmacy through Babylon?\n\n  Yes, I did.\n\n  Can I just check that with you?\n\n  Knightsbridge. Practice.\n\n  Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\n\n  Okay.\n\n  And.\n\n  Also?\n\n  You'll be able to pick them up from there.\n\n  How soon is that going to be at the practice? In 5 minutes?\n\n  Um, I would give it longer than that.\n\n  Okay.\n\n  Give it.\n\n  Okay.\n\n  An hour or so.\n\n  All right then. Thank you. I'll pick that at lunchtime.\n\n  Okay.\n\n  Okay.\n\n  All right then.\n\n  Thank you.\n\n  Take care. Bye.\n\n  Bye.\n\n  Sorry, I didn't keep.","marks":[{"start":186,"end":194,"said":"SW two two HZ. Hello.","significant":false},{"start":225,"end":245,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":434,"end":440,"said":"It stays","significant":false},{"start":1039,"end":1039,"said":"Seven.","significant":false},{"start":1223,"end":1228,"said":"Spots. 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Non-smoker.\nObjective\nNo physical examination, urinalysis or vital signs documented during remote consultation.\nAssessment\nSuspected UTI/cystitis, based on 6-day dysuria, malodorous urine, suprapubic/lower central abdominal pain and reported haematuria.\nNo reported fever or loin/back pain to suggest upper urinary tract involvement at time of consultation.\nPlan\nPrescribe 3-day course of antibiotics; prescription to be sent to requested Knightsbridge Practice pharmacy.\nAdvise collect/start antibiotics as soon as available.\nEncourage oral fluids: 2.5–3 L/day.\nMay try cranberry juice and OTC urinary alkalinising sachets from pharmacy.\nAdvise obtain thermometer and monitor temperature.\nSafety-net: seek further review if worsening/non-settling pain, fever, lower back/loin pain, difficulty passing urine, symptoms not resolving after treatment, or recurrent similar episodes.\nNo routine follow-up required if symptoms resolve.","review":65.6842105263158,"saved":238.81578947368422,"clean":true,"effort":0.0,"sig":[],"mb":8.948391,"latency":17.502,"signable":83.18621052631579}],"heidi":[{"label":"Run 1","wer":9.81651376146789,"text":"Good morning. I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Um, thirty Rimbridge Street, SW two two hz. And your date of birth? Fourteen oh two seventy-four. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? Six days now. Pardon? For six days. Six days. Okay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loom. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back- lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any low back pain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass all? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Mabavin. Mebarin. Mebabetin. I've had Medarin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes, I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. And do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. Will have to get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so two and a half to three liters a day. You can get some cranberry juice and take drink that as well. That sometimes helps, and also some sachets.\n\nWhich you can get from the chemists and stuff, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again. Okay. The other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar\n\nUm, you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Um, have you got any other questions? Uh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knights Bridge Practice. Okay, that's fine. So the antibiotics that I'm gonna prescribe, um, will go through to that pharmacy, and then- Also-\n\nYou'll be able to pick them up from there. How soon is that gonna be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I didn't keep","marks":[{"start":170,"end":179,"said":"Redbridge","significant":false},{"start":202,"end":202,"said":"Hello.","significant":false},{"start":227,"end":235,"said":"forty","significant":false},{"start":243,"end":262,"said":"nineteen seventy four. OK.","significant":false},{"start":437,"end":445,"said":"It stays","significant":false},{"start":613,"end":618,"said":"loo and","significant":false},{"start":1007,"end":1007,"said":"Seven.","significant":false},{"start":1170,"end":1175,"said":"Spots. OK.","significant":false},{"start":1448,"end":1451,"said":"lower","significant":false},{"start":1887,"end":1887,"said":"No.","significant":false},{"start":2188,"end":2191,"said":"stool","significant":false},{"start":2276,"end":2279,"said":"","significant":false},{"start":2307,"end":2307,"said":"No.","significant":false},{"start":2411,"end":2439,"said":"Mebeverine Mebeverine.","significant":true},{"start":2449,"end":2457,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":2621,"end":2628,"said":"You're","significant":false},{"start":3467,"end":3472,"said":"do","significant":false},{"start":3591,"end":3609,"said":"OK. Um.","significant":false},{"start":3906,"end":3912,"said":"litres","significant":false},{"start":4055,"end":4073,"said":"chemist some sachets","significant":false},{"start":4806,"end":4817,"said":"reccurently.","significant":false},{"start":4893,"end":4898,"said":"OK. Yeah. OK then.","significant":false},{"start":4949,"end":4959,"said":"where will","significant":false},{"start":5121,"end":5135,"said":"Knightsbridge","significant":false},{"start":5246,"end":5246,"said":"How soon","significant":false},{"start":5252,"end":5263,"said":"then","significant":false},{"start":5425,"end":5432,"said":"All right","significant":false},{"start":5479,"end":5492,"said":"OK. All right","significant":false},{"start":5499,"end":5509,"said":"","significant":false},{"start":5525,"end":5525,"said":"Thank you. .","significant":false},{"start":5540,"end":5551,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria x6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Unpleasant urine odour\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Intermittent central lower abdominal pain, 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Spotting blood in urine\"."],["The note captures: Able to pass urine and maintain oral intake.","no","No mention of being able to pass urine or maintain oral intake."],["The note captures: No fever and no loin/lower back pain.","yes","\"No fever\"; \"No back pain, no loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"No vaginal discharge\"; \"No previous similar symptoms\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","no","IBS and mebeverine 200 mg TDS are not documented."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not recorded anywhere."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Symptoms suggestive of UTI\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Commence 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3L daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","\"Review if symptoms worsen, develop lower back pain or high temperature, difficulty passing urine, or if symptoms recur\"."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"No follow-up required if symptoms resolve\" plus review if symptoms recur."]],"claims":[],"note":"Subjective\n\n- Dysuria x6 days\n\n- Unpleasant urine odour\n\n- Spotting blood in urine\n\n- Intermittent central lower abdominal pain, 7/10\n\n- No fever\n\n- No back pain, no loin pain\n\n- No vaginal discharge\n\n- No previous similar symptoms\n\n- Denies recent dehydration, excessive exercise, regular sexual intercourse\n\n- Regular periods\n\n- No change in bowel habit, no weight loss\n\n\n\n\nObjective\n\n- No fever reported\n\n- No thermometer at home\n\n\n\n\nAssessment\n\n- Symptoms suggestive of UTI\n\n\n\n\nPlan\n\n- Obtain thermometer and monitor temperature\n\n- Commence 3-day course of antibiotics; prescription sent to Knightsbridge Practice pharmacy\n\n- Increase fluid intake to 2.5-3L daily\n\n- Consider cranberry juice and urine alkalinising sachets (details to be noted)\n\n- Review if symptoms worsen, develop lower back pain or high temperature, difficulty passing urine, or if symptoms recur\n\n- No follow-up required if symptoms resolve","review":102.78947368421052,"saved":201.71052631578948,"clean":false,"effort":20.0,"sig":[["missing","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","Regular mebeverine 200 mg TDS and IBS history absent from the record, so the medication list is incomplete."],["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy omitted in a consultation where an antibiotic is prescribed."]],"mb":34.040949,"latency":26.69,"signable":129.47947368421052},{"label":"Run 2","wer":10.458715596330276,"text":"Good morning, I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Uh, thirty Redbridge Street, SW two two HZ. And your date of birth? Fourteen oh two seventy-four. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? Six days now. Pardon? For six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loom. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any low back pain? No. I've got and low loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass all? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habits? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Mebarin. Pardon? Mebarin. Mebabe. I've had Mebarin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes, I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. Will I get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water.\n\nSo two and a half to three liters a day. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist and saches which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again. Okay. The other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you?\n\nNightbridge practice. Okay. That's fine. So the antibiotics that I'm gonna prescribe, will go through to that pharmacy, and then you'll be able to pick them up from there. How soon is that gonna be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I didn't keep","marks":[{"start":199,"end":199,"said":"Hello.","significant":false},{"start":224,"end":232,"said":"forty","significant":false},{"start":240,"end":259,"said":"nineteen seventy four. 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Um.","significant":false},{"start":3896,"end":3902,"said":"litres","significant":false},{"start":4052,"end":4062,"said":"some sachets","significant":false},{"start":4790,"end":4801,"said":"reccurently.","significant":false},{"start":4877,"end":4882,"said":"OK. Yeah. OK then. Um","significant":false},{"start":4921,"end":4931,"said":"Uh where will","significant":false},{"start":5090,"end":5101,"said":"Knightsbridge","significant":false},{"start":5208,"end":5208,"said":"How soon","significant":false},{"start":5379,"end":5386,"said":"All right","significant":false},{"start":5433,"end":5446,"said":"OK. All right","significant":false},{"start":5453,"end":5463,"said":"","significant":false},{"start":5479,"end":5479,"said":"Thank you. .","significant":false},{"start":5494,"end":5505,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria x6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Unpleasant urinary odour\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Intermittent lower abdominal pain, central, 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Macroscopic haematuria\"."],["The note captures: Able to pass urine and maintain oral intake.","partial","\"Eating and drinking well\" but ability to pass urine not recorded."],["The note captures: No fever and no loin/lower back pain.","partial","\"Denies fever\" but lists \"Low loin pain\" as present, contradicting the denial."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"Denies previous similar symptoms\" and \"Denies vaginal discharge\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","no","Neither IBS nor mebeverine 200 mg TDS is recorded."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Suspected UTI\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"checking temperature with thermometer from pharmacy\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increased fluid intake 2.5-3L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Review if pain worsens, lower back pain, high temperature, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Recurrent/non-resolving review captured but no mention that routine post-course review is not needed."]],"claims":[["Low loin pain","Transcript says \"no loin pain as well\"; patient denied back/loin pain."]],"note":"Subjective\n\n- Dysuria x6 days\n\n- Unpleasant urinary odour\n\n- Intermittent lower abdominal pain, central, 7/10\n\n- Macroscopic haematuria\n\n- Low loin pain\n\n- Denies fever\n\n- Denies previous similar symptoms\n\n- Denies increased exercise, dehydration, recent changes in sexual activity\n\n- Denies vaginal discharge\n\n- Regular periods\n\n- No change in bowel habit, no weight loss\n\n- Eating and drinking well\n\n\n\n\nObjective\n\n- No temperature documented (no thermometer at home)\n\n\n\n\nAssessment\n\n- Suspected UTI\n\n\n\n\nPlan\n\n- Counselled on checking temperature with thermometer from pharmacy\n\n- 3-day course of antibiotics prescribed\n\n- Increased fluid intake 2.5-3L/day, cranberry juice, urinary alkalising sachets (details to be added to notes)\n\n- Advised to seek review if pain worsens, lower back pain develops, high temperature, or difficulty passing urine\n\n- Advised to seek review if symptoms recurrent or not resolving after treatment\n\n- Prescription sent to Nightbridge practice pharmacy, available for collection in ~1 hour","review":137.69736842105263,"saved":166.80263157894737,"clean":false,"effort":30.0,"sig":[["partial","No fever and no loin/lower back pain.","Loin pain recorded as present when denied, suggesting upper tract infection."],["missing","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","Past history and regular medication (mebeverine 200 mg TDS) absent from record."],["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy not recorded in a consult where antibiotics were prescribed."]],"mb":34.085909,"latency":25.369,"signable":163.06636842105263},{"label":"Run 3","wer":10.825688073394495,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Uh, thirty Redbridge Street, SW two two HZ. And your date of birth? Fourteen oh two seven four. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? Six days now. Pardon? Or six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loom. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any low back pain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass stool? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habits? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Meriden. Mebarin. Mebedin. I've had Mebarin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes, I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. Will I get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them.\n\nThe other thing which is important to do is to drink lots of water, so two and a half to three liters a day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist and saches, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\nOkay. And the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Have you got any other questions? No. What would be the pharmacy I'll be picking up?\n\nMy medication from. So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knight Bridge Practice. Okay. That's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. And you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye.\n\nSorry. I don't keep","marks":[{"start":202,"end":202,"said":"Hello.","significant":false},{"start":227,"end":235,"said":"forty","significant":false},{"start":243,"end":248,"said":"nineteen seventy","significant":false},{"start":435,"end":443,"said":"It stays","significant":false},{"start":457,"end":459,"said":"Uh","significant":false},{"start":606,"end":611,"said":"loo and","significant":false},{"start":999,"end":999,"said":"Seven.","significant":false},{"start":1162,"end":1167,"said":"Spots. OK.","significant":false},{"start":1440,"end":1443,"said":"lower","significant":false},{"start":1879,"end":1879,"said":"No.","significant":false},{"start":2263,"end":2274,"said":"habit","significant":false},{"start":2302,"end":2302,"said":"No.","significant":false},{"start":2406,"end":2432,"said":"Mebeverine Mebeverine.","significant":false},{"start":2442,"end":2450,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":2614,"end":2621,"said":"You're","significant":false},{"start":3456,"end":3461,"said":"do","significant":false},{"start":3580,"end":3592,"said":"OK. Um.","significant":false},{"start":3890,"end":3896,"said":"litres","significant":false},{"start":4052,"end":4062,"said":"some sachets","significant":false},{"start":4796,"end":4807,"said":"reccurently.","significant":false},{"start":4883,"end":4888,"said":"OK. Yeah. OK then. Um","significant":false},{"start":4927,"end":4937,"said":"Uh where will","significant":false},{"start":5097,"end":5110,"said":"Knightsbridge","significant":false},{"start":5168,"end":5176,"said":"gonna","significant":false},{"start":5220,"end":5220,"said":"How soon","significant":false},{"start":5224,"end":5224,"said":"then","significant":false},{"start":5285,"end":5293,"said":"gonna","significant":false},{"start":5388,"end":5395,"said":"All right","significant":false},{"start":5442,"end":5455,"said":"OK. All right","significant":false},{"start":5462,"end":5472,"said":"","significant":false},{"start":5488,"end":5488,"said":"Thank you. .","significant":false},{"start":5504,"end":5514,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria x6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"with unpleasant odour\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Lower abdominal pain, midline, 7/10, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Visible blood in urine over past 6 days\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","Able to pass urine; eating and drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever, back pain, loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No previous similar symptoms; denies vaginal discharge."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","no","IBS and mebeverine 200 mg TDS are not documented."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not documented."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Symptoms suggestive of UTI\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Advised to obtain thermometer and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"increase fluid intake to 2.5-3L daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Return if pain worsens, not resolving, back pain, high temperature, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Recurrent problem review and no follow-up if resolved."]],"claims":[],"note":"Subjective:\n\n- Dysuria x6 days, with unpleasant odour\n\n- Lower abdominal pain, midline, 7/10, intermittent\n\n- Visible blood in urine over past 6 days\n\n- Able to pass urine\n\n- Eating and drinking normally\n\n- Denies fever, back pain, loin pain\n\n- No previous similar symptoms\n\n- Denies recent excessive exercise, dehydration, sexual intercourse\n\n- Denies vaginal discharge\n\n- Regular periods\n\n- No change in bowel habit, no weight loss\n\n\n\n\nObjective:\n\n- No temperature documented (no thermometer at home)\n\n\n\n\nAssessment:\n\n- Symptoms suggestive of UTI\n\n\n\n\nPlan:\n\n- Advised to obtain thermometer and monitor temperature\n\n- 3-day course of antibiotics prescribed; prescription sent to Knight Bridge Practice pharmacy\n\n- Advised to increase fluid intake to 2.5-3L daily\n\n- Suggested cranberry juice and urine alkalinising sachets (details to be noted)\n\n- Safety-netting: return if pain worsens, symptoms do not resolve, develops lower back pain, high temperature, or difficulty passing urine; also if recurrent problem\n\n- No follow-up required if symptoms resolve","review":92.10526315789474,"saved":212.39473684210526,"clean":false,"effort":13.333333333333334,"sig":[["missing","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","IBS and regular mebeverine 200 mg TDS omitted."],["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy omitted while antibiotics are being prescribed."]],"mb":33.704291,"latency":23.402,"signable":115.50726315789474},{"label":"Run 4","wer":10.733944954128441,"text":"Good morning. I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Uh, 30 Redbridge Street, SW two two hz. And your date of birth? 140274. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? Six days now. Pardon? For six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loop. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any low back pain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass all? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habits? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Mervin. Pardon? Mebarin. Mebaden. I've had Medarin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes, I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. Will I get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them.\n\nThe other thing which is important to do is to drink lots of water, so two and a half to three liters a day. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\n\nOkay. And the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Have you got any other questions? No. What would be the pharmacy I'll be picking up?\n\nMy medication from. So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightbridge practice. Okay. That's fine. So the antibiotics that I'm going to prescribe, will go through to that pharmacy. And you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye bye.\n\nSorry. I think","marks":[{"start":198,"end":198,"said":"Hello.","significant":false},{"start":223,"end":236,"said":"forty oh two nineteen seventy four. 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All right","significant":false},{"start":5440,"end":5450,"said":"","significant":false},{"start":5465,"end":5465,"said":"Thank you. .","significant":false},{"start":5481,"end":5486,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Six days of dysuria recorded."],["The note captures: Unpleasant or strong urine odour.","no","Unpleasant urine odour is not recorded."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Central, intermittent lower abdominal pain 7/10."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Blood spotting in urine recorded."],["The note captures: Able to pass urine and maintain oral intake.","partial","'Eating and drinking normally' recorded; ability to pass urine not stated."],["The note captures: No fever and no loin/lower back pain.","yes","No fever and no loin/lower back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","no","IBS and mebeverine 200 mg TDS are not recorded."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","UTI is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","Three-day antibiotic course prescribed."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain a thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluids 2.5-3 L/day."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Recontact for worsening/persistent pain, fever, back pain or difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","'Follow-up if... recurrent episodes' recorded but no statement that routine post-course review is unnecessary."]],"claims":[],"note":"Subjective:\n\n- Dysuria x6 days\n\n- Lower abdominal pain, central, intermittent, 7/10\n\n- Haematuria - spotting blood in urine\n\n- No fever, no loin pain, no back pain\n\n- Eating and drinking normally\n\n- No vaginal discharge\n\n- No change in bowel habit, no weight loss\n\n- No history of similar symptoms\n\n- No recent exercise, dehydration or sexual intercourse\n\n- Regular periods\n\n\n\n\nObjective:\n\n- No temperature recorded (no thermometer at home)\n\n\n\n\nAssessment:\n\n- Likely UTI\n\n\n\n\nPlan:\n\n- Obtain thermometer from pharmacy and monitor temperature\n\n- 3-day course of antibiotics prescribed\n\n- Advised to drink 2.5-3L water daily\n\n- Recommended cranberry juice\n\n- Suggested sachets from chemist to alter urine acidity\n\n- Safety net: review if pain worsens, lower back pain, high temperature, or difficulty passing urine\n\n- Follow-up if symptoms not resolving or recurrent episodes\n\n- Prescription sent to Knightbridge Practice pharmacy; collect in ~1 hour","review":125.61842105263159,"saved":178.8815789473684,"clean":false,"effort":26.666666666666668,"sig":[["missing","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","Regular medication (mebeverine 200 mg TDS) and the IBS history are absent from the record."],["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy is omitted in a consultation that prescribes antibiotics."]],"mb":38.073021,"latency":25.25,"signable":150.8684210526316},{"label":"Run 5","wer":10.18348623853211,"text":"Good morning. I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Um, thirty Redbridge Street, SW two two hz. And your date of birth? Fourteen oh two nineteen seventy-four. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? Six days now. Pardon? For six days. Six days. Okay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loom. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back- lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any lower back pain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass all? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habits? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meberen. Mebarin. Mebabe. I've had Medarin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes, I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. And do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. I'll have to get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water.\n\nSo two and a half to three liters a day. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemists and safety, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again. Okay. The other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you?\n\nNightbridge practice. Okay. That's fine. So the antibiotics that I'm gonna prescribe, will go through to that pharmacy. And then How soon? You'll be able to pick them up from there. How soon is that gonna be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I didn't keep","marks":[{"start":202,"end":202,"said":"Hello.","significant":false},{"start":227,"end":235,"said":"forty","significant":false},{"start":252,"end":271,"said":"seventy four. OK.","significant":false},{"start":446,"end":454,"said":"It stays","significant":false},{"start":622,"end":627,"said":"loo and","significant":false},{"start":1016,"end":1016,"said":"Seven.","significant":false},{"start":1179,"end":1184,"said":"Spots. OK.","significant":false},{"start":1898,"end":1898,"said":"No.","significant":false},{"start":2199,"end":2202,"said":"stool","significant":false},{"start":2280,"end":2291,"said":"habit","significant":false},{"start":2319,"end":2319,"said":"No.","significant":false},{"start":2423,"end":2448,"said":"Mebeverine Mebeverine.","significant":false},{"start":2458,"end":2466,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":2630,"end":2637,"said":"You're","significant":false},{"start":3476,"end":3481,"said":"do","significant":false},{"start":3600,"end":3618,"said":"OK. Um.","significant":false},{"start":3916,"end":3922,"said":"litres","significant":false},{"start":4064,"end":4083,"said":"chemist some sachets","significant":false},{"start":4812,"end":4823,"said":"reccurently.","significant":false},{"start":4899,"end":4904,"said":"OK. Yeah. OK then. Um","significant":false},{"start":4943,"end":4953,"said":"Uh where will","significant":false},{"start":5112,"end":5123,"said":"Knightsbridge","significant":false},{"start":5232,"end":5240,"said":"","significant":false},{"start":5249,"end":5249,"said":"And then","significant":false},{"start":5411,"end":5418,"said":"All right","significant":false},{"start":5465,"end":5478,"said":"OK. All right","significant":false},{"start":5485,"end":5495,"said":"","significant":false},{"start":5511,"end":5511,"said":"Thank you. .","significant":false},{"start":5526,"end":5537,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria x6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"with unpleasant odour\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Lower abdominal pain, midline, 7/10, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Blood spotting in urine over past 6 days\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","Able to pass urine; eating and drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever, lower back pain, loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge; no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS; \"Mebeverine 200mg TDS\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergies: clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Symptoms suggestive of UTI\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer from pharmacy and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"drink 2.5-3L water daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-netted for worsening pain, back pain, high temperature, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","No routine follow-up if resolved; contact if recurrent."]],"claims":[],"note":"Subjective\n\n- Dysuria x6 days, with unpleasant odour\n\n- Lower abdominal pain, midline, 7/10, intermittent\n\n- Blood spotting in urine over past 6 days\n\n- Able to pass urine\n\n- Eating and drinking normally\n\n- Denies fever, lower back pain, loin pain\n\n- No previous similar symptoms\n\n- Denies recent excessive exercise, dehydration, regular sexual intercourse\n\n- No vaginal discharge\n\n- Regular periods\n\n\n\n\nPast Medical History\n\n- IBS - no recent change in bowel habit, no PR bleeding\n\n- Allergies: clindamycin\n\n\n\n\nMedications\n\n- Mebeverine 200mg TDS\n\n\n\n\nSocial History\n\n- Lives with friends\n\n- Support worker\n\n- Alcohol: occasional, ~1 glass wine/week\n\n- Non-smoker\n\n\n\n\nObjective\n\n- No temperature documented (no thermometer at home)\n\n\n\n\nAssessment\n\n- Symptoms suggestive of UTI\n\n- No signs of systemic infection; possibility of ascending infection if symptoms worsen\n\n\n\n\nPlan\n\n- Obtain thermometer from pharmacy and monitor temperature\n\n- 3-day course of antibiotics prescribed, dispensed at Nightbridge Practice pharmacy (available ~1 hour)\n\n- Advised to drink 2.5-3L water daily\n\n- Suggested cranberry juice and urine alkalising sachets (details to be added to notes)\n\n- Safety-netted: seek review if pain worsens, lower back pain develops, high temperature, or difficulty passing urine\n\n- No routine follow-up required if symptoms resolve after antibiotics\n\n- Advised to contact clinic if symptoms worsen, fail to resolve, or recur","review":61.578947368421055,"saved":242.92105263157896,"clean":true,"effort":0.0,"sig":[],"mb":38.796452,"latency":26.072,"signable":87.65094736842106},{"label":"Run 6","wer":11.009174311926607,"text":"Good morning, I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please?\n\nHi, my name is Susan. Uh, 30 Redbridge Street, SW two two HZ. And your date of birth? 140274. Okay. Are you in a private place so you can have a consultation today?\n\nYes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? Six days now. Pardon? Six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loop. I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all? I've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last six days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all. And and any did you you said you didn't have any low back pain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. No. Okay. And any any other symptoms, any vaginal discharge or anything like that?\n\nNo. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass all? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habits? No. Any weight loss or anything?\n\nNo. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Merbin. Had it? Mebarin. Mebabin. I've had Medrin. Do you take that regularly? Yes. Okay. And it do you take it three times a day? Yes I do. Two hundred milligrams? Yes. Any allergies? Any allergies? Clindamycin. You are allergic to clindamycin. Okay. And anyone in your family had any medical problems?\n\nNo. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\n\nNo. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for three days. Okay. Will I get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them.\n\nThe other thing which is important to do is to drink lots of water, so two and a half to three liters a day. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist and saches, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature, or you have any problems actually passing the urine, then it's very important that we speak to you again.\n\nOkay. And the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar problem recurrently, then it's important for us to talk talk to you in more detail about that. Okay. Have you got any other questions? No. What would be the pharmacy I'll be picking up?\n\nMy medication from. So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightbridge practice. Okay. That's fine. So the antibiotics that I'm going to prescribe, will go through to that pharmacy. And you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye.\n\nSorry. I think","marks":[{"start":195,"end":195,"said":"Hello.","significant":false},{"start":220,"end":233,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":408,"end":416,"said":"It stays","significant":false},{"start":576,"end":581,"said":"loo and","significant":false},{"start":969,"end":969,"said":"Seven.","significant":false},{"start":1132,"end":1137,"said":"Spots. 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Um","significant":false},{"start":4898,"end":4908,"said":"Uh where will","significant":false},{"start":5068,"end":5080,"said":"Knightsbridge","significant":false},{"start":5138,"end":5146,"said":"gonna","significant":false},{"start":5191,"end":5191,"said":"How soon","significant":false},{"start":5195,"end":5195,"said":"then","significant":false},{"start":5256,"end":5264,"said":"gonna","significant":false},{"start":5359,"end":5366,"said":"All right","significant":false},{"start":5413,"end":5426,"said":"OK. All right","significant":false},{"start":5433,"end":5443,"said":"","significant":false},{"start":5459,"end":5459,"said":"Thank you. .","significant":false},{"start":5475,"end":5480,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria x6 days\"."],["The note captures: Unpleasant or strong urine odour.","no","Records \"Foul-smelling discharge\" rather than unpleasant-smelling urine, which misattributes the odour and conflicts with no vaginal discharge."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Intermittent central lower abdominal pain, 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Blood spotting in urine over last 6 days\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","Passing urine okay; eating and drinking okay."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever, loin pain, low back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No previous similar symptoms; no vaginal discharge."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","no","IBS and mebeverine 200 mg TDS are not documented."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not documented."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Likely urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer from pharmacy; monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"drink 2.5-3L water daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net for worse pain, back pain, high temperature, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Review if problem recurs captured; no statement that no routine review is needed if better."]],"claims":[["Foul-smelling discharge","Patient described an unpleasant smell when passing urine and explicitly denied vaginal discharge; no discharge was reported."]],"note":"Subjective\n\n- Dysuria x6 days\n\n- Foul-smelling discharge\n\n- Intermittent central lower abdominal pain, 7/10\n\n- Blood spotting in urine over last 6 days\n\n- Passing urine okay\n\n- Eating and drinking okay\n\n- Denies fever, loin pain, low back pain\n\n- No previous similar symptoms\n\n- Denies recent excessive exercise, dehydration, increased sexual activity\n\n- Regular periods\n\n- No vaginal discharge\n\n\n\n\nObjective\n\n- Nil examination performed (telehealth consultation)\n\n\n\n\nAssessment\n\n- Likely urinary tract infection\n\n\n\n\nPlan\n\n- Obtain thermometer from pharmacy; monitor temperature\n\n- 3-day course of antibiotics prescribed; prescription sent to Knightbridge practice\n\n- Advised to drink 2.5–3L water daily\n\n- Suggested cranberry juice and urinary alkalising sachets from chemist\n\n- Safety-net: seek further review if pain worsens, lower back pain develops, high temperature, or difficulty passing urine\n\n- Advised to seek further review if symptoms do not resolve or problem recurs","review":126.30263157894737,"saved":178.19736842105263,"clean":false,"effort":30.0,"sig":[["missing","Unpleasant or strong urine odour.","Urine odour recorded as foul-smelling discharge, contradicting her denial of discharge; could redirect diagnosis."],["missing","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","IBS and regular mebeverine 200 mg TDS omitted from the record."],["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy omitted while antibiotics are being prescribed."]],"mb":37.196626,"latency":24.981,"signable":151.28363157894736}],"freed":[{"label":"Run 1","wer":13.394495412844037,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the 1st line of your address, please?\n  Hi, my name is Susan, 30 Redbridge Street, S. W. 2, 2, H. Z. And your date of birth?\n  14-02-1974. Okay, are you in a private place where you can have a consultation today? Yes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? 6 days now. Pardon?\n  6 days.\n  6 days, okay. And just tell me a bit more about that. How did it start?\n  I've got this thing when I pee and it hurts when I go to the loo. I've got this very unpleasant smell that comes out.\n  Okay. Have you had any other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay, is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of one to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay, and have you actually been able to pass water okay? Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right, and have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or held a temperature with this?\n  No, not at all.\n  You said you didn't have any lower back pain?\n  No, I've got a no-loin pain as well.\n  Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything?\n  No.\n  No, okay. And any other symptoms, any vaginal discharge or anything like that?\n  No, just the blood spot in my...\n  Do you have regular periods?\n  Yes, I do.\n  Okay. And in the past, have you had any medical problems at all? No medical, no. Have you had any problems with your kidneys or any urine infections?\n  I had IBS before.\n  Okay. And how's that been recently? Any change in your bowel habit? Any blood running past stool?\n  Yeah, I've had spotting in my urine.\n  Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meverine. I've had heparin. Do you take that regularly?\n  Yes.\n  Okay, and do you take it 3 times a day?\n  Yes, I do.\n  200 milligrams? Yes. Any allergies? Any allergies?\n  Clindamycin.\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems? No. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. OK. And where do you work? What's your job?\n  I'm a support worker.\n  OK. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. OK. Do you smoke? No. OK. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally we can treat this infection without having to test your urine with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics?\n  Yes, I would be.\n  It would just be for 3 days. Okay. Do I have to get my prescription? Yes, so I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3 litres a day. You can get some cranberry juice and drink that as well, that sometimes helps, and also some sachets which you can get from the chemist. some stethos which just help change the acidity of your urine so I can put the details of that on your notes. If you feel like your pain is getting worse or not settling you get lower back pain or you're getting a high temperature or you have any problems actually passing urine then it's very important that we speak to you again. The other thing is if it becomes a common thing or a recurrent problem... then we need to talk to you again about it.\n  So do I have to go after I finish my course of antibiotics?\n  No, not if you're better. If you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No. What would be the pharmacy I would be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightsbridge Practice. Okay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. You'll be able to pick them up from there.\n  How soon is that going to be at the practice? In 5 minutes?\n  I would give it longer than that. Give it an hour or so.\n  All right then. Thank you. I'll pick you up at lunchtime.\n  Okay. All right then. Thank you. Take care. Bye. Bye.","marks":[{"start":100,"end":103,"said":"first","significant":false},{"start":179,"end":184,"said":"SW","significant":false},{"start":191,"end":196,"said":"HZ. Hello.","significant":false},{"start":223,"end":239,"said":"forty oh two nineteen seventy four. 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Um","significant":false},{"start":4737,"end":4747,"said":"Uh where will","significant":false},{"start":4764,"end":4771,"said":"I'll","significant":false},{"start":4979,"end":4987,"said":"gonna","significant":false},{"start":5031,"end":5031,"said":"How soon And then","significant":false},{"start":5094,"end":5102,"said":"gonna","significant":false},{"start":5235,"end":5241,"said":"that","significant":false},{"start":5280,"end":5290,"said":"","significant":false},{"start":5306,"end":5306,"said":"Thank you. .","significant":false},{"start":5311,"end":5311,"said":"Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","yes","States able to pass urine without difficulty and to eat and drink."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and lower back/loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily recorded."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","'Follow up if urinary infections become recurrent' captured, but no statement that routine review is unnecessary if better."]],"claims":[["Medications list includes 'Heparin'","Transcript names only mebeverine as a regular medication; heparin is never mentioned."]],"note":"Subjective\nSusan, a patient with a history of irritable bowel syndrome, presents with a 6-day history of dysuria, malodorous urine, hematuria, and lower abdominal pain.\n\nShe reports pain with urination that started 6 days ago, accompanied by a very unpleasant smell to her urine. She has also noticed spotted blood in her urine over the same 6-day period. She reports lower abdominal pain, located in the middle of her abdomen, rated 7 out of 10 in severity, which is intermittent in nature. She has been able to pass urine without difficulty. She denies fever or feeling feverish. She denies lower back pain or loin pain. She denies vaginal discharge. She reports regular menstrual periods. She denies any change in bowel habit. She has been able to eat and drink without difficulty. She denies any recent excessive exercise, dehydration, or increased sexual activity. She has not experienced these symptoms before.\n\nMedical History  \n- Irritable bowel syndrome\n\nMedications and Supplements  \n- Mebeverine 200 mg PO three times daily  \n- Heparin\n\nAllergies  \n- Clindamycin\n\nSocial History  \n- Occupation: Works as a support worker  \n- Living Situation: Lives with friends  \n- Alcohol: Occasional, one glass of wine per week  \n- Tobacco: Non-smoker\n\nReview of Systems  \n- General: Denies fever  \n- Gastrointestinal: Denies change in bowel habit  \n- Genitourinary: Denies difficulty passing urine, vaginal discharge  \n- Musculoskeletal: Denies lower back pain\n\nObjective\nN/A\n\nAssessment & Plan\nSusan presents with a 6-day history of dysuria, hematuria, and lower abdominal pain consistent with a urinary tract infection.\n\nUrinary Tract Infection  \nAssessment: Patient presents with classic symptoms of urinary tract infection including dysuria for 6 days, hematuria, specifically spotted blood in urine over the last 6 days, unpleasant-smelling urine, and lower abdominal pain rated 7/10 that comes and goes. No fever reported, no lower back pain, and able to pass urine normally. No previous history of urinary tract infections or kidney problems. History of IBS but no recent changes in bowel habits. No vaginal discharge reported. Clinical presentation is highly suggestive of uncomplicated urinary tract infection.  \nPlan:  \n- Prescribe 3-day course of antibiotics  \n- Prescription to be sent to Knightsbridge Practice pharmacy, to be available in approximately 1 hour  \n- Patient to start antibiotics as soon as possible after pickup  \n- Increase fluid intake to 2.5-3 liters per day  \n- Consider cranberry juice for additional symptom relief  \n- Use urine acidifying sachets available from pharmacy  \n- Obtain thermometer to monitor temperature at home  \n- Return for reassessment if symptoms worsen, develop lower back pain, experience high fever, have difficulty passing urine, or if symptoms do not resolve with treatment  \n- Follow up if urinary infections become recurrent\n","review":161.5921052631579,"saved":142.9078947368421,"clean":false,"effort":13.333333333333334,"sig":[["fabrication","Medications list includes 'Heparin'","Heparin is invented; only mebeverine was named, and a false anticoagulant entry affects prescribing and bleeding assessment."]],"mb":14.074332,"latency":44.874,"signable":194.2711052631579},{"label":"Run 2","wer":13.577981651376147,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the 1st line of your address, please?\n  Hi, my name is Susan, 30 Redbridge Street, S. W. 2, 2, H. Z. And your date of birth?\n  14-02-1974. Okay, are you in a private place where you can have a consultation today? Yes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? 6 days now. Pardon? 6 days. 6 days, okay. And just tell me a bit more about that. How did it start?\n  I've got this thing when I pee and it hurts when I go to the loo. I've got this very unpleasant smell that comes out.\n  Okay. Have you had any other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay, is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay, and have you actually been able to pass water okay? Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right, and have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or held a temperature with this?\n  No, not at all.\n  You said you didn't have any lower back pain?\n  No, I've got anal loin pain as well.\n  Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything?\n  No.\n  No, okay. And any other symptoms, any vaginal discharge or anything like that?\n  No, just blood spot in my...\n  Do you have regular periods?\n  Yes, I do.\n  Okay. In the past, have you had any medical problems at all? No medical, no. Have you had any problems with your kidneys or any urine infections?\n  I had IBS before.\n  Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass stool?\n  Yeah, I've had spotting in my urine.\n  Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had Mevrin. I've had heparin. Do you take that regularly?\n  Yes.\n  Okay, and do you take it 3 times a day?\n  Yes, I do.\n  200 milligrams? Yes. Any allergies? Any allergies?\n  Clindamycin.\n  You are allergic to clindamycin, okay. And anyone in your family had any medical problems? No. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. OK. And where do you work? What's your job?\n  I'm a support worker.\n  OK. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. OK. Do you smoke? No. OK. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally we can treat this infection without having to test your urine with a course of antibiotics. Okay. How do you feel about that? Are you happy to take a course of antibiotics?\n  Yes, I would be.\n  It would just be for 3 days. Okay. Do I have to get my prescription? Yes, so I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 litres a day. You can get some cranberry juice and drink that as well, that sometimes helps, and also some sachets which you can get from the chemist. some stethos which just help change the acidity of your urine so I can put the details of that on your notes. If you feel like your pain is getting worse or not settling you get lower back pain or you're getting a high temperature or you have any problems actually passing urine then it's very important that we speak to you again. The other thing is if it becomes a common thing or a recurrent problem... then we need to talk to you again about it.\n  So do I have to go after I finish my course of antibiotics?\n  No, not if you're better. If you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No, what would be the pharmacy I would be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightsbridge practice. Okay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. You'll be able to pick them up from there.\n  How soon is that going to be at practice? In 5 minutes?\n  I would give it longer than that. Give it an hour or so.\n  All right then. Thank you. I'll pick you up at lunchtime.\n  Okay. All right then. Thank you. Take care. Bye. Bye.","marks":[{"start":100,"end":103,"said":"first","significant":false},{"start":179,"end":184,"said":"SW","significant":false},{"start":191,"end":196,"said":"HZ. Hello.","significant":false},{"start":223,"end":239,"said":"forty oh two nineteen seventy four. 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Um","significant":false},{"start":4730,"end":4740,"said":"Uh where will","significant":false},{"start":4757,"end":4764,"said":"I'll","significant":false},{"start":4972,"end":4980,"said":"gonna","significant":false},{"start":5024,"end":5024,"said":"How soon And then","significant":false},{"start":5087,"end":5095,"said":"gonna","significant":false},{"start":5224,"end":5230,"said":"that","significant":false},{"start":5269,"end":5279,"said":"","significant":false},{"start":5295,"end":5295,"said":"Thank you. .","significant":false},{"start":5300,"end":5300,"said":"Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","yes","States able to pass urine without difficulty and to eat and drink."],["The note captures: No fever and no loin/lower back pain.","no","Denies fever and lower back pain but states 'She also reports anal loin pain', contradicting the patient's 'no loin pain'."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","partial","IBS and 200 mg TDS recorded but drug given as 'Mevrin' rather than mebeverine."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Recurrence review mentioned but does not state that no routine post-course review is needed if better."]],"claims":[["She also reports anal loin pain","Patient explicitly said 'no loin pain as well'; no anal pain mentioned anywhere."],["Medications list includes 'Heparin'","Transcript names only mebeverine as a regular medication; heparin is never mentioned."]],"note":"Subjective\nSusan, a patient with a history of irritable bowel syndrome, presents with a 6-day history of dysuria, suprapubic pain, and hematuria. She reports pain on urination accompanied by a very unpleasant smell to her urine. She has also noted spotted blood in her urine over the same 6-day period. She describes intermittent pain in her lower abdomen, localized to the middle, rated 7 out of 10 in severity. She also reports anal loin pain. She has been able to pass urine without difficulty. She denies fever or feeling feverish. She denies lower back pain. She denies vaginal discharge. She reports regular menstrual periods. She denies any change in bowel habit, blood in stool, or weight loss. She has been able to eat and drink without difficulty. She denies recent excessive exercise, dehydration, or increased sexual activity. She has never had these symptoms before and has no history of kidney problems or prior urinary tract infections.\n\nMedical History  \n- Irritable bowel syndrome (IBS)\n\nMedications and Supplements  \n- Mevrin 200 mg PO three times daily  \n- Heparin\n\nAllergies  \n- Clindamycin\n\nSocial History  \n- Occupation: Works as a support worker  \n- Living Situation: Lives with friends  \n- Alcohol: Occasional, one glass of wine per week  \n- Tobacco: Denies smoking\n\nReview of Systems  \n- General: Denies fever, weight loss  \n- Gastrointestinal: Denies change in bowel habit, blood in stool  \n- Genitourinary: Denies difficulty urinating, vaginal discharge\n\nObjective\nN/A\n\nAssessment & Plan\n52-year-old female with history of IBS, presenting with 6-day history of dysuria, hematuria, and lower abdominal pain.\n\nUrinary Tract Infection  \nAssessment: Patient presents with classic symptoms of urinary tract infection including dysuria for 6 days, hematuria described as spotted blood in urine, and lower abdominal pain rated 7/10 that is intermittent. Additional symptoms include unpleasant urinary odor and anal loin pain. No fever reported. No previous history of urinary tract infections or kidney problems. Clinical presentation is consistent with uncomplicated urinary tract infection.  \nPlan:  \n- Prescribe 3-day course of antibiotics  \n- Prescription to be sent to Knightsbridge practice pharmacy, available for pickup in approximately one hour  \n- Increase fluid intake to 2.5-3 liters daily  \n- Consider cranberry juice supplementation  \n- Obtain urinary acidity sachets from pharmacy  \n- Monitor temperature with thermometer obtained from pharmacy  \n- Return for reassessment if symptoms worsen, develop lower back pain, experience high fever, have difficulty passing urine, or if problem becomes recurrent\n","review":192.39473684210526,"saved":112.10526315789474,"clean":false,"effort":26.666666666666668,"sig":[["missing","No fever and no loin/lower back pain.","Note says she reports loin pain when she explicitly denied loin pain."],["partial","History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","Drug recorded as Mevrin, not a real drug name for mebeverine, risking medication reconciliation error."]],"mb":12.02011,"latency":60.293,"signable":237.58373684210525},{"label":"Run 3","wer":13.761467889908257,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the 1st line of your address, please?\n  Hi, my name is Susan, 30 Redbridge Street, SW22HZ.\n  And your date of birth? 14-02-1974. Okay, are you in a private place you can have a consultation today? Yes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? 6 days now. Pardon?\n  6 days.\n  6 days, okay. And just tell me a bit more about that. How did it start?\n  I've got this thing when I pee and it hurts when I go to the loo. I've got this very unpleasant smell that comes out.\n  Okay. Have you had any other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay, is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of one to ten, with ten being the worst pain? Seven. And is it constant or does it come and go? Comes and goes. Okay, and have you actually been able to pass water okay? Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right, and have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or held a temperature with this?\n  No, not at all.\n  You said you didn't have any low back pain?\n  No, I've got no loin pain as well.\n  Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything?\n  No.\n  No, okay. And any other symptoms, any vaginal discharge or anything like that?\n  No, just blood spots in my...\n  Do you have regular periods?\n  Yes, I do.\n  Okay. In the past, have you had any medical problems at all? No medical, no. Have you had any problems with your kidneys or any urine infections?\n  I had IBS before.\n  Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass stool?\n  Yeah, I've had spotting in my urine.\n  Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meverine. I've had heparin. Do you take that regularly?\n  Yes.\n  Okay, and do you take it 3 times a day?\n  Yes, I do.\n  200 milligrams? Yes. Any allergies? Any allergies?\n  Clindamycin.\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems? No. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. OK. And where do you work? What's your job?\n  I'm a support worker.\n  OK. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. OK. Do you smoke? No. OK. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally we can treat this infection without having to test your urine with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics?\n  Yes, I would be.\n  It would just be for 3 days. Okay. Do I have to get my prescription? Yes, so I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3 liters a day. You can get some cranberry juice and drink that as well, that sometimes helps, and also some sachets which you can get from the chemist. some stethos which just help change the acidity of your urine so I can put the details of that on your notes. If you feel like your pain is getting worse or not settling you get lower back pain or you're getting a high temperature or you have any problems actually passing urine then it's very important that we speak to you again. The other thing is if it becomes a common thing or a recurrent problem... then we need to talk to you again about it.\n  So do I have to go after I finish my course of antibiotics?\n  No, not if you're better. If you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No, what would be the pharmacy I would be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightsbridge practice. Okay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. You'll be able to pick them up from there.\n  How soon is that going to be at practice? In 5 minutes?\n  I would give it longer than that. Give it an hour or so.\n  All right then. Thank you. I'll pick you up at lunchtime.\n  Okay. All right then. Thank you. Take care. Bye. Bye.","marks":[{"start":100,"end":103,"said":"first","significant":false},{"start":179,"end":186,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":229,"said":"forty oh two nineteen seventy four. 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Um","significant":false},{"start":4717,"end":4727,"said":"Uh where will","significant":false},{"start":4744,"end":4751,"said":"I'll","significant":false},{"start":4959,"end":4967,"said":"gonna","significant":false},{"start":5011,"end":5011,"said":"How soon And then","significant":false},{"start":5074,"end":5082,"said":"gonna","significant":false},{"start":5211,"end":5217,"said":"that","significant":false},{"start":5256,"end":5266,"said":"","significant":false},{"start":5282,"end":5282,"said":"Thank you. .","significant":false},{"start":5287,"end":5287,"said":"Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"6-day history of dysuria\" with pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","\"very unpleasant smell to her urine\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"lower abdominal pain, midline, rated 7 out of 10 ... intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"spotted blood in her urine over the same 6-day period\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"able to pass urine without difficulty\" and \"able to eat and drink without difficulty\"."],["The note captures: No fever and no loin/lower back pain.","yes","\"denies fever\" and \"denies low back pain or loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"denies vaginal discharge\" and \"has not experienced these symptoms before\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS listed with \"Mebeverine 200 mg PO three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Allergies: \"Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"consistent with a urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribe 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer to monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3 liters daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Return if worsening, lower back pain, high fever, difficulty passing urine; persistent covered via recurrence/resolve wording."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"if UTI becomes recurrent\" and \"No routine follow-up needed if symptoms resolve\"."]],"claims":[["Medication list includes \"Heparin\"","No anticoagulant or heparin is mentioned anywhere; the only medication discussed is mebeverine."]],"note":"Subjective\nSusan, a patient with a history of irritable bowel syndrome, presents with a 6-day history of dysuria, malodorous urine, and hematuria. She reports pain on urination along with a very unpleasant smell to her urine. She has also noticed spotted blood in her urine over the same 6-day period. She reports being able to pass urine without difficulty. She has associated lower abdominal pain, midline, rated 7 out of 10 in severity, which is intermittent in nature. She denies fever or feeling feverish. She denies low back pain or loin pain. She denies vaginal discharge. She reports regular periods. She denies any change in bowel habit. She has been able to eat and drink without difficulty. She denies recent excessive exercise, dehydration, or increased sexual activity. She has not experienced these symptoms before.\n\nMedical History  \n- Irritable bowel syndrome\n\nMedications and Supplements  \n- Mebeverine 200 mg PO three times daily  \n- Heparin\n\nAllergies  \n- Clindamycin\n\nSocial History  \n- Occupation: Works as a support worker  \n- Living Situation: Lives with friends  \n- Alcohol: Occasional, one glass of wine per week  \n- Tobacco: Denies smoking\n\nReview of Systems  \n- General: Denies fever  \n- Gastrointestinal: Denies change in bowel habit  \n- Genitourinary: Denies difficulty passing urine, vaginal discharge  \n- Musculoskeletal: Denies low back pain\n\nObjective\nN/A\n\nAssessment & Plan\nSusan presents with a 6-day history of dysuria, hematuria, and lower abdominal pain consistent with a urinary tract infection.\n\nUrinary Tract Infection  \nAssessment: Patient presents with classic symptoms of urinary tract infection including dysuria for 6 days, hematuria with blood spots noted in urine over the same timeframe, and lower abdominal pain rated 7/10 that is intermittent and centrally located. Associated symptoms include foul-smelling urine. No fever reported, no lower back pain, and able to pass urine normally. No previous history of urinary tract infections or kidney problems. Clinical presentation is highly suggestive of uncomplicated urinary tract infection.  \nPlan:  \n- Prescribe 3-day course of antibiotics  \n- Prescription to be sent to Knightsbridge practice pharmacy, allow approximately 1 hour for processing  \n- Increase fluid intake to 2.5-3 liters daily  \n- Consider cranberry juice supplementation  \n- Use urine acidity modification sachets available from pharmacy  \n- Obtain thermometer to monitor temperature  \n- Return for reassessment if symptoms worsen, develop lower back pain, experience high fever, have difficulty passing urine, or if UTI becomes recurrent  \n- No routine follow-up needed if symptoms resolve with treatment\n","review":134.21052631578948,"saved":170.28947368421052,"clean":false,"effort":10.0,"sig":[["fabrication","Medication list includes \"Heparin\"","Heparin never mentioned; an invented anticoagulant in the medication list could affect prescribing and bleeding assessment given haematuria."]],"mb":14.024493,"latency":52.924,"signable":174.01452631578948},{"label":"Run 4","wer":13.394495412844037,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the 1st line of your address, please?\n  Hi, my name is Susan, 30 Redbridge Street, S. W. 2, 2, H. Z. And your date of birth?\n  14-02-1974. Okay, are you in a private place where you can have a consultation today? Yes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? 6 days now. Pardon?\n  6 days.\n  6 days, okay. And just tell me a bit more about that. How did it start?\n  I've got this thing when I pee and it hurts when I go to the loo. I've got this very unpleasant smell that comes out.\n  Okay. Have you had any other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay, is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of one to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay, and have you actually been able to pass water okay? Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right, and have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or held a temperature with this?\n  No, not at all.\n  You said you didn't have any lower back pain?\n  No, I've got a no-loin pain as well.\n  Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything?\n  No.\n  No, okay. And any other symptoms, any vaginal discharge or anything like that?\n  No, just the blood spot in my...\n  Do you have regular periods?\n  Yes, I do.\n  Okay. And in the past, have you had any medical problems at all? No medical, no. Have you had any problems with your kidneys or any urine infections?\n  I had IBS before.\n  Okay. And how's that been recently? Any change in your bowel habit? Any blood running past stool?\n  Yeah, I've had spotting in my urine.\n  Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meverine. I've had heparin. Do you take that regularly?\n  Yes.\n  Okay, and do you take it 3 times a day?\n  Yes, I do.\n  200 milligrams? Yes. Any allergies? Any allergies?\n  Clindamycin.\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems? No. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. OK. And where do you work? What's your job?\n  I'm a support worker.\n  OK. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. OK. Do you smoke? No. OK. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally we can treat this infection without having to test your urine with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics?\n  Yes, I would be.\n  It would just be for 3 days. Okay. Do I have to get my prescription? Yes, so I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3 litres a day. You can get some cranberry juice and drink that as well, that sometimes helps, and also some sachets which you can get from the chemist. some stethos which just help change the acidity of your urine so I can put the details of that on your notes. If you feel like your pain is getting worse or not settling you get lower back pain or you're getting a high temperature or you have any problems actually passing urine then it's very important that we speak to you again. The other thing is if it becomes a common thing or a recurrent problem... then we need to talk to you again about it.\n  So do I have to go after I finish my course of antibiotics?\n  No, not if you're better. If you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No. What would be the pharmacy I would be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightsbridge Practice. Okay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. You'll be able to pick them up from there.\n  How soon is that going to be at the practice? In 5 minutes?\n  I would give it longer than that. Give it an hour or so.\n  All right then. Thank you. I'll pick you up at lunchtime.\n  Okay. All right then. Thank you. Take care. Bye. Bye.","marks":[{"start":100,"end":103,"said":"first","significant":false},{"start":179,"end":184,"said":"SW","significant":false},{"start":191,"end":196,"said":"HZ. Hello.","significant":false},{"start":223,"end":239,"said":"forty oh two nineteen seventy four. 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Um","significant":false},{"start":4737,"end":4747,"said":"Uh where will","significant":false},{"start":4764,"end":4771,"said":"I'll","significant":false},{"start":4979,"end":4987,"said":"gonna","significant":false},{"start":5031,"end":5031,"said":"How soon And then","significant":false},{"start":5094,"end":5102,"said":"gonna","significant":false},{"start":5235,"end":5241,"said":"that","significant":false},{"start":5280,"end":5290,"said":"","significant":false},{"start":5306,"end":5306,"said":"Thank you. .","significant":false},{"start":5311,"end":5311,"said":"Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","yes","States able to pass urine without difficulty and to eat and drink."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and lower back/loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily recorded."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","'if UTI becomes recurrent' captured, but no statement that routine review is unnecessary if better."]],"claims":[["Medications list includes 'Heparin'","Transcript names only mebeverine as a regular medication; heparin is never mentioned."]],"note":"Subjective\nCliniTech Benchmark a9fa9b32 presents with a 6-day history of dysuria, malodorous urine, hematuria, and lower abdominal pain. She reports pain on urination accompanied by a very unpleasant smell to her urine. She has also noted spotted blood in her urine, which has been present over the last six days. She describes intermittent lower abdominal pain, located in the middle of her abdomen, rated 7 out of 10 in severity, which comes and goes. She has been able to pass urine without difficulty. She denies fever or feeling feverish. She denies lower back pain or loin pain. She denies vaginal discharge. She reports regular menstrual periods. She denies any change in bowel habit, weight loss, or blood in stool. She has not had these symptoms before. She denies recent excessive exercise, dehydration, or increased sexual intercourse as contributing factors. She has been able to eat and drink without difficulty.\n\nMedical History  \n- Irritable bowel syndrome (IBS)\n\nMedications and Supplements  \n- Mebeverine 200 mg PO three times daily  \n- Heparin\n\nAllergies  \n- Clindamycin\n\nSocial History  \n- Occupation: Works as a support worker  \n- Living Situation: Lives with friends  \n- Alcohol: Occasional, one glass of wine per week  \n- Tobacco: Denies smoking\n\nReview of Systems  \n- General: Denies fever, weight loss  \n- Gastrointestinal: Denies change in bowel habit, blood in stool  \n- Genitourinary: Denies difficulty urinating, vaginal discharge  \n- Musculoskeletal: Denies lower back pain\n\nObjective\nN/A\n\nAssessment & Plan\n52-year-old female with history of IBS, presenting with a 6-day history of dysuria, hematuria, and lower abdominal pain.\n\nUrinary Tract Infection  \nAssessment: Patient presents with classic symptoms of urinary tract infection including dysuria for 6 days, hematuria, and lower abdominal pain rated 7/10 that comes and goes. The combination of painful urination, blood in urine, and abdominal discomfort without fever or back pain is consistent with lower urinary tract infection. Patient has no previous history of UTIs and denies recent precipitating factors such as dehydration, increased sexual activity, or vigorous exercise.  \nPlan:  \n- Prescribe 3-day course of antibiotics  \n- Prescription to be sent to Knightsbridge Practice pharmacy, to be ready in approximately one hour  \n- Increase fluid intake to 2.5-3 liters per day  \n- Consider cranberry juice and urine acidifying sachets from pharmacy  \n- Monitor temperature with thermometer purchased from pharmacy  \n- Return for reassessment if symptoms worsen, develop fever, experience back pain, have difficulty urinating, or if UTI becomes recurrent\n","review":149.2763157894737,"saved":155.2236842105263,"clean":false,"effort":13.333333333333334,"sig":[["fabrication","Medications list includes 'Heparin'","Heparin is invented; only mebeverine was named, and a false anticoagulant entry affects prescribing and bleeding assessment."]],"mb":14.058696,"latency":50.419,"signable":187.4653157894737},{"label":"Run 5","wer":13.394495412844037,"text":"Good morning, I'm Doctor Smith from Babylon. Can you just confirm your name, date of birth, and the 1st line of your address, please?\n  Hi, my name is Susan, 30 Redbridge Street, S. W. 2, 2, H. Z. And your date of birth?\n  14-02-1974. Okay, are you in a private place where you can have a consultation today? Yes, I am. Okay, what can I do for you? It hurts when I pee. Okay, and how long has that been going on for? 6 days now. Pardon?\n  6 days.\n  6 days, okay. And just tell me a bit more about that. How did it start?\n  I've got this thing when I pee and it hurts when I go to the loo. I've got this very unpleasant smell that comes out.\n  Okay. Have you had any other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay, is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of one to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay, and have you actually been able to pass water okay? Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right, and have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or held a temperature with this?\n  No, not at all.\n  You said you didn't have any lower back pain?\n  No, I've got a no-loin pain as well.\n  Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything?\n  No.\n  No, okay. And any other symptoms, any vaginal discharge or anything like that?\n  No, just the blood spot in my...\n  Do you have regular periods?\n  Yes, I do.\n  Okay. And in the past, have you had any medical problems at all? No medical, no. Have you had any problems with your kidneys or any urine infections?\n  I had IBS before.\n  Okay. And how's that been recently? Any change in your bowel habit? Any blood running past stool?\n  Yeah, I've had spotting in my urine.\n  Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meverine. I've had heparin. Do you take that regularly?\n  Yes.\n  Okay, and do you take it 3 times a day?\n  Yes, I do.\n  200 milligrams? Yes. Any allergies? Any allergies?\n  Clindamycin.\n  You're allergic to clindamycin? Okay. And anyone in your family had any medical problems? No. That's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. OK. And where do you work? What's your job?\n  I'm a support worker.\n  OK. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. OK. Do you smoke? No. OK. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally we can treat this infection without having to test your urine with a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics?\n  Yes, I would be.\n  It would just be for 3 days. Okay. Do I have to get my prescription? Yes, so I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3 litres a day. You can get some cranberry juice and drink that as well, that sometimes helps, and also some sachets which you can get from the chemist. some stethos which just help change the acidity of your urine so I can put the details of that on your notes. If you feel like your pain is getting worse or not settling you get lower back pain or you're getting a high temperature or you have any problems actually passing urine then it's very important that we speak to you again. The other thing is if it becomes a common thing or a recurrent problem... then we need to talk to you again about it.\n  So do I have to go after I finish my course of antibiotics?\n  No, not if you're better. If you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No. What would be the pharmacy I would be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knightsbridge Practice. Okay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy. You'll be able to pick them up from there.\n  How soon is that going to be at the practice? In 5 minutes?\n  I would give it longer than that. Give it an hour or so.\n  All right then. Thank you. I'll pick you up at lunchtime.\n  Okay. All right then. Thank you. Take care. Bye. Bye.","marks":[{"start":100,"end":103,"said":"first","significant":false},{"start":179,"end":184,"said":"SW","significant":false},{"start":191,"end":196,"said":"HZ. Hello.","significant":false},{"start":223,"end":239,"said":"forty oh two nineteen seventy four. 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Um","significant":false},{"start":4737,"end":4747,"said":"Uh where will","significant":false},{"start":4764,"end":4771,"said":"I'll","significant":false},{"start":4979,"end":4987,"said":"gonna","significant":false},{"start":5031,"end":5031,"said":"How soon And then","significant":false},{"start":5094,"end":5102,"said":"gonna","significant":false},{"start":5235,"end":5241,"said":"that","significant":false},{"start":5280,"end":5290,"said":"","significant":false},{"start":5306,"end":5306,"said":"Thank you. .","significant":false},{"start":5311,"end":5311,"said":"Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","yes","States able to pass urine without difficulty and to eat and drink."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and lower back/loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily recorded."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Recurrent UTI review plus 'No routine follow-up needed if symptoms resolve with treatment'."]],"claims":[["Medications list includes 'Heparin'","Transcript names only mebeverine as a regular medication; heparin is never mentioned."]],"note":"Subjective\nSusan, a patient with a history of irritable bowel syndrome, presents with a 6-day history of dysuria, malodorous urine, hematuria, and lower abdominal pain. She reports pain on urination accompanied by a very unpleasant smell to her urine, both ongoing for 6 days. She has also noted spotted blood in her urine over the same period. She describes intermittent pain in her lower abdomen, located in the middle, rated 7 out of 10 in severity, which comes and goes. She has been able to pass urine without difficulty. She denies fever or feeling feverish. She denies lower back pain or loin pain. She denies vaginal discharge. She reports regular menstrual periods. She denies any change in bowel habit, weight loss, or blood in stool. She has not had these symptoms before. She denies recent excessive exercise, dehydration, or increased sexual activity as contributing factors. She has been able to eat and drink without difficulty.\n\nMedical History  \n- Irritable bowel syndrome\n\nMedications and Supplements  \n- Mebeverine 200 mg PO three times daily  \n- Heparin\n\nAllergies  \n- Clindamycin\n\nSocial History  \n- Occupation: Works as a support worker  \n- Living Situation: Lives with friends  \n- Alcohol: Occasional, 1 glass of wine per week  \n- Tobacco: Denies smoking\n\nReview of Systems  \n- General: Denies fever, weight loss  \n- Gastrointestinal: Denies change in bowel habit, blood in stool  \n- Genitourinary: Denies difficulty urinating, vaginal discharge  \n- Musculoskeletal: Denies lower back pain\n\nObjective\nN/A\n\nAssessment & Plan\nSusan presents with a 6-day history of dysuria, hematuria, and lower abdominal pain.\n\nUrinary Tract Infection  \nAssessment: Patient presents with classic symptoms of urinary tract infection including dysuria for 6 days, hematuria, and lower abdominal pain rated 7/10 that comes and goes. No fever reported. No previous history of UTIs or kidney problems. Patient has history of IBS but no recent change in bowel habits. No vaginal discharge reported. Clinical presentation is consistent with uncomplicated UTI.  \nPlan:  \n- Prescribe 3-day course of antibiotics  \n- Prescription to be sent to Knightsbridge Practice pharmacy, allow approximately 1 hour for processing  \n- Increase fluid intake to 2.5-3 liters daily  \n- Consider cranberry juice and urine acidifying sachets from pharmacy  \n- Obtain thermometer to monitor temperature  \n- Return for reassessment if symptoms worsen, develop lower back pain, high fever, difficulty passing urine, or if UTI becomes recurrent  \n- No routine follow-up needed if symptoms resolve with treatment\n","review":132.9473684210526,"saved":171.5526315789474,"clean":false,"effort":10.0,"sig":[["fabrication","Medications list includes 'Heparin'","Heparin is invented; only mebeverine was named, and a false anticoagulant entry affects prescribing and bleeding assessment."]],"mb":13.973397,"latency":47.947,"signable":168.7113684210526}],"cliniscripts":[{"label":"Run 1","wer":8.715596330275229,"text":"Good morning.\nI'm Dr. Smith from Babylon.\nCan you just confirm your name, date of birth, and the first line of your address, please?\nHi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ. And your date of birth?\n14/02/1974. Okay. Are you in a private place so you can have a consultation today?\nYes, I am. Okay. What can I do for you?\nIt hurts when I pee.\nOkay. And how long has that been going on for?\n6 days now. Pardon?\nFor 6 days. 6 days.\nOkay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loo. Okay. And I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\nI've got pain in my tummy. Whereabouts?\nIn my lower tummy. Okay. Is it one-sided, or in the middle?\nIn the middle. And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain. 7.\nAnd is it constant, or does it come and go?\nComes and goes. Okay. And have you actually been able to pass water okay? Yes, but I've had spotted, uh, blood in my urine, spotted.\nOkay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay?\nYes.\nUm, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this?\nNo. Not at all. Um, and any did you you said you didn't have any low back pain? No.\nI've got um, and no loin pain as well. Okay. And have you had these symptoms before? No.\nNever? No.\nAnd was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse, or anything?\nNo. No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\nNo.\nJust the blood spot in my. Okay. Do you have regular periods?\nYes, I do. Okay.\nUm, and at in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay.\nAnd how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\nYeah, I've had spotting in my urine. In your okay. Um, any change in your bowel habit? No. Any weight loss or anything?\nNo. Any other medical problems or surgery in the past?\nNo. Do you take regular medications?\nI've had Mebivine. Pardon? Mebivine. Meb. I've had Mebivine. Do you take that regularly? Yes.\nOkay. And it do you take it 3 times a day? Yes, I do.\n200 milligrams?\nYes. Any allergies?\nAny allergies? Clindamycin. You're allergic to clindamycin. Okay.\nAnd anyone in your family had any medical problems?\nNo.\nThat's fine. And whereabouts do you live? Do you live with friends, family?\nI live with friends.\nOkay. And where do you work? What's your job?\nI'm a support worker.\nOkay.\nDo you drink alcohol at all?\nOccasionally. So how much in average week?\nOne glass of wine a week.\nOkay. Do you smoke?\nNo. Okay.\nUm, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\nNo. Okay.\nIt would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down. Okay. Um, normally we can treat this infection without having to test your urine. Uh, with, with the course of antibiotics.\nOkay.\nUm, how would you feel about that? Are you happy to take a course of antibiotics?\nYes, I would be. It would just be for 3 days. Okay. Um. So how do I get my prescription? Yes.\nSo I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing, which is important to do, is to drink lots of water. So 2 and a half to 3 liters a day. Yeah. Um, you can get some cranberry juice and take drink that as well. That's sometimes helps.\nAnd also some sachets. Um, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I, I can put the details of that on your notes. Okay then. Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\nOkay. Um, the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\nSo do I have to call after I finish my course of antibiotics? No, not if you're better. Okay. If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk talk to you in more detail about that.\nOkay then. Um, have you got any other questions?\nUh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did.\nCan I just check that with you?\nKnightsbridge Practice. Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\nAnd then. Also. You'll be able to pick them up from there.\nHow soon is that going to be at the practice?\nIn 5 minutes? Um, I would give it longer than that. Give it a. Okay. An hour or so. All right then. Thank you. I'll pick that at lunchtime.\nOkay. All right then. Thank you. Take care. Bye. Bye. Sorry, I don","marks":[{"start":180,"end":188,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":230,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":404,"end":410,"said":"It stays","significant":false},{"start":968,"end":968,"said":"Seven.","significant":false},{"start":1137,"end":1151,"said":"Spots. OK.","significant":false},{"start":1425,"end":1428,"said":"lower","significant":false},{"start":1876,"end":1881,"said":"No.","significant":false},{"start":2107,"end":2114,"said":"how's","significant":false},{"start":2285,"end":2288,"said":"","significant":false},{"start":2316,"end":2316,"said":"No.","significant":false},{"start":2419,"end":2451,"said":"Mebeverine Mebeverine.","significant":true},{"start":2461,"end":2470,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":3478,"end":3483,"said":"do","significant":false},{"start":3608,"end":3619,"said":"","significant":false},{"start":3913,"end":3919,"said":"litres","significant":false},{"start":3999,"end":4005,"said":"that","significant":false},{"start":4847,"end":4858,"said":"reccurently.","significant":false},{"start":4995,"end":5005,"said":"where will","significant":false},{"start":5239,"end":5247,"said":"gonna","significant":false},{"start":5296,"end":5296,"said":"How soon","significant":false},{"start":5307,"end":5312,"said":"","significant":false},{"start":5373,"end":5381,"said":"gonna","significant":false},{"start":5564,"end":5574,"said":"","significant":false},{"start":5590,"end":5590,"said":"Thank you. .","significant":false},{"start":5605,"end":5608,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"dysuria ... ongoing for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"unpleasant smell associated with urination\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"lower abdominal pain, localized to the middle, rated 7/10 ... intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"spotted blood in urine\" for 6 days."],["The note captures: Able to pass urine and maintain oral intake.","no","Does not record that she can pass urine or is eating and drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","\"denies fever, low back pain, loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies \"vaginal discharge\"; \"have not had these symptoms before\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","partial","Records \"Mebivine 200mg three times a day\" but omits the IBS history and misspells the drug."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"allergy to Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"highly suggestive of a urinary tract infection (UTI)\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribe a 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"get a thermometer and check temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"drink 2.5 to 3 liters of water daily\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Seek review for worsening pain, lower back pain, high temperature, difficulty passing urine; non-resolution also covered."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Recurrence triggers further review, but does not state no routine review is needed if better."]],"claims":[],"note":"S (Subjective):\n- Patient presents with dysuria, described as pain upon urination, ongoing for 6 days.\n- They report an unpleasant smell associated with urination.\n- Patient also experiences lower abdominal pain, localized to the middle, rated 7/10 in severity, which is intermittent.\n- Hematuria, described as spotted blood in urine, has been present for the last 6 days.\n- Patient denies fever, low back pain, loin pain, vaginal discharge, or recent changes in bowel habits. They have not had these symptoms before.\n\nO (Objective):\n- Patient confirmed identity as Susan, DOB 14/02/1974, address 30 Redbridge Street, SW2 2HZ.\n- Patient reported taking Mebivine 200mg three times a day regularly.\n- Patient states allergy to Clindamycin.\n- Patient reports living with friends and working as a support worker.\n- Patient consumes alcohol occasionally, approximately one glass of wine per week, and does not smoke.\n\nA (Assessment):\n- The patient's symptoms are highly suggestive of a urinary tract infection (UTI).\n- Key symptoms include dysuria, malodorous urine, lower abdominal pain, and hematuria.\n- Absence of fever and loin pain suggests the infection may not yet involve the kidneys.\n\nP (Plan):\n- Prescribe a 3-day course of antibiotics to be sent to Knightsbridge Practice pharmacy.\n- Advise patient to drink 2.5 to 3 liters of water daily.\n- Recommend cranberry juice and alkaline sachets (available from chemist) to help with symptoms and urine acidity.\n- Advise patient to monitor for worsening pain, development of lower back pain, high temperature, or difficulty passing urine, and to seek further medical review if these occur.\n- Advise patient to get a thermometer and check temperature to monitor for fever.\n- If symptoms do not resolve with treatment or become recurrent, further investigation will be required.\n","review":133.9736842105263,"saved":170.5263157894737,"clean":false,"effort":13.333333333333334,"sig":[],"mb":22.618669,"latency":24.096,"signable":143.9776842105263},{"label":"Run 2","wer":8.807339449541285,"text":"Good morning.\nI'm Dr. Smith from Babylon.\nCan you just confirm your name, date of birth, and the first line of your address, please?\nHi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ. And your date of birth?\n14/02/1974. Okay. Are you in a private place so you can have a consultation today?\nYes, I am. Okay. What can I do for you?\nIt hurts when I pee.\nOkay. And how long has that been going on for?\n6 days now. Pardon?\nFor 6 days. 6 days.\nOkay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loo. Okay. And I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or ba lower back pain at all?\nI've got pain in my tummy. Whereabouts?\nIn my lower tummy. Okay. Is it one-sided or in the middle?\nIn the middle. And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain. 7. And is it constant, or does it come and go?\nComes and goes. Okay.\nAnd have you actually been able to pass water okay?\nYes, but I've had spotted, uh, blood in my urine.\nOkay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay?\nYes.\nUm, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. Um, and any did you you said you didn't have any low back pain? No.\nI've got um, and no loin pain as well. Okay. And have you had these symptoms before? No.\nNever? No.\nAnd was there anything you were doing recently, which you think may have contributed to it? Have you be have you been doing lots of exercise, been dehydrated? Um, been having regular sexual intercourse or anything?\nNo. No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\nNo.\nJust the blood spot in my. Okay. Do you have regular periods?\nYes, I do. Okay.\nUm, and at in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\nYeah, I've had spotting in my urine. In your okay. Um, any change in your bowel habit? No. Any weight loss or anything?\nNo. Any other medical problems or surgery in the past?\nNo. Do you take regular medications?\nI've had Mebivine.\nPardon? Mebiverine. Meb. I've had Mebiverine. Do you take that regularly? Yes.\nOkay. And it do you take it 3 times a day? Yes, I do.\n200 milligrams?\nYes. Any allergies?\nAny allergies? Clindamycin. You're allergic to clindamycin. Okay.\nAnd anyone in your family had any medical problems?\nNo.\nThat's fine. And whereabouts do you live? Do you live with friends, family?\nI live with friends.\nOkay. And where do you work? What's your job?\nI'm a support worker.\nOkay.\nDo you drink alcohol at all?\nOccasionally. So how much in an average week?\nOne glass of wine a week.\nOkay. Do you smoke?\nNo. Okay.\nUm, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\nNo. Okay.\nIt would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down. Okay. Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\nOkay.\nUm, how would you feel about that? Are you happy to take a course of antibiotics?\nYes, I would be. It would just be for 3 days?\nOkay. Um. So how get my prescription? Yes.\nSo I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 liters a day. Yeah. Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the det\nails of that on your notes. Okay then. Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\nOkay. Um, the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\nSo do I have to call after I finish my course of antibiotics? No, not if you're better. Okay. If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk talk to you in more detail about that.\nOkay then. Um, have you got any other questions?\nUh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did.\nCan I just check that with you?\nKnightsbridge Practice. Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\nOkay. And. Also?\nYou'll be able to pick them up from there.\nHow soon is that going to be at the practice?\nIn 5 minutes? Um, I would give it longer than that. Give it a. Okay. An hour or so.\nAll right then. Thank you. I'll pick that at lunchtime.\nOkay. All right then. Thank you. Take care. Bye. Bye. Sorry, I don","marks":[{"start":180,"end":188,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":230,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":404,"end":410,"said":"It stays","significant":false},{"start":735,"end":737,"said":"back","significant":false},{"start":965,"end":965,"said":"Seven.","significant":false},{"start":1134,"end":1139,"said":"Spots. OK.","significant":false},{"start":1413,"end":1416,"said":"lower","significant":false},{"start":1866,"end":1871,"said":"No.","significant":false},{"start":2097,"end":2104,"said":"how's","significant":false},{"start":2275,"end":2278,"said":"","significant":false},{"start":2306,"end":2306,"said":"No.","significant":false},{"start":2409,"end":2443,"said":"Mebeverine Mebeverine.","significant":false},{"start":2453,"end":2464,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":3473,"end":3478,"said":"do","significant":false},{"start":3603,"end":3609,"said":"","significant":false},{"start":3901,"end":3907,"said":"litres","significant":false},{"start":3987,"end":3993,"said":"that","significant":false},{"start":4157,"end":4165,"said":"details","significant":false},{"start":4834,"end":4845,"said":"reccurently.","significant":false},{"start":4982,"end":4992,"said":"where will","significant":false},{"start":5226,"end":5234,"said":"gonna","significant":false},{"start":5284,"end":5289,"said":"How soon","significant":false},{"start":5295,"end":5299,"said":"then","significant":false},{"start":5361,"end":5369,"said":"gonna","significant":false},{"start":5552,"end":5562,"said":"","significant":false},{"start":5578,"end":5578,"said":"Thank you. .","significant":false},{"start":5593,"end":5596,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","partial","Records eating and drinking adequately but not that she can pass urine OK."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and lower back/loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","partial","Denies vaginal discharge, but no mention that she has not had these symptoms before."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with 'Mebiverine 200mg three times a day' recorded (spelling variant)."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not recorded anywhere."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Recurrence review mentioned but does not state that no routine post-course review is needed if better."]],"claims":[],"note":"S (Subjective):\n- The patient reports dysuria, describing it as pain when they pee, which started 6 days ago.\n- They also report an unpleasant smell associated with their urine and spotted blood in their urine over the last 6 days.\n- The patient describes lower abdominal pain, located in the middle, rating it 7/10 in severity, and notes it comes and goes.\n- They deny any fever, temperature, lower back pain, loin pain, or vaginal discharge.\n- The patient has a history of Irritable Bowel Syndrome (IBS) and takes Mebiverine 200mg three times a day, with no recent changes in bowel habits or weight loss.\n\nO (Objective):\n- The patient confirmed their identity and was in a private place for the consultation.\n- They reported being able to eat and drink adequately.\n- The patient stated they do not have a thermometer at home.\n- The patient was cooperative and communicative throughout the consultation.\n\nA (Assessment):\n- The doctor's primary assessment is a likely urine infection, consistent with the patient's reported symptoms.\n- Differential diagnoses were not explicitly discussed in the conversation.\n\nP (Plan):\n- Prescribe a 3-day course of antibiotics for the suspected urine infection.\n- Send the prescription to the patient's requested pharmacy, Knightsbridge Practice, to be available in approximately one hour.\n- Advise the patient to increase fluid intake to 2.5-3 liters of water daily.\n- Recommend considering cranberry juice and over-the-counter sachets to alter urine acidity.\n- Advise the patient to obtain a thermometer and monitor their temperature.\n- Instruct the patient to contact the clinic again if symptoms worsen, do not resolve, if they develop lower back pain or a high temperature, experience difficulty passing urine, or if the problem becomes recurrent.\n","review":148.17105263157896,"saved":156.32894736842104,"clean":false,"effort":16.666666666666664,"sig":[["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy not recorded despite antibiotics being prescribed."]],"mb":22.652398,"latency":29.454,"signable":163.17105263157896},{"label":"Run 3","wer":9.08256880733945,"text":"Good morning.\nI'm Dr. Smith from Babylon.\nCan you just confirm your name, date of birth, and the first line of your address, please?\nHi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ. And your date of birth?\n14/02/1974. Okay. Are you in a private place so you can have a consultation today?\nYes, I am. Okay. What can I do for you?\nIt hurts when I pee.\nOkay. And how long has that been going on for?\n6 days now. Pardon?\nFor 6 days. 6 days.\nOkay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loo. Okay. And I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or ba lower back pain at all?\nI've got pain in my tummy. Whereabouts?\nIn my lower tummy. Okay. Is it one-sided or in the middle?\nIn the middle. And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain. 7. And is it constant, or does it come and go?\nComes and goes. Okay.\nAnd have you actually been able to pass water okay?\nYes, but I've had spotted, uh, blood in my urine.\nOkay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay?\nYes.\nUm, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. Um, and any did you you said you didn't have any low back pain? No.\nI've got um, and no loin pain as well. Okay. And have you had these symptoms before? No.\nNever? No.\nAnd was there anything you were doing recently, which you think may have contributed to it? Have you be have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?\nNo. No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\nNo.\nJust the blood spot in my. Okay. Do you have regular periods?\nYes, I do. Okay.\nUm, and at in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\nYeah, I've had spotting in my urine. In your okay. Um, any change in your bowel habit? No. Any weight loss or anything?\nNo. Any other medical problems or surgery in the past?\nNo. Do you take regular medications?\nI've had Mebivine.\nPardon? Mebiverine. Mebi. I've had Mebiverine. Do you take that regularly? Yes.\nOkay. And it do you take it 3 times a day? Yes, I do.\n200 milligrams?\nYes. Any allergies?\nAny allergies? Clindamycin. You're allergic to clindamycin. Okay.\nAnd anyone in your family had any medical problems?\nNo.\nThat's fine. And whereabouts do you live? Do you live with friends, family?\nI live with friends.\nOkay. And where do you work? What's your job?\nI'm a support worker.\nOkay.\nDo you drink alcohol at all?\nOccasionally. So how much in an average week?\nOne glass of wine a week.\nOkay. Do you smoke?\nNo. Okay.\nUm, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\nNo. Okay.\nIt would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down. Okay. Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\nOkay.\nUm, how would you feel about that? Are you happy to take a course of antibiotics?\nYes, I would be. It would just be for 3 days?\nOkay. Um. So how do I get my prescription? Yes.\nSo I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing, which is important to do, is to drink lots of water. So 2 and a half to 3 liters a day. Yeah. Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets, which just help change the acidity of your urine. So I, I can put the det\nails of that on your notes. Okay then. Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\nOkay. Um, the other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\nSo do I have to call after I finish my course of antibiotics? No, not if you're better. Okay. If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk th talk to you in more detail about that.\nOkay then. Um, have you got any other questions?\nUh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did.\nCan I just check that with you?\nKnightsbridge. Practice. Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\nOkay. And. Also,. You'll be able to pick them up from there.\nHow soon is that going to be at the practice?\nIn 5 minutes? Um, I would give it longer than that. Give it a. Okay. An hour or so. All right then. Thank you. I'll pick that at lunchtime.\nOkay. All right then. Thank you. Take care. Bye. Bye. Sorry, I didn","marks":[{"start":180,"end":188,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":230,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":404,"end":410,"said":"It stays","significant":false},{"start":735,"end":737,"said":"back","significant":false},{"start":965,"end":965,"said":"Seven.","significant":false},{"start":1134,"end":1139,"said":"Spots. OK.","significant":false},{"start":1413,"end":1416,"said":"lower","significant":false},{"start":1866,"end":1871,"said":"No.","significant":false},{"start":2097,"end":2104,"said":"how's","significant":false},{"start":2275,"end":2278,"said":"","significant":false},{"start":2306,"end":2306,"said":"No.","significant":false},{"start":2409,"end":2444,"said":"Mebeverine Mebeverine.","significant":false},{"start":2454,"end":2465,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":3474,"end":3479,"said":"do","significant":false},{"start":3604,"end":3615,"said":"","significant":false},{"start":3909,"end":3915,"said":"litres","significant":false},{"start":3995,"end":4001,"said":"that","significant":false},{"start":4166,"end":4174,"said":"details","significant":false},{"start":4844,"end":4855,"said":"reccurently.","significant":false},{"start":4892,"end":4894,"said":"","significant":false},{"start":4995,"end":5005,"said":"where will","significant":false},{"start":5240,"end":5248,"said":"gonna","significant":false},{"start":5298,"end":5303,"said":"How soon","significant":false},{"start":5309,"end":5315,"said":"then","significant":false},{"start":5376,"end":5384,"said":"gonna","significant":false},{"start":5567,"end":5577,"said":"","significant":false},{"start":5593,"end":5593,"said":"Thank you. .","significant":false},{"start":5608,"end":5612,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"dysuria ... ongoing for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"unpleasant smell associated with urination\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"lower abdominal pain, localized to the middle ... intermittent and rated 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"blood spotting in urine for the past 6 days\"."],["The note captures: Able to pass urine and maintain oral intake.","no","Does not record that she can pass urine or maintain oral intake."],["The note captures: No fever and no loin/lower back pain.","yes","\"Denies fever, low back pain, loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies \"vaginal discharge\"; \"No previous similar symptoms\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","\"known history of IBS\" and \"Mebiverine 200mg three times daily\" (spelling variant)."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Known allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Suspected urinary tract infection (UTI)\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribe a 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"purchase a thermometer to monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"increase fluid intake to 2.5-3 liters per day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Contact if worsening pain, lower back pain, high temperature, difficulty passing urine, or not resolving."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","no","No mention of recurrent episodes review or that no routine post-course review is needed."]],"claims":[],"note":"S (Subjective):\n- Patient presents with dysuria, described as pain upon urination, ongoing for 6 days.\n- Reports an unpleasant smell associated with urination.\n- Experiences lower abdominal pain, localized to the middle, described as intermittent and rated 7/10 in severity.\n- Noted blood spotting in urine for the past 6 days.\n- Denies fever, low back pain, loin pain, vaginal discharge, recent dehydration, excessive exercise, or unusual sexual intercourse. No previous similar symptoms.\n\nO (Objective):\n- Patient confirmed identity: Susan, DOB 14/02/1974, 30 Redbridge Street, SW2 2HZ.\n- Patient has a known history of IBS, currently stable with no recent change in bowel habits, blood in stool, or weight loss.\n- Current regular medication: Mebiverine 200mg three times daily.\n- Known allergy: Clindamycin.\n- Social history: Lives with friends, works as a support worker, occasionally drinks one glass of wine per week, non-smoker.\n\nA (Assessment):\n- Suspected urinary tract infection (UTI).\n- Differential diagnoses include other causes of dysuria and hematuria.\n- Patient's symptoms are consistent with an acute uncomplicated UTI.\n\nP (Plan):\n- Prescribe a 3-day course of antibiotics to be collected from Knightsbridge Practice pharmacy.\n- Advised patient to increase fluid intake to 2.5-3 liters per day.\n- Recommended cranberry juice and over-the-counter sachets to alter urine acidity.\n- Advised to monitor for worsening pain, development of lower back pain, high temperature, or difficulty passing urine, and to contact clinician if these occur or if symptoms do not resolve.\n- Advised to purchase a thermometer to monitor temperature, as no fever reported currently.\n","review":119.81578947368422,"saved":184.68421052631578,"clean":false,"effort":13.333333333333334,"sig":[["missing","Review recurrent episodes; no routine post-course review is needed if completely better.","Safety-netting advice to return for recurrent episodes was given but is absent from the note."]],"mb":22.669198,"latency":24.109,"signable":129.81078947368422},{"label":"Run 4","wer":8.807339449541285,"text":"Good morning.\nI'm Dr. Smith from Babylon.\nCan you just confirm your name, date of birth, and the first line of your address, please?\nHi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ. And your date of birth?\n14/02/1974. Okay. Are you in a private place so you can have a consultation today?\nYes, I am. Okay. What can I do for you?\nIt hurts when I pee.\nOkay. And how long has that been going on for?\n6 days now. Pardon?\nFor 6 days. 6 days.\nOkay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loo. Okay. And I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\nI've got pain in my tummy. Whereabouts?\nIn my lower tummy. Okay. Is it one-sided or in the middle?\nIn the middle. And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain. 7. And is it constant, or does it come and go?\nComes and goes. Okay.\nAnd have you actually been able to pass water okay?\nYes, but I've had spotted, uh, blood in my urine.\nOkay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay?\nYes.\nUm, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. Um, and any did you you said you didn't have any low back pain? No.\nI've got um, and no loin pain as well. Okay. And have you had these symptoms before? No.\nNever? No.\nAnd was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?\nNo. No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\nNo.\nJust the blood spot in my. Okay. Do you have regular periods?\nYes, I do. Okay.\nUm, and in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\nYeah, I've had spotting in my urine. In your okay. Um, any change in your bowel habit? No. Any weight loss or anything?\nNo. Any other medical problems or surgery in the past?\nNo. Do you take regular medications?\nI've had Mebivine.\nPardon? Mebiverine. Meb. I've had Mebiverine. Do you take that regularly? Yes.\nOkay. And do you take it 3 times a day? Yes, I do.\n200 milligrams?\nYes. Any allergies?\nAny allergies? Clindamycin. You're allergic to clindamycin. Okay.\nAnd anyone in your family had any medical problems?\nNo.\nThat's fine. And whereabouts do you live? Do you live with friends, family?\nI live with friends.\nOkay. And where do you work? What's your job?\nI'm a support worker.\nOkay.\nDo you drink alcohol at all?\nOccasionally. So how much in average week?\nOne glass of wine a week. Okay. Do you smoke?\nNo. Okay.\nUm, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\nNo. Okay.\nIt would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down. Okay. Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\nOkay.\nUm, how would you feel about that? Are you happy to take a course of antibiotics?\nYes, I would be. It would just be for 3 days.\nOkay. Um. So how do I get my prescription? Yes.\nSo I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 liters a day. Yeah. Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the det\nails of that on your notes. Okay then. Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\nOkay. Um, the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\nSo do I have to call after I finish my course of antibiotics? No, not if you're better. Okay. If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk talk to you in more detail about that.\nOkay then. Um, have you got any other questions?\nUh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did.\nCan I just check that with you?\nKnightsbridge Practice. Okay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\nOkay. And. Also?\nYou'll be able to pick them up from there.\nHow soon is that going to be at the practice?\nIn 5 minutes? Um, I would give it longer than that. Give it a. Okay. An hour or so.\nAll right then. Thank you. I'll pick that at lunchtime.\nOkay. All right then. Thank you. Take care. Bye. Bye. Sorry, I don","marks":[{"start":180,"end":188,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":230,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":404,"end":410,"said":"It stays","significant":false},{"start":967,"end":967,"said":"Seven.","significant":false},{"start":1136,"end":1141,"said":"Spots. OK.","significant":false},{"start":1415,"end":1418,"said":"lower","significant":false},{"start":1865,"end":1870,"said":"No.","significant":false},{"start":2093,"end":2100,"said":"how's","significant":false},{"start":2271,"end":2274,"said":"","significant":false},{"start":2302,"end":2302,"said":"No.","significant":false},{"start":2405,"end":2439,"said":"Mebeverine Mebeverine.","significant":false},{"start":2449,"end":2460,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":3463,"end":3468,"said":"do","significant":false},{"start":3593,"end":3604,"said":"","significant":false},{"start":3896,"end":3902,"said":"litres","significant":false},{"start":3982,"end":3988,"said":"that","significant":false},{"start":4152,"end":4160,"said":"details","significant":false},{"start":4829,"end":4840,"said":"reccurently.","significant":false},{"start":4977,"end":4987,"said":"where will","significant":false},{"start":5221,"end":5229,"said":"gonna","significant":false},{"start":5279,"end":5284,"said":"How soon","significant":false},{"start":5290,"end":5294,"said":"then","significant":false},{"start":5356,"end":5364,"said":"gonna","significant":false},{"start":5547,"end":5557,"said":"","significant":false},{"start":5573,"end":5573,"said":"Thank you. .","significant":false},{"start":5588,"end":5591,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Captures 6-day history of dysuria/pain on urination."],["The note captures: Unpleasant or strong urine odour.","yes","Records unpleasant smell of urine."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Intermittent central lower abdominal pain rated 7/10 captured."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Records spotted blood in urine / haematuria."],["The note captures: Able to pass urine and maintain oral intake.","no","Neither ability to pass urine nor eating/drinking is mentioned."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and lower back/loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Denies vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","partial","Mebiverine 200mg three times daily recorded but IBS history omitted."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Urinary tract infection is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","3-day course of antibiotics prescribed, no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluid intake 2.5-3 litres daily advised."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net covers worsening symptoms, back pain, high temperature and difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","Follow-up if not resolving or recurrent is recorded, but not that no routine review is needed if better."]],"claims":[],"note":"S (Subjective):\n- Patient presents with dysuria, described as pain upon urination, ongoing for 6 days.\n- Reports an unpleasant smell associated with urination.\n- Experiences lower abdominal pain, localized to the middle, described as intermittent and rated 7/10 in severity.\n- Noted blood spotting in urine, present over the last 6 days.\n- Denies fever, low back pain, loin pain, vaginal discharge, or changes in bowel habits. No prior history of similar symptoms.\n\nO (Objective):\n- Patient confirmed identity as Susan, born 14/02/1974, residing at 30 Redbridge Street, SW2 2HZ.\n- Patient takes Mebiverine 200mg three times daily.\n- Patient reports an allergy to Clindamycin.\n- Patient lives with friends and works as a support worker.\n- Patient consumes alcohol occasionally, approximately one glass of wine per week, and does not smoke.\n\nA (Assessment):\n- Suspected urinary tract infection.\n- Patient denies fever, which is noted.\n\nP (Plan):\n- Patient advised to obtain a thermometer and monitor temperature.\n- Prescription for a 3-day course of antibiotics to be sent to Knightsbridge Practice pharmacy.\n- Patient advised to drink 2.5 to 3 liters of water daily, consider cranberry juice, and use sachets from the chemist to alter urine acidity.\n- Patient advised to seek further review if pain worsens, lower back pain develops, high temperature occurs, or if there are difficulties passing urine.\n- Follow-up recommended if symptoms do not resolve with treatment or if the problem becomes recurrent.\n","review":118.5,"saved":186.0,"clean":false,"effort":13.333333333333334,"sig":[],"mb":22.49195,"latency":23.912,"signable":128.488},{"label":"Run 5","wer":8.623853211009175,"text":"Good morning.\nI'm Dr. Smith from Babylon.\nCan you just confirm your name, date of birth, and the first line of your address, please?\nHi. My name is Susan. Um, 30 Redbridge Street, SW2 2HZ. And your date of birth?\n14/02/1974. Okay. Are you in a private place so you can have a consultation today?\nYes, I am. Okay. What can I do for you?\nIt hurts when I pee.\nOkay. And how long has that been going on for?\n6 days now. Pardon?\nFor 6 days. 6 days.\nOkay. And just tell me a bit more about that. How did it start? Um, I've got this thing when I pee, and it hurts when I go to the loo. Okay. And I've got this very unpleasant smell that comes out. Okay. And have you had any other symptoms along with that? Have you had any abdominal pain or back lower back pain at all?\nI've got pain in my tummy. Whereabouts?\nIn my lower tummy. Okay. Is it one-sided or in the middle?\nIn the middle. And how bad would you say that is on a scale of 1 to 10? With 10 being the worst pain. 7. And is it constant, or does it come and go?\nComes and goes. Okay.\nAnd have you actually been able to pass water okay?\nYes, but I've had spotted, uh, blood in my urine.\nOkay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay?\nYes.\nUm, and have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. Um, and any did you you said you didn't have any low back pain? No.\nI've got um, and no loin pain as well. Okay. And have you had these symptoms before? No.\nNever? No.\nAnd was there anything you were doing recently, which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, um, been having regular sexual intercourse or anything?\nNo. No? Okay. And any, any other symptoms? Any vaginal discharge or anything like that?\nNo.\nJust the blood spot in my. Okay. Do you have regular periods?\nYes, I do. Okay.\nUm, and in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS before. Okay. And how has that been recently? Any change in your bowel habit? Any blood when you pass stool?\nYeah, I've had spotting in my urine. In your okay. Um, any change in your bowel habit? No. Any weight loss or anything?\nNo. Any other medical problems or surgery in the past?\nNo. Do you take regular medications?\nI've had Mebivine.\nPardon? Mebeverine. Meb. I've had Mebeverine. Do you take that regularly? Yes.\nOkay. And do you take it 3 times a day? Yes, I do.\n200 milligrams?\nYes. Any allergies?\nAny allergies? Clindamycin. You're allergic to clindamycin. Okay.\nAnd anyone in your family had any medical problems?\nNo.\nThat's fine. And whereabouts do you live? Do you live with friends, family?\nI live with friends.\nOkay. And where do you work? What's your job?\nI'm a support worker.\nOkay.\nDo you drink alcohol at all?\nOccasionally. So how much in average week?\nOne glass of wine a week. Okay. Do you smoke?\nNo. Okay.\nUm, it sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home?\nNo. Okay.\nIt would be helpful if you could get a thermometer from the pharmacy and do check your temperature, just to make sure that it isn't going up and down. Okay. Um, normally we can treat this infection without having to test your urine. Uh, with, with a course of antibiotics.\nOkay.\nUm, how would you feel about that? Are you happy to take a course of antibiotics?\nYes, I would be. It would just be for 3 days.\nOkay. Um. So how do I get my prescription? Yes.\nSo I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can, and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3 liters a day. Yeah. Um, you can get some cranberry juice and take drink that as well. That's sometimes helps. And also some sachets, um, which you can get from the chemist, some sachets which just help change the acidity of your urine. So I, I can put the det\nails of that on your notes. Okay then. Um, if you feel like your pain is getting worse or not settling, you get lower back pain, um, or you're getting a high temperature, or you have any problems actually passing urine, then it's very important that we speak to you again.\nOkay. Um, the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it.\nSo do I have to call after I finish my course of antibiotics? No, not if you're better. Okay. If you're if you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar um, you keep getting a similar problem, recurrently, then it's important for us to talk talk to you in more detail about that.\nOkay then. Um, have you got any other questions?\nUh, no. Uh, what would be the pharmacy I'll be picking up my medication from? Um, so have you already requested a pharmacy through Babylon? Yes, I did.\nCan I just check that with you?\nKnightsbridge Practice.\nOkay. That's fine. So the antibiotics, that I'm going to prescribe, um, will go through to that pharmacy.\nOkay. And. Also?\nYou'll be able to pick them up from there.\nHow soon is that going to be at the practice?\nIn 5 minutes? Um, I would give it longer than that. Give it a. Okay. An hour or so.\nAll right then. Thank you. I'll pick that at lunchtime.\nOkay. All right then. Thank you. Take care. Bye. Bye. Sorry, I did","marks":[{"start":180,"end":188,"said":"SW two two HZ. Hello.","significant":false},{"start":213,"end":230,"said":"forty oh two nineteen seventy four. OK.","significant":false},{"start":404,"end":410,"said":"It stays","significant":false},{"start":967,"end":967,"said":"Seven.","significant":false},{"start":1136,"end":1141,"said":"Spots. 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Allergic to Clindamycin.\n\nO (Objective):\n- Patient confirmed identity with name, date of birth (14/02/1974), and address (30 Redbridge Street, SW2 2HZ).\n- Patient is in a private place for consultation.\n- Patient denies feeling feverish and does not have a thermometer at home.\n\nA (Assessment):\n- The doctor suspects a urinary tract infection based on the patient's reported symptoms of dysuria, unpleasant urine smell, lower abdominal pain, and hematuria.\n\nP (Plan):\n- Prescribe a 3-day course of antibiotics to be sent to the requested pharmacy (Knightsbridge Practice).\n- Advised to drink 2.5 to 3 liters of water daily, consume cranberry juice, and consider over-the-counter sachets to alter urine acidity.\n- Patient advised to obtain a thermometer and monitor temperature.\n- Follow-up recommended if pain worsens, lower back pain develops, high temperature occurs, problems with urination arise, or if symptoms do not resolve or become recurrent.\n","review":101.22368421052632,"saved":203.2763157894737,"clean":false,"effort":10.0,"sig":[],"mb":22.654402,"latency":22.829,"signable":110.18768421052631}],"lyrebird":[{"label":"Run 1","wer":10.550458715596331,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please? Hi. My name is Susan. 30 Ridbridge Street, s w 2 2 h zed. And your date of birth? 14 o 2 74. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? 6 days now. Pardon? For 6 days. 6 days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loo. I've got this very unpleasant smell that comes out. Okay. And have you had any other\n\nSymptoms along with that. Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. At whereabouts? In my lower tummy. Okay. Is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10 with 10 being the worst pain? 7. And is it constant, or does it come and go? Comes and goes. Okay. And have you\n\nActually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. And any did you you said you didn't have any lower\n\nPain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse, or anything? No. No? Okay.\n\nAnd any any other symptoms, any vaginal discharge, or anything like that? No. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS\n\nOkay. And how's that been recently? Any change in your bowel habit? Any blood when you passed? Or Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meibelin. Pardon? I've had\n\nEvergreen. Do you take that regularly? Yes. Okay. And do you take it 3 times a day? Yes. I do. 200 milligrams? Yes. Any allergies? Any allergies? Clindamycin. You're allergic to clindamycin. Okay. And anyone in your family had any medical problems? No.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in your average week? 1 glass of wine a week. Okay. Do you smoke? No. Okay.\n\nIt sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine, with with a course of antibiotics.\n\nOkay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for 3 days. Okay. Perhaps get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3\n\nA day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemists and sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature\n\nYou have any problems actually passing urine, then it's very important that we speak to you again. Okay. And the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar\n\nProblem recurrently, then it's important for us to talk talk to you in more detail about that. Okay then. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you? Knightsbridge Practice. Okay. That's fine. So the antibiotics\n\nThat I'm gonna prescribe, and we'll go through to that pharmacy. Then you'll be able to pick them up from there. How soon is that gonna be at the practice? In 5 minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I don't","marks":[{"start":161,"end":170,"said":"Redbridge","significant":false},{"start":179,"end":182,"said":"SW","significant":false},{"start":187,"end":193,"said":"HZ. Hello.","significant":false},{"start":218,"end":222,"said":"forty oh","significant":false},{"start":225,"end":234,"said":"nineteen seventy four. 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Um.","significant":false},{"start":3801,"end":3801,"said":"litres","significant":true},{"start":3950,"end":3962,"said":"chemist some","significant":false},{"start":4205,"end":4205,"said":"or","significant":false},{"start":4700,"end":4711,"said":"reccurently.","significant":false},{"start":4836,"end":4846,"said":"Uh where will","significant":false},{"start":5093,"end":5102,"said":"um will","significant":false},{"start":5131,"end":5131,"said":"How soon And","significant":false},{"start":5294,"end":5301,"said":"All right","significant":false},{"start":5348,"end":5361,"said":"OK. All right","significant":false},{"start":5368,"end":5378,"said":"","significant":false},{"start":5394,"end":5394,"said":"Thank you. .","significant":false},{"start":5409,"end":5414,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"6-day history of dysuria\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Offensive-smelling urine\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Suprapubic pain, intermittent, 7/10 severity\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Haematuria (blood spotting in urine)\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"Able to pass urine without difficulty\"; \"Eating and drinking normally\"."],["The note captures: No fever and no loin/lower back pain.","partial","\"No fever\" and \"No loin pain\" recorded, but absence of lower back pain is not stated."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"No vaginal discharge\"; \"No previous urinary tract infections\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS and \"Mebeverine 200mg orally three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Assessment: \"Urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Advised to purchase thermometer and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"increase fluid intake to 2.5-3 litres per day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net: pain worsens, loin pain, fever, difficulty passing urine, failure to resolve."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","\"re-consult if symptoms become recurrent\" captured, but not that no routine review is needed if better."]],"claims":[["no rectal bleeding","Asked about blood in stool, patient answered about urine spotting and never denied rectal bleeding; the negation is not supported."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n6-day history of dysuria\n\nOffensive-smelling urine\n\nHaematuria (blood spotting in urine)\n\nSuprapubic pain, intermittent, 7/10 severity\n\nNo fever or chills\n\nNo loin pain\n\nAble to pass urine without difficulty\n\nEating and drinking normally\n\nNo vaginal discharge\n\nRegular menstrual periods\n\nNo previous urinary tract infections\n\nNo recent dehydration, excessive exercise, or sexual intercourse\n\nPast medical history: Irritable bowel syndrome (no recent change in bowel habit, no rectal bleeding, no weight loss)\n\nCurrent medications: Mebeverine 200mg orally three times daily\n\nAllergy: Clindamycin\n\nSocial history: Lives with friends, works as support worker, alcohol consumption 1 glass wine per week, non-smoker\n\n\n\n\nObjective:\n\nPatient confirmed identity and address\n\nConsultation conducted in private setting\n\nNo temperature recorded (patient does not own thermometer)\n\nNo examination findings documented\n\n\n\n\nAssessment:\n\nUrinary tract infection\n\n\n\n\nPlan:\n\n3-day course of antibiotics prescribed to Knightsbridge Practice pharmacy\n\nAdvised to increase fluid intake to 2.5-3 litres per day\n\nRecommended cranberry juice\n\nAdvised to obtain urinary alkalinising sachets from pharmacy\n\nAdvised to purchase thermometer and monitor temperature\n\nSafety netting provided: return if pain worsens, develops loin pain, develops fever, experiences difficulty passing urine, or symptoms fail to resolve with treatment\n\nAdvised to re-consult if symptoms become recurrent\n\nPrescription available for collection in approximately 1 hour","review":104.38157894736841,"saved":200.1184210526316,"clean":false,"effort":16.666666666666664,"sig":[["fabrication","no rectal bleeding","Patient never denied blood in stool (answered about urine), so 'no rectal bleeding' is an unsupported negative on a relevant topic."]],"mb":16.294804,"latency":19.294,"signable":123.67557894736841},{"label":"Run 2","wer":10.825688073394495,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please? Hi. My name is Susan. 30 Ridbridge Street, s w 2 2 h zed. And your date of birth? 14 0 2 7 4. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? 6 days now. Pardon? For 6 days. 6 days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loo. I've got this very unpleasant smell that comes out. Okay. And have you had any other\n\nSymptoms along with that. Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. At whereabouts? In my lower tummy. Okay. Is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10 with 10 being the worst pain? 7. And is it constant, or does it come and go? Comes and goes. Okay. And have you\n\nActually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. And any did you you said you didn't have any low\n\nPain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse, or anything? No. No? Okay.\n\nAnd any any other symptoms, any vaginal discharge or anything like that? No. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS\n\nOkay. And how's that been recently? Any change in your bowel habit? Any blood when you passed stool? Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meibepine. Pardon? Meibepine. I've had\n\nDo you take that regularly? Yes. Okay. And do you take it 3 times a day? Yes. I do. 200 milligrams? Yes. Any allergies? Any allergies? Clindamycin. You're allergic to clindamycin. Okay. And anyone in your family had any medical problems? No.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in your average week? 1 glass of wine a week. Okay. Do you smoke? No. Okay.\n\nIt sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine, with with a course of antibiotics.\n\nOkay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for 3 days. Okay. And my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3\n\nA day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And, also, some sachets, which you can get from the chemists and sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature\n\nYou have any problems actually passing urine, then it's very important that we speak to you again. Okay. And the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar\n\nProblem recurrently, then it's important for us to talk talk to you in more detail about that. Okay then. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you? Knightsbridge Practice. Okay. That's fine. So the antibiotics\n\nThat I'm gonna prescribe, and we'll go through to that pharmacy. Then you'll be able to pick them up from there. How soon is that gonna be at the practice? In 5 minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. Don't","marks":[{"start":161,"end":170,"said":"Redbridge","significant":false},{"start":179,"end":182,"said":"SW","significant":false},{"start":187,"end":193,"said":"HZ. Hello.","significant":false},{"start":218,"end":222,"said":"forty oh","significant":false},{"start":225,"end":226,"said":"nineteen seventy","significant":false},{"start":410,"end":416,"said":"It stays","significant":false},{"start":727,"end":727,"said":"back","significant":true},{"start":957,"end":957,"said":"Seven.","significant":false},{"start":1122,"end":1127,"said":"Spots. OK.","significant":false},{"start":1393,"end":1396,"said":"lower back","significant":false},{"start":1829,"end":1829,"said":"No.","significant":false},{"start":2031,"end":2036,"said":"before. OK.","significant":false},{"start":2118,"end":2124,"said":"pass","significant":false},{"start":2215,"end":2218,"said":"","significant":false},{"start":2246,"end":2246,"said":"No.","significant":false},{"start":2349,"end":2378,"said":"Mebeverine Mebeverine.","significant":true},{"start":2387,"end":2387,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":2861,"end":2865,"said":"a","significant":false},{"start":3380,"end":3385,"said":"do","significant":false},{"start":3500,"end":3509,"said":"OK. Um. get","significant":false},{"start":3795,"end":3795,"said":"litres","significant":true},{"start":3946,"end":3958,"said":"chemist some","significant":false},{"start":4201,"end":4201,"said":"or","significant":false},{"start":4696,"end":4707,"said":"reccurently.","significant":false},{"start":4832,"end":4842,"said":"Uh where will","significant":false},{"start":5089,"end":5098,"said":"um will","significant":false},{"start":5127,"end":5127,"said":"How soon And","significant":false},{"start":5290,"end":5297,"said":"All right","significant":false},{"start":5344,"end":5357,"said":"OK. All right","significant":false},{"start":5364,"end":5374,"said":"","significant":false},{"start":5390,"end":5390,"said":"Thank you. .","significant":false},{"start":5403,"end":5408,"said":"I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"dysuria for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Offensive-smelling urine\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Suprapubic pain, intermittent, 7/10 severity\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Haematuria (blood spotting in urine)\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"Able to pass urine without difficulty\" and \"Eating and drinking normally\"."],["The note captures: No fever and no loin/lower back pain.","yes","\"No fever or chills\" and \"No loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"No vaginal discharge\" and \"No previous episodes of urinary tract infection\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with \"Mebeverine 200mg three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","Assessment \"Urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics prescribed\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Advised to purchase thermometer from pharmacy to monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"increase fluid intake to 2.5-3 litres per day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety net covers worsening pain, loin pain, fever, urinary retention, non-resolution."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"Re-contact if recurrent infections develop\" and \"No routine follow-up required if symptoms resolve\"."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n52-year-old female presenting with dysuria for 6 days\n\nOffensive-smelling urine\n\nHaematuria (blood spotting in urine)\n\nSuprapubic pain, intermittent, 7/10 severity\n\nAble to pass urine without difficulty\n\nNo fever or chills\n\nNo loin pain\n\nNo vaginal discharge\n\nEating and drinking normally\n\nNo weight loss\n\nNo change in bowel habit\n\nRegular menstrual periods\n\nNo previous episodes of urinary tract infection\n\nNo recent dehydration, excessive exercise, or sexual intercourse\n\nPast medical history: Irritable bowel syndrome\n\nCurrent medications: Mebeverine 200mg three times daily\n\nAllergy: Clindamycin\n\nSocial history: Support worker, lives with friends, non-smoker, alcohol consumption 1 glass of wine per week\n\n\n\n\nObjective:\n\nPatient confirmed privacy for consultation\n\nNo fever reported\n\nNo thermometer available at home\n\n\n\n\nAssessment:\n\nUrinary tract infection\n\n\n\n\nPlan:\n\n3-day course of antibiotics prescribed\n\nPrescription sent to Knightsbridge Practice for collection\n\nAdvised to increase fluid intake to 2.5-3 litres per day\n\nRecommended cranberry juice\n\nAdvised to purchase urinary alkalinising sachets from pharmacy\n\nAdvised to purchase thermometer from pharmacy to monitor temperature\n\nSafety netting provided: Re-contact if pain worsens, loin pain develops, fever occurs, urinary retention, or symptoms fail to resolve with treatment\n\nRe-contact if recurrent infections develop\n\nNo routine follow-up required if symptoms resolve","review":64.73684210526316,"saved":239.76315789473682,"clean":true,"effort":0.0,"sig":[],"mb":12.563244,"latency":22.087,"signable":86.82384210526317},{"label":"Run 3","wer":10.458715596330276,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please? Hi. My name is Susan. 30 Ridbridge Street, s w 2 2 h zed. And your date of birth? 14 o 2 74. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? 6 days now. Pardon? For 6 days. 6 days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loo. I've got this very unpleasant smell that comes out. Okay. And have you had any other\n\nSymptoms along with that. Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. At whereabouts? In my lower tummy. Okay. Is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10 with 10 being the worst pain? 7. And is it constant, or does it come and go? Comes and goes. Okay. And have you\n\nActually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. And any did you you said you didn't have any lower\n\nPain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse, or anything? No. No? Okay.\n\nAnd any any other symptoms, any vaginal discharge, or anything like that? No. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And and in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS\n\nOkay. And how's that been recently? Any change in your bowel habit? Any blood when you passed? Or Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meibelin. Pardon? I've had\n\nEvergreen. Do you take that regularly? Yes. Okay. And do you take it 3 times a day? Yes. I do. 200 milligrams? Yes. Any allergies? Any allergies? Clindamycin. You're allergic to clindamycin. Okay. And anyone in your family had any medical problems? No.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in your average week? 1 glass of wine a week. Okay. Do you smoke? No. Okay.\n\nIt sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine, with with a course of antibiotics.\n\nOkay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for 3 days. Okay. Get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3\n\nA day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist and sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature\n\nYou have any problems actually passing urine, then it's very important that we speak to you again. Okay. The other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar\n\nProblem recurrently, then it's important for us to talk talk to you in more detail about that. Okay then. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you? Knightsbridge Practice. Okay. That's fine. So the antibiotics\n\nThat I'm gonna prescribe, and we'll go through to that pharmacy. Then you'll be able to pick them up from there. How soon is that gonna be at the practice? In 5 minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I don't","marks":[{"start":161,"end":170,"said":"Redbridge","significant":false},{"start":179,"end":182,"said":"SW","significant":false},{"start":187,"end":193,"said":"HZ. Hello.","significant":false},{"start":218,"end":222,"said":"forty oh","significant":false},{"start":225,"end":234,"said":"nineteen seventy four. OK.","significant":false},{"start":409,"end":415,"said":"It stays","significant":false},{"start":726,"end":726,"said":"back","significant":true},{"start":956,"end":956,"said":"Seven.","significant":false},{"start":1121,"end":1126,"said":"Spots. OK.","significant":false},{"start":1397,"end":1397,"said":"back","significant":true},{"start":1831,"end":1831,"said":"No.","significant":false},{"start":2037,"end":2042,"said":"before. OK.","significant":false},{"start":2124,"end":2134,"said":"pass stool","significant":false},{"start":2218,"end":2221,"said":"","significant":false},{"start":2249,"end":2249,"said":"No.","significant":false},{"start":2352,"end":2368,"said":"Mebeverine Mebeverine.","significant":true},{"start":2380,"end":2390,"said":"Mebeverine. Pardon No birth .","significant":false},{"start":2863,"end":2867,"said":"a","significant":false},{"start":3382,"end":3387,"said":"do","significant":false},{"start":3797,"end":3797,"said":"litres","significant":true},{"start":3954,"end":3957,"said":"some","significant":false},{"start":4200,"end":4200,"said":"or","significant":false},{"start":4691,"end":4702,"said":"reccurently.","significant":false},{"start":4827,"end":4837,"said":"Uh where will","significant":false},{"start":5084,"end":5093,"said":"um will","significant":false},{"start":5122,"end":5122,"said":"How soon And","significant":false},{"start":5285,"end":5292,"said":"All right","significant":false},{"start":5339,"end":5352,"said":"OK. All right","significant":false},{"start":5359,"end":5369,"said":"","significant":false},{"start":5385,"end":5385,"said":"Thank you. .","significant":false},{"start":5400,"end":5405,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Six days of dysuria recorded."],["The note captures: Unpleasant or strong urine odour.","yes","Unpleasant/malodorous urine recorded."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Central, intermittent lower abdominal pain 7/10."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Blood spotting in urine recorded."],["The note captures: Able to pass urine and maintain oral intake.","yes","Able to pass urine and eating/drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","No fever and no loin/lower back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","UTI is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","Three-day antibiotic course prescribed."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain a thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluids 2.5-3 L/day."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Recontact for worsening/persistent pain, fever, back pain or difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Review if recurrent; no routine follow-up if resolved."]],"claims":[["No fever or chills","Chills/rigors were never asked about or denied; only fever/temperature was denied."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n52-year-old female presenting with dysuria for 6 days\n\nOffensive-smelling urine\n\nHaematuria (spotting in urine)\n\nSuprapubic pain, intermittent, 7/10 severity\n\nNo fever or chills\n\nNo loin pain\n\nAble to pass urine without difficulty\n\nEating and drinking normally\n\nRegular menstrual periods\n\nNo vaginal discharge\n\nNo previous urinary tract infections\n\nNo recent dehydration, excessive exercise, or sexual intercourse\n\nPast medical history: Irritable bowel syndrome (no recent change in bowel habit, no weight loss)\n\nCurrent medications: Mebeverine 200mg three times daily\n\nAllergy: Clindamycin\n\nSocial history: Lives with friends, works as support worker, alcohol consumption 1 glass wine per week, non-smoker\n\n\n\n\nObjective:\n\nPatient confirmed in private location for consultation\n\nNo fever reported\n\nNo thermometer available at home\n\n\n\n\nAssessment:\n\nUrinary tract infection\n\n\n\n\nPlan:\n\nPrescribed 3-day course of antibiotics (prescription sent to Knightsbridge Practice)\n\nAdvised to increase fluid intake to 2.5-3 litres per day\n\nRecommended cranberry juice\n\nAdvised to purchase urinary alkalinising sachets from pharmacy\n\nAdvised to obtain thermometer from pharmacy and monitor temperature\n\nSafety netting provided: advised to re-contact if pain worsens, loin pain develops, fever occurs, urinary retention develops, or symptoms recur\n\nNo routine follow-up required if symptoms resolve with treatment","review":74.84210526315789,"saved":229.6578947368421,"clean":false,"effort":10.0,"sig":[["fabrication","No fever or chills","Invents a denial of chills/rigors, which is relevant to excluding pyelonephritis and was never asked."]],"mb":16.339105,"latency":18.289,"signable":93.13110526315789},{"label":"Run 4","wer":10.458715596330276,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please? Hi. My name is Susan. 30 Ridbridge Street, s w 2 2 h zed. And your date of birth? 14 o 2 74. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? 6 days now. Pardon? For 6 days. 6 days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loo. I've got this very unpleasant smell that comes out. Okay. And have you had any other\n\nSymptoms along with that. Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. At whereabouts? In my lower tummy. Okay. Is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10 with 10 being the worst pain? 7. And is it constant, or does it come and go? Comes and goes. Okay. And have you\n\nActually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. And any did you you said you didn't have any lower\n\nPain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse, or anything? No. No. Okay.\n\nAnd any any other symptoms, any vaginal discharge, or anything like that? No. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And and in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS\n\nOkay. And how's that been recently? Any change in your bowel habit? Any blood when you passed? Or Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meibelin. Pardon? I've had\n\nEvergreen. Do you take that regularly? Yes. Okay. And do you take it 3 times a day? Yes. I do. 200 milligrams? Yes. Any allergies? Any allergies? Clindamycin. You're allergic to clindamycin. Okay. And anyone in your family had any medical problems? No.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in your average week? 1 glass of wine a week. Okay. Do you smoke? No. Okay.\n\nIt sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine with with a course of antibiotics.\n\nOkay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for 3 days. Okay. Get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water, so 2 and a half to 3\n\nA day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemist and sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature\n\nYou have any problems actually passing urine, then it's very important that we speak to you again. Okay. The other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar\n\nProblem recurrently, then it's important for us to talk talk to you in more detail about that. Okay then. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you? Knightsbridge Practice. Okay. That's fine. So the antibiotics\n\nThat I'm gonna prescribe, and we'll go through to that pharmacy. Then you'll be able to pick them up from there. How soon is that gonna be at the practice? In 5 minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I don't","marks":[{"start":161,"end":170,"said":"Redbridge","significant":false},{"start":179,"end":182,"said":"SW","significant":false},{"start":187,"end":193,"said":"HZ. Hello.","significant":false},{"start":218,"end":222,"said":"forty oh","significant":false},{"start":225,"end":234,"said":"nineteen seventy four. 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All right","significant":false},{"start":5358,"end":5368,"said":"","significant":false},{"start":5384,"end":5384,"said":"Thank you. .","significant":false},{"start":5399,"end":5404,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"dysuria for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Offensive-smelling urine\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Suprapubic pain, intermittent, 7/10 severity\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Haematuria (spotting in urine)\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"Able to pass urine without difficulty\"; \"Oral intake maintained\"."],["The note captures: No fever and no loin/lower back pain.","yes","\"No fever or feeling feverish\"; \"No loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"No vaginal discharge\"; \"First episode of these symptoms\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","\"IBS\" and \"Mebeverine 200mg PO TDS\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Advised to obtain thermometer from pharmacy and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"increase fluid intake to 2.5-3 litres per day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety netting covers worsening pain, loin pain, fever, urinary retention, non-resolution."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","\"Advised to return if recurrent urinary tract infections develop\" captured, but not that no post-course review is needed if better."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n52-year-old female presenting with dysuria for 6 days\n\nOffensive-smelling urine\n\nHaematuria (spotting in urine)\n\nSuprapubic pain, intermittent, 7/10 severity\n\nAble to pass urine without difficulty\n\nOral intake maintained\n\nNo fever or feeling feverish\n\nNo loin pain\n\nNo vaginal discharge\n\nRegular menstrual cycles\n\nFirst episode of these symptoms\n\nNo recent dehydration, excessive exercise, or sexual intercourse\n\nPast medical history: IBS (stable, no recent change in bowel habit, no rectal bleeding, no weight loss)\n\nCurrent medications: Mebeverine 200mg PO TDS\n\nAllergy: Clindamycin\n\nSocial history: Lives with friends, works as support worker, alcohol 1 glass wine per week, non-smoker\n\nFamily history: Non-contributory\n\n\n\n\nObjective:\n\nPatient confirmed in private location for consultation\n\nNo thermometer available at home\n\nNo documented fever\n\n\n\n\nAssessment:\n\nUrinary tract infection\n\n\n\n\nPlan:\n\nPrescribed 3-day course of antibiotics (prescription sent to Knightsbridge Practice)\n\nAdvised to increase fluid intake to 2.5-3 litres per day\n\nRecommended cranberry juice\n\nAdvised to purchase urinary alkalinising sachets over-the-counter from pharmacy\n\nAdvised to obtain thermometer from pharmacy and monitor temperature\n\nSafety netting provided: Return if pain worsens, loin pain develops, fever occurs, urinary retention develops, or symptoms fail to resolve with treatment\n\nAdvised to return if recurrent urinary tract infections develop\n\nPatient to collect prescription from pharmacy in approximately 1 hour","review":82.96052631578948,"saved":221.53947368421052,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":16.346821,"latency":16.986,"signable":99.94652631578948},{"label":"Run 5","wer":10.550458715596331,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address, please? Hi. My name is Susan. 30 Ridbridge Street, s w 2 2 h zed. And your date of birth? 14 o 2 74. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on for? 6 days now. Pardon? For 6 days. 6 days. Okay. And just tell me a bit more about that. How did it start? I've got this thing when I pee, and it hurts when I go to the loo. I've got this very unpleasant smell that comes out. Okay. And have you had any other\n\nSymptoms along with that. Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. At whereabouts? In my lower tummy. Okay. Is it one-sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10 with 10 being the worst pain? 7. And is it constant, or does it come and go? Comes and goes. Okay. And have you\n\nActually been able to pass water okay? Yes. But I've had spotted blood in my urine. Okay. And is that just over the last 6 days? Yes. Right. And have you been able to eat and drink okay? Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No. Not at all. And any did you you said you didn't have any lower\n\nPain? No. I've got and no loin pain as well. Okay. And have you had these symptoms before? No. Never? No. And was there anything you were doing recently which you think may have contributed to it? Have you have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse, or anything? No. No? Okay.\n\nAnd any any other symptoms, any vaginal discharge, or anything like that? No. Just the blood spot in my Do you have regular periods? Yes. I do. Okay. And in the past, have you had any medical problems at all? No medical. No. Have you had any problems with your kidneys or any urine infections? I had IBS\n\nOkay. And how's that been recently? Any change in your bowel habit? Any blood when you passed? Or Yeah. I've had spotting in my urine. In your okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? I've had meibelin. Pardon? I've had\n\nEvergreen. Do you take that regularly? Yes. Okay. And do you take it 3 times a day? Yes. I do. 200 milligrams? Yes. Any allergies? Any allergies? Clindamycin. You're allergic to clindamycin. Okay. And anyone in your family had any medical problems? No.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in your average week? 1 glass of wine a week. Okay. Do you smoke? No. Okay.\n\nIt sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy and do check your temperature just to make sure that it isn't going up and down. Okay. Normally, we can treat this infection without having to test your urine, with with a course of antibiotics.\n\nOkay. How would you feel about that? Are you happy to take a course of antibiotics? Yes. I would be. It would just be for 3 days. Okay. Perhaps get my prescription? Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, get them pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So 2 and a half to 3\n\nA day. Yeah. You can get some cranberry juice and take drink that as well. That sometimes helps. And also some sachets, which you can get from the chemists and sachets, which just help change the acidity of your urine. So I I can put the details of that on your notes. Okay then. If you feel like your pain is getting worse or not settling, you get lower back pain, or you're getting a high temperature\n\nYou have any problems actually passing urine, then it's very important that we speak to you again. Okay. And the other thing is if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No. Not if you're better. Okay. If you're if you feel like your symptoms get worse at any point or they're not resolving with the treatment or you keep getting a similar you keep getting a similar\n\nProblem recurrently, then it's important for us to talk talk to you in more detail about that. Okay then. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So have you already requested a pharmacy through Babylon? Yes. I did. Can I just check that with you? Knightsbridge Practice. Okay. That's fine. So the antibiotics\n\nThat I'm gonna prescribe, and we'll go through to that pharmacy. Then you'll be able to pick them up from there. How soon is that gonna be at the practice? In 5 minutes? I would give it longer than that. Give it an hour or so. Alright then. Thank you. I'll pick that at lunchtime. Okay. Alright then. Thank you. Take care. Bye. Bye. Sorry. I don't","marks":[{"start":161,"end":170,"said":"Redbridge","significant":false},{"start":179,"end":182,"said":"SW","significant":false},{"start":187,"end":193,"said":"HZ. Hello.","significant":false},{"start":218,"end":222,"said":"forty oh","significant":false},{"start":225,"end":234,"said":"nineteen seventy four. 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Um.","significant":false},{"start":3801,"end":3801,"said":"litres","significant":true},{"start":3950,"end":3962,"said":"chemist some","significant":false},{"start":4205,"end":4205,"said":"or","significant":false},{"start":4700,"end":4711,"said":"reccurently.","significant":false},{"start":4836,"end":4846,"said":"Uh where will","significant":false},{"start":5093,"end":5102,"said":"um will","significant":false},{"start":5131,"end":5131,"said":"How soon And","significant":false},{"start":5294,"end":5301,"said":"All right","significant":false},{"start":5348,"end":5361,"said":"OK. All right","significant":false},{"start":5368,"end":5378,"said":"","significant":false},{"start":5394,"end":5394,"said":"Thank you. .","significant":false},{"start":5409,"end":5414,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Offensive-smelling urine\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Suprapubic pain, central, 7/10 severity, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Haematuria (spotting in urine)\"."],["The note captures: Able to pass urine and maintain oral intake.","partial","\"Able to void normally\" captured; oral intake not mentioned."],["The note captures: No fever and no loin/lower back pain.","yes","No fever; no loin or flank pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge; no previous urinary tract infections."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS; \"Mebeverine 200mg three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed 3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain thermometer to monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3 litres per day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Return if pain worsens, loin pain, fever or difficulty voiding."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Re-consult if recurrent; no routine follow-up if resolved."]],"claims":[],"note":"Subjective:\n\nDysuria for 6 days\n\nOffensive-smelling urine\n\nHaematuria (spotting in urine)\n\nSuprapubic pain, central, 7/10 severity, intermittent\n\nAble to void normally\n\nNo fever or chills\n\nNo loin pain or flank pain\n\nNo vaginal discharge\n\nRegular menstrual periods\n\nNo previous urinary tract infections\n\nNo recent dehydration, excessive exercise, or sexual activity\n\nPast medical history: IBS (stable, no recent change in bowel habit, no rectal bleeding, no weight loss)\n\nCurrent medications: Mebeverine 200mg three times daily\n\nAllergy: Clindamycin\n\nSocial history: Lives with friends, works as support worker, alcohol consumption 1 glass wine per week, non-smoker\n\n\n\n\nObjective:\n\nPatient confirmed privacy for consultation\n\nNo fever documented (patient advised to obtain thermometer from pharmacy to monitor temperature)\n\n\n\n\nAssessment:\n\nUrinary tract infection\n\n\n\n\nPlan:\n\nPrescribed 3-day course of antibiotics (prescription sent to Knightsbridge Practice)\n\nAdvised to commence antibiotics as soon as possible\n\nIncrease fluid intake to 2.5-3 litres per day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets available from pharmacy\n\nSafety netting advice provided: return if pain worsens, develops loin pain, fever, or difficulty voiding\n\nAdvised to re-consult if symptoms do not resolve with treatment or if recurrent infections occur\n\nNo routine follow-up required if symptoms resolve","review":73.52631578947367,"saved":230.97368421052633,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":16.415674,"latency":19.079,"signable":92.60531578947368}],"preve":[{"label":"Run 1","wer":11.284403669724771,"text":"Good morning, I'm Doctor Smith.\n\nFrom Babylon. Can you just confirm your name, date of birth, the first line of your address, please?\n\nHi. My name is Susan. 30 Ridge Street.\n\nSW 22 H Zed.\n\nAnd your date of birth? Fourteen o two seven four. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you?\n\nIt hurts when I pee.\n\nOkay. And how long has that been going on for?\n\nSix days now.\n\nPardon?\n\nFor six days.\n\nSix days. Okay. And just tell me a bit more about that.\n\nHow did it start? I've got this\n\nthing when I pee, and it hurts when I go to the loo.\n\nI've got this very unpleasant smell that comes out.\n\nOkay.\n\nAnd have you had any other symptoms along with that?\n\nHave you had any abdominal pain or lower back pain at all?\n\nI've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one-sided or in the middle?\n\nIn the middle.\n\nAnd how bad would you say that is on a scale of one to 10?\n\nWith 10 being the worst\n\npain. Seven.\n\nAnd is it constant or does it come and go?\n\nComes and goes.\n\nOkay. And have you actually been able to\n\npass water\n\nokay? Yes. But I've had spotted\n\nblood in my urine. Okay. And\n\nis that just over the last\n\nsix days? Yes.\n\nRight. And have you been able to eat and drink okay?\n\nYes.\n\nAnd have you had a temperature? Do you feel like you've been feverish or had a\n\ntemperature with this?\n\nNo. Not at all.\n\nAnd any did you you said you didn't have any low back pain?\n\nNo. I've got\n\nand no loin pain as well.\n\nOkay. And\n\nhave you had these symptoms before?\n\nNo. Never?\n\nNo.\n\nAnd was there anything you were doing recently\n\nwhich you think may have contributed to it? Have you have you been doing lots\n\nof exercise, been dehydrated, been having regular sexual intercourse,\n\nanything?\n\nNo.\n\nNo. Okay. And any any other symptoms\n\nAny vaginal discharge or anything like that?\n\nNo. Just the blood spot\n\nin my\n\nk. Do you have regular periods?\n\nYes. I do. Okay.\n\nAnd and\n\nin the past, have you had any medical problems at all?\n\nNo medical. No. Have you had any problems with your kidneys or any urine\n\ninfections?\n\nI had IBS before. Okay.\n\nAnd how's that been recently? Any change in your bowel habit? Any blood when you\n\npassed stool?\n\nYeah. I've had spotting in my urine.\n\nIn your okay. Any change in your bowel habit?\n\nNo.\n\nAny weight loss or anything? No. Any other medical problems or\n\nsurgery in the past?\n\nNo.\n\nDo you take regular medications?\n\nI've had mebepin Pardon? Delivery.\n\nI've had meberine. Do you take that regularly?\n\nYes.\n\nOkay. And do you take it three times a day?\n\nYes. I do.\n\nTwo hundred milligrams?\n\nYes. Any\n\nallergies?\n\nAny allergies?\n\nClindamycin.\n\nYou're allergic to clindamycin. Okay.\n\nAnd anyone in your family had any medical problems?\n\nNo.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family?\n\nI live with friends. Okay.\n\nAnd where do you work? What's your job?\n\nI'm a support worker.\n\nOkay.\n\nDo you drink alcohol at all?\n\nOccasionally. So how much in your average week?\n\nOne glass of wine a week.\n\nOkay. Do you smoke?\n\nNo.\n\nOkay. It sounds very much like you\n\nmight have an infection in your urine. Did you say you haven't felt feverish?\n\nNo fever at all.\n\nHave you got a thermometer at home?\n\nNo.\n\nOkay. It would be helpful if you could get a thermometer from this\n\npharmacy and do check your temperature just to make sure that it isn't\n\ngoing up and\n\ndown. Okay.\n\nNormally, we can treat this\n\nwithout having to test your urine with with a course of antibiotics.\n\nOkay.\n\nHow would you feel about that? Are you happy\n\ntake a course of antibiotics?\n\nYes. I would be. It would just\n\nbe for three days.\n\nOkay. And get my prescription?\n\nYes. So I can send a prescription through to your requested pharmacy for that.\n\nIf you take them as soon as you can,\n\npick them up as soon as you can and start\n\ntaking them,\n\nThe other thing which is important to do is to drink lots of water\n\nSo two and a half to three liters a day. Yeah. You can get some cranberry juice\n\nand take drink that as well. That sometimes helps and also some\n\nsachets which you can get from the chemist and stuff which\n\njust help change the acidity of your urine. So I\n\ncan put the details of that on your notes. Okay then.\n\nIf you feel like your pain is getting worse or not\n\nsettling, you get lower back pain,\n\nor you're getting a high temperature or you have any problems at\n\nactually passing urine, then it's very important that we speak to you again.\n\nOkay.\n\nAnd the other thing is if it becomes a\n\ncommon thing or a current problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course\n\nantibiotics?\n\nNo. Not if you're better.\n\nOkay.\n\nIf you're if you feel like your symptoms get worse at any point,\n\nor they're not resolving with the treatment or you keep getting a similar\n\nyou keep getting a similar problem\n\nrecurrently, then it's important for us to talk talk\n\nto you in more detail about that.\n\nOkay then.\n\nHave you got any other questions?\n\nNo. What would be the pharmacy I'll be picking up my medication from?\n\nSo have you already requested a pharmacy through Babylon?\n\nYes. I did.\n\nCan I just check that with\n\nyou?\n\nKnightsbridge practice.\n\nOkay. That's\n\nfine. So the antibiotics that I'm gonna prescribe\n\nwill go through to that pharmacy.\n\nAnd then you'll be able to pick them up from there.\n\nHow soon is that gonna be at the practice? In five minutes?\n\nI would give it longer than that. Give it an hour or so.\n\nAlright then. Thank you. I'll pick that at lunchtime.\n\nOkay. Alright then.\n\nThank you. Take care. Bye. Bye.\n\nSorry. I don't keep","marks":[{"start":160,"end":165,"said":"Redbridge","significant":true},{"start":178,"end":187,"said":"two two HZ. Hello.","significant":false},{"start":213,"end":223,"said":"forty oh","significant":false},{"start":228,"end":233,"said":"nineteen seventy","significant":false},{"start":423,"end":431,"said":"It stays","significant":false},{"start":754,"end":754,"said":"back","significant":true},{"start":994,"end":994,"said":"Seven.","significant":false},{"start":1163,"end":1168,"said":"Spots. 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All right","significant":false},{"start":5545,"end":5555,"said":"","significant":false},{"start":5571,"end":5571,"said":"Thank you. .","significant":false},{"start":5587,"end":5597,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Pain on urination for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Foul-smelling urine reported\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Intermittent lower central abdominal (suprapubic) pain, 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Spots of blood in urine over the same 6 days\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"Able to pass urine\"; \"Able to eat and drink\"."],["The note captures: No fever and no loin/lower back pain.","yes","\"Denies fever\"; \"Denies low back or loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","Vaginal discharge denied; \"No prior similar episodes\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS and \"Mebeverine 200 mg, three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergies: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Suspected uncomplicated urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course; agent not specified\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer and monitor temperature regularly\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Hydration 2.5–3 L water/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net: worsening pain, fever, low back/loin pain, difficulty passing urine, persistence/recurrence."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"No routine follow-up if symptoms resolve\"; re-consult if recur."]],"claims":[],"note":"Presenting Condition\n\nPain on urination for 6 days\n\nFoul-smelling urine reported\n\nIntermittent lower central abdominal (suprapubic) pain, 7/10\n\nAble to pass urine\n\nSpots of blood in urine over the same 6 days\n\nDenies fever\n\nDenies low back or loin pain\n\nNo prior similar episodes\n\nNo recent triggers identified (exercise, dehydration, frequent sexual intercourse)\n\nRegular periods\n\nAble to eat and drink\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPrevious MSK injuries\n\nIBS previously\n\n\n\n\nPast Medical History\n\nIBS\n\nNo past surgeries reported\n\nFamily history: denies significant conditions\n\nAllergies: Clindamycin\n\n\n\n\nMedications\n\nMebeverine 200 mg, three times daily\n\nAntibiotics prescribed for presumed UTI (3-day course; agent not specified)\n\n\n\n\nRed Flag/Screening Questions\n\nFever: denies\n\nLow back pain: denies\n\nLoin pain: denies\n\nVaginal discharge: denies\n\nBowel habit change: denies\n\nWeight loss: denies\n\nDysuria: present\n\nHaematuria: present (spotting)\n\nEating/drinking: able\n\n\n\n\nSocial History\n\nLives with friends\n\nSupport worker\n\nAlcohol: ~1 glass wine/week\n\nNon-smoker\n\n\n\n\nGoals\n\nResolution of urinary pain and associated symptoms\n\n\n\n\nObjective\n\n(Consent obtained)\n\nNo physical examination performed in this teleconsultation\n\n\n\n\nDiagnosis\n\nSuspected uncomplicated urinary tract infection\n\nPrognosis: expected improvement with 3-day antibiotics if uncomplicated\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nStart prescribed 3-day antibiotic course promptly\n\nHydration 2.5–3 L water/day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets from pharmacy\n\nCheck temperature with a home thermometer\n\nSafety-net: seek review if pain worsens, develops fever, low back/loin pain, difficulty passing urine, or if symptoms persist/recur\n\nPrescription sent to nominated pharmacy (Knightsbridge practice)\n\n// Patient agreeable; plans to collect at lunchtime\n\n\n\n\nPlan\n\nNo routine follow-up if symptoms resolve after antibiotics\n\nRe-consult if symptoms worsen, fail to improve, or recur\n\nObtain thermometer and monitor temperature regularly\n","review":87.15789473684211,"saved":217.3421052631579,"clean":true,"effort":0.0,"sig":[],"mb":12.770921,"signable":110.05989473684211},{"label":"Run 2","wer":11.559633027522937,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address\n\nplease? Hi. My name is Susan. 30 Redbridge Street.\n\nS W 22 H Z. And your date of birth? Fourteen o two seven. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you?\n\nIt hurts when I pee.\n\nOkay. And how long has that been going on\n\nfor?\n\nSix days now.\n\nPardon?\n\nFor six days.\n\nSix days. Okay.\n\nAnd just tell me a bit more about that. How did it start?\n\nI've got this thing when I pee, and it hurts when I go\n\nthe loo.\n\nI've got this very unpleasant smell that comes\n\nout. Okay.\n\nAnd have you had any other symptoms along with\n\nthat? Have you had any abdominal pain or lower back pain at all?\n\nI've got pain in my tummy.\n\nAt whereabouts?\n\nIn my lower tummy.\n\nOkay. Is it one-sided or in the middle? In the middle.\n\nAnd how bad would you say that is on a scale of one to 10?\n\nWith 10 being the worst pain? Seven. And is it\n\nconstant, or does it come and go?\n\nComes and goes.\n\nOkay. And have you actually been able to\n\npass water okay?\n\nYes. But I've had\n\nspotted blood in my urine. Okay.\n\nAnd is that just over the last six days?\n\nYes.\n\nRight. And have you been able to eat and drink okay?\n\nYes.\n\nAnd have you had a temp\n\nDo you feel like you've been feverish or had a temperature with this?\n\nNo. Not at all.\n\nAnd any\n\ndid you\n\nyou said you didn't have any lower back pain?\n\nNo. I've got\n\nand no loin pain as\n\nwell. Okay.\n\nAnd have you had these symptoms before?\n\nNo. Never?\n\nNo.\n\nAnd was there anything you were doing recently which you think may have\n\ncontributed to it? Have you have you been doing lots of exercise, been dehydrated?\n\nBeen having regular sexual intercourse, or anything?\n\nNo.\n\nNope. Okay. And\n\nany any other symptoms? Any vaginal discharge or\n\nanything like that?\n\nNo. Just the blood\n\nspot in my\n\nDo you have regular periods?\n\nYes. I do.\n\nOkay.\n\nAnd and in the past, have you had any medical\n\nproblems at all? No medical. No.\n\nHave you had any problems with your kidneys or any urine infections?\n\nI had IBS before.\n\nOkay.\n\nAnd how's that been recently? Any change in your bowel habit? Any blood when you\n\npassed stool?\n\nYeah. I've had spotting in my urine.\n\nIn your okay. Any change in your bowel habit? No.\n\nAny weight loss or anything? No. Any other medical problems\n\nor surgery in the past?\n\nNo.\n\nDo you take regular medications?\n\nI've had mebepin Pardon? Delivery.\n\nI've had mebevin.\n\nDo you take that regularly?\n\nYes.\n\nOkay. And do you take it three times a day?\n\nYes. I do.\n\nTwo hundred milligrams?\n\nYes.\n\nAny allergies?\n\nAny\n\nallergies? Clindamycin.\n\nYou are allergic to clindamycin. Okay.\n\nAnd anyone in your family had any medical problems?\n\nNo.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family?\n\nI live with friends. Okay.\n\nAnd where do you work? What's your job?\n\nI'm a support worker.\n\nOkay. Do you drink alcohol\n\nat all?\n\nOccasionally.\n\nSo how much in your average week?\n\nOne glass of wine a week.\n\nOkay. Do you smoke?\n\nNo.\n\nOkay. It sounds very much like you\n\nmight have an infection in your urine. Did you say you haven't felt feverish?\n\nNo fever at all.\n\nHave you got a thermometer at home?\n\nNo.\n\nOkay. It would be helpful if you could\n\nget a thermometer from the pharmacy and do check your temp\n\njust to make sure that it isn't going up and down.\n\nOkay.\n\nNormally, we can treat this infection without having to test your urine with with a course of antibiotics.\n\nOkay.\n\nHow would you feel about that? Are you happy\n\ntake a course of antibiotics? Yes. I would be. It would just be for three days.\n\nOkay. And get my prescription?\n\nYes. So I can send a prescription through to your requested pharmacy for that.\n\nIf you take them as soon as you can,\n\npick them up as soon as you can and start taking them.\n\nThe other thing which is important to do is to drink lots of water.\n\nSo two and a half to three liters a day. Yeah. You can get some cranberry juice\n\nand take drink that as well. That sometimes helps. And also some\n\nsachets, which you can get from the chemist and sachets, which\n\njust help change the acidity of your urine. So I\n\nI can put the details of that on your notes. Okay then.\n\nIf you feel like your pain is getting worse or not\n\nsettling, you get lower back pain,\n\nor you're getting a high temperature, or you have any problems at\n\nactually passing urine, then it's very important that we speak to you again.\n\nOkay.\n\nAnd the other thing is if it becomes a\n\ncommon thing or a current problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course of antibiotics?\n\nNo. Not if you're better.\n\nOkay.\n\nIf you're if you feel like your symptoms get worse at any point,\n\nor they're not resolving with the treatment or you keep getting a similar\n\nyou keep getting a similar problem\n\nrecurrently, then it's important for us to talk talk\n\nto you in more detail about that.\n\nOkay then.\n\nHave you got any other questions?\n\nNo. What would be the pharmacy I'll be picking up my medication from?\n\nSo have you already requested a pharmacy through Babylon?\n\nYes. I\n\ndid. Can I just check that with you?\n\nKnightsbridge practice. Okay. That's\n\nfine. So the antibiotics that I'm gonna prescribe\n\nwe'll go through to that pharmacy.\n\nAnd then\n\nyou'll be able to pick them up from there.\n\nHow soon is that gonna be out of practice? In five minutes?\n\nI would give it longer than that. Give it an hour or\n\nso.\n\nAlright then. Thank you. I'll pick that at lunchtime.\n\nOkay. Alright then.\n\nThank\n\nyou. Take care. Bye. Bye. Sorry. I don't keep","marks":[{"start":180,"end":191,"said":"SW two two HZ. Hello.","significant":false},{"start":216,"end":226,"said":"forty oh","significant":false},{"start":231,"end":243,"said":"nineteen seventy four. OK.","significant":true},{"start":422,"end":430,"said":"It stays","significant":false},{"start":751,"end":751,"said":"back","significant":true},{"start":994,"end":994,"said":"Seven.","significant":false},{"start":1164,"end":1169,"said":"Spots. 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All right","significant":false},{"start":5557,"end":5568,"said":"","significant":false},{"start":5584,"end":5584,"said":"Thank you. .","significant":false},{"start":5599,"end":5609,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Pain on urination for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Malodorous urine reported\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Lower abdominal pain, midline, intermittent, pain score 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Visible blood spotting in urine\"."],["The note captures: Able to pass urine and maintain oral intake.","yes","\"Able to pass urine\" and \"Eating/drinking: able\"."],["The note captures: No fever and no loin/lower back pain.","yes","\"Denies fever\" and \"Denies lower back pain and loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"Vaginal discharge: denies\" and \"No prior similar episodes\"."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS plus \"Mebeverine 200 mg, three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Suspected uncomplicated urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Start 3-day antibiotic course\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain thermometer and monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Hydration 2.5–3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net lists worsening pain, lower back pain, fever, difficulty passing urine, non-resolution."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"No routine follow-up if resolved post-course\" and re-consult if recur."]],"claims":[],"note":"Presenting Condition\n\nPain on urination for 6 days\n\nMalodorous urine reported\n\nLower abdominal pain, midline, intermittent, pain score 7/10\n\nVisible blood spotting in urine over same 6-day period\n\nAble to pass urine\n\nDenies fever\n\nDenies lower back pain and loin pain\n\nNo prior similar episodes\n\nNo noted contributing factors (denies ↑exercise, dehydration, regular sexual intercourse)\n\n\n\n\nRadiology\n\nNo imaging discussed\n\n\n\n\nPast Medical History\n\nIrritable bowel syndrome (IBS); no recent change in bowel habit; no rectal bleeding reported\n\nNo other medical problems or past surgery stated\n\nAllergy: Clindamycin\n\n\n\n\nMedications\n\nMebeverine 200 mg, three times daily\n\n\n\n\nRed Flag/Screening Questions\n\nFever: denies\n\nLower back/loin pain: denies\n\nBowel habit change: denies\n\nWeight loss: denies\n\nVaginal discharge: denies\n\nEating/drinking: able\n\n\n\n\nSocial History\n\nLives with friends\n\nOccupation: Support worker\n\nAlcohol: ~1 glass of wine/week\n\nTobacco: non-smoker\n\nFamily history: none reported relevant\n\n\n\n\nGoals\n\nSymptom relief of dysuria and abdominal pain\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nSuspected uncomplicated urinary tract infection (based on dysuria, malodour, haematuria, lower abdo pain, no fever/loin pain)\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nStart 3-day antibiotic course as prescribed; collect from nominated pharmacy\n\nHydration 2.5–3 L/day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets from chemist\n\nObtain thermometer and monitor temperature\n\nSafety-net: seek review if worsening pain, onset of lower back pain, fever, difficulty passing urine, non-resolution, or recurrent episodes\n\n// Patient agreeable to antibiotics; plans pickup at lunchtime; advised 1 hour before collection\n\n\n\n\nPlan\n\nBegin antibiotics today; monitor symptoms and temperature\n\nNo routine follow-up if resolved post-course\n\nRe-consult if symptoms worsen, persist after treatment, or recur\n\nPrescription sent to Knightsbridge practice pharmacy\n","review":85.57894736842105,"saved":218.92105263157896,"clean":true,"effort":0.0,"sig":[],"mb":12.666583,"signable":114.88494736842105},{"label":"Run 3","wer":11.284403669724771,"text":"Good morning, I'm Doctor Smith.\n\nFrom Babylon. Can you just confirm your name, date of birth, the first line of your address, please?\n\nHi. My name is Susan. 30 Ridge Street.\n\nSW 22 H Zed.\n\nAnd your date of birth? Fourteen o two seven. Four. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am. Okay. What can I do for you?\n\nIt hurts when I pee.\n\nOkay. And how long has that been going on for?\n\nSix days now.\n\nPardon?\n\nFor six days.\n\nSix days. Okay. And just tell me a bit more about that.\n\nHow did it start? I've got this\n\nthing when I pee, and it hurts when I go to the loo.\n\nI've got this very unpleasant smell that comes out.\n\nOkay.\n\nAnd have you had any other symptoms along with that?\n\nHave you had any abdominal pain or lower back pain at all?\n\nI've got pain in my tummy. Whereabouts?\n\nIn my lower tummy. Okay. Is it one-sided or in the middle?\n\nIn the middle.\n\nAnd how bad would you say that is on a scale of one to 10?\n\nWith 10 being the worst\n\npain. Seven.\n\nAnd is it constant or does it come and go?\n\nComes and goes.\n\nOkay. And have you actually been able to\n\npass water\n\nokay? Yes. But I've had spotted\n\nblood in my urine. Okay. And\n\nis that just over the last\n\nsix days? Yes.\n\nRight. And have you been able to eat and drink okay?\n\nYes.\n\nAnd have you had a temperature? Do you feel like you've been feverish or had a\n\ntemperature with this?\n\nNo. Not at all.\n\nAnd any... Did you... You said you didn't have any low back pain?\n\nNo. I've got\n\nand no loin pain as well.\n\nOkay. And\n\nhave you had these symptoms before?\n\nNo. Never?\n\nNo.\n\nAnd was there anything you were doing recently\n\nwhich you think may have contributed to it? Have you have you been doing lots\n\nof exercise, been dehydrated, been having regular sexual intercourse,\n\nanything?\n\nNo.\n\nNo. Okay. And any any other symptoms\n\nAny vaginal discharge or anything like that?\n\nNo. Just the blood spot\n\nin my...\n\nK. Do you have regular periods?\n\nYes. I do. Okay.\n\nAnd and\n\nin the past, have you had any medical problems at all?\n\nNo medical. No. Have you had any problems with your kidneys or any urine\n\ninfections?\n\nI had IBS before. Okay.\n\nAnd how's that been recently? Any change in your bowel habit? Any blood when you\n\npassed stool?\n\nYeah. I've had spotting in my urine.\n\nIn your... Okay. Any change in your bowel habit?\n\nNo.\n\nAny weight loss or anything? No. Any other medical problems or\n\nsurgery in the past?\n\nNo.\n\nDo you take regular medications?\n\nI've had mebepin Pardon? Delivery.\n\nI've had meberine. Do you take that regularly?\n\nYes.\n\nOkay. And do you take it three times a day?\n\nYes. I do.\n\nTwo hundred milligrams?\n\nYes. Any\n\nallergies?\n\nAny allergies?\n\nClindamycin.\n\nYou're allergic to clindamycin. Okay.\n\nAnd anyone in your family had any medical problems?\n\nNo.\n\nThat's fine. And whereabouts do you live? Do you live with friends, family?\n\nI live with friends. Okay.\n\nAnd where do you work? What's your job?\n\nI'm a support worker.\n\nOkay.\n\nDo you drink alcohol at all?\n\nOccasionally. So how much in your average week?\n\nOne glass of wine a week.\n\nOkay. Do you smoke?\n\nNo.\n\nOkay. It sounds very much like you\n\nmight have an infection in your urine. Did you say you haven't felt feverish?\n\nNo fever at all.\n\nHave you got a thermometer at home?\n\nNo.\n\nOkay. It would be helpful if you could get a thermometer from this\n\npharmacy and do check your temperature just to make sure that it isn't\n\ngoing up and\n\ndown. Okay.\n\nNormally, we can treat this\n\nwithout having to test your urine with with a course of antibiotics.\n\nOkay.\n\nHow would you feel about that? Are you happy\n\ntake a course of antibiotics?\n\nYes. I would be. It would just\n\nbe for three days.\n\nOkay. And get my prescription?\n\nYes. So I can send a prescription through to your requested pharmacy for that.\n\nIf you take them as soon as you can,\n\npick them up as soon as you can and start\n\ntaking them,\n\nThe other thing which is important to do is to drink lots of water\n\nSo two and a half to three liters a day. Yeah. You can get some cranberry juice\n\nand take... Drink that as well. That sometimes helps and also some\n\nsachets which you can get from the chemist and stuff which\n\njust help change the acidity of your urine. So I\n\ncan put the details of that on your notes. Okay then.\n\nIf you feel like your pain is getting worse or not\n\nsettling, you get lower back pain,\n\nor you're getting a high temperature or you have any problems at\n\nactually passing urine, then it's very important that we speak to you again.\n\nOkay.\n\nAnd the other thing is if it becomes a\n\ncommon thing or a current problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course\n\nantibiotics?\n\nNo. Not if you're better.\n\nOkay.\n\nIf you're... If you feel like your symptoms get worse at any point,\n\nor they're not resolving with the treatment or you keep getting a similar\n\nyou keep getting a similar problem\n\nrecurrently, then it's important for us to talk talk\n\nto you in more detail about that.\n\nOkay then.\n\nHave you got any other questions?\n\nNo. What would be the pharmacy I'll be picking up my medication from?\n\nSo have you already requested a pharmacy through Babylon?\n\nYes. I did.\n\nCan I just check that with\n\nyou?\n\nKnightsbridge practice.\n\nOkay. That's\n\nfine. So the antibiotics that I'm gonna prescribe\n\nwill go through to that pharmacy.\n\nAnd then you'll be able to pick them up from there.\n\nHow soon is that gonna be at the practice? In five minutes?\n\nI would give it longer than that. Give it an hour or so.\n\nAlright then. Thank you. I'll pick that at lunchtime.\n\nOkay. Alright then.\n\nThank you. Take care. Bye. Bye.\n\nSorry. I don't keep","marks":[{"start":160,"end":165,"said":"Redbridge","significant":true},{"start":178,"end":187,"said":"two two HZ. Hello.","significant":false},{"start":213,"end":223,"said":"forty oh","significant":false},{"start":228,"end":234,"said":"nineteen seventy","significant":false},{"start":424,"end":432,"said":"It stays","significant":false},{"start":755,"end":755,"said":"back","significant":true},{"start":995,"end":995,"said":"Seven.","significant":false},{"start":1164,"end":1169,"said":"Spots. 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Pardon No birth .","significant":false},{"start":3005,"end":3009,"said":"a","significant":false},{"start":3447,"end":3447,"said":"infection","significant":false},{"start":3530,"end":3535,"said":"do","significant":false},{"start":3802,"end":3802,"said":"get them","significant":false},{"start":3957,"end":3963,"said":"litres","significant":false},{"start":4122,"end":4131,"said":"some sachets","significant":false},{"start":4541,"end":4548,"said":"recurrent","significant":true},{"start":4878,"end":4889,"said":"reccurently.","significant":false},{"start":5018,"end":5028,"said":"Uh where will","significant":false},{"start":5314,"end":5314,"said":"How soon","significant":false},{"start":5488,"end":5495,"said":"All right","significant":false},{"start":5543,"end":5556,"said":"OK. All right","significant":false},{"start":5564,"end":5574,"said":"","significant":false},{"start":5590,"end":5590,"said":"Thank you. .","significant":false},{"start":5606,"end":5616,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","Six days of dysuria recorded."],["The note captures: Unpleasant or strong urine odour.","yes","Unpleasant/malodorous urine recorded."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","Central, intermittent lower abdominal pain 7/10."],["The note captures: Visible spots of blood in urine/haematuria.","yes","Blood spotting in urine recorded."],["The note captures: Able to pass urine and maintain oral intake.","yes","Able to pass urine and eating/drinking normally."],["The note captures: No fever and no loin/lower back pain.","yes","No fever and no loin/lower back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge and no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS with mebeverine 200 mg three times daily."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","Clindamycin allergy recorded."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","UTI is the working diagnosis."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","Three-day antibiotic course prescribed."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","Advised to obtain a thermometer and monitor temperature."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","Fluids 2.5-3 L/day."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Recontact for worsening/persistent pain, fever, back pain or difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Review if recurrent; no routine follow-up if resolved."]],"claims":[],"note":"Presenting Condition\n\nHx: 6 days of dysuria and malodorous urine\n\nPain: Lower abdominal pain, midline, intensity 7/10, intermittent\n\nAssociated sx: Dysuria, malodorous urine, visible spotting of blood in urine\n\nProgression: Ongoing over 6 days\n\nPrevious episodes: Denies prior similar symptoms\n\nImpact: Able to pass urine\n\nAggravating/easing factors: Not discussed\n\nContributing factors: Denies recent excess exercise, dehydration, or increased sexual activity\n\nReasons for visit: Painful urination and malodorous urine\n\n\n\n\nRadiology\n\nNone discussed\n\n\n\n\nPrevious MSK injuries\n\nNone mentioned\n\n\n\n\nPast Medical History\n\nIBS\n\nDenies kidney problems or prior urine infections\n\nSurgical hx: Denies prior surgery\n\nAllergies: Clindamycin\n\n\n\n\nMedications\n\nMebeverine 200 mg, three times daily (regular)\n\n\n\n\nRed Flag/Screening Questions\n\nFever: Denies\n\nLow back pain/loin pain: Denies\n\nBowel habit change: Denies\n\nBlood in stool: Denies\n\nWeight loss: Denies\n\nVaginal discharge: Denies\n\nEating/drinking: Able to eat and drink\n\n\n\n\nSocial History\n\nLives with friends\n\nOccupation: Support worker\n\nAlcohol: ~1 glass wine/week\n\nTobacco: Non‑smoker\n\nFamily hx: Denies relevant problems\n\n\n\n\nGoals\n\nSymptom relief and resolution with antibiotics\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Remote consultation; no physical exam performed\n\n\n\n\nDiagnosis\n\nProbable uncomplicated urinary tract infection\n\nPrognosis: Expected improvement with 3‑day antibiotic course\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nRx: 3‑day course of antibiotics sent to requested pharmacy (Knightsbridge practice)\n\nEd:\n\nStart antibiotics as soon as collected\n\nHydration 2.5–3.0 L/day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets from pharmacist\n\nSafety‑net: Seek review if worsening pain, new low back/loin pain, fever, difficulty passing urine, or no improvement\n\n// Patient agreed to plan and will collect at lunchtime\n\n\n\n\nPlan\n\nBegin antibiotics today; monitor symptoms\n\nNo routine follow‑up if symptoms resolve\n\nRecontact if symptoms worsen, do not resolve after course, or recur frequently\n\nTemperature monitoring advised; obtain a thermometer and check if febrile\n","review":91.57894736842105,"saved":212.92105263157896,"clean":true,"effort":0.0,"sig":[],"mb":12.795205,"signable":116.55594736842106},{"label":"Run 4","wer":12.018348623853212,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address,\n\nplease? Hi. My name is Susan. 30 Redbridge Street,\n\nSW 22 H Zed.\n\nAnd your date of birth? Fourteen o two seven. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am.\n\nOkay. What can I do for you?\n\nIt\n\nhurts when I pee.\n\nOkay. And how long is\n\nbeen going on for?\n\nSix days\n\nnow.\n\nPardon?\n\nFor six days. Six\n\ndays.\n\nOkay. And just tell me a bit more about that.\n\nHow did it start?\n\nI've got this\n\nthing when I pee, and it hurts when I go to the loo.\n\nI've got this very unpleasant smell that comes out.\n\nOkay.\n\nAnd have you had any other symptoms along with\n\nthat? Have you had any abdominal pain or lower back pain at all?\n\nI've got\n\npain in my tummy.\n\nWhereabouts?\n\nIn my lower tummy. Okay. Is it one-sided or in the middle?\n\nIn the middle. And how bad would you say that is on a scale of one to 10?\n\nWith 10 being the worst pain.\n\nSeven.\n\nAnd is it constant or does it come and go?\n\nComes and goes.\n\nOkay. And have you actually been able\n\npass water okay?\n\nYes. But I've had spotted blood\n\nin my urine. Okay.\n\nAnd is that just over the\n\nlast\n\nsix days?\n\nYes.\n\nRight. And have you been able to eat and drink okay?\n\nYes.\n\nAnd have you had a temperature? Do you feel like you've\n\nbeen feverish or had a temperature with this?\n\nNo. Not at all.\n\nAnd and then you did you you said you didn't have any low back pain?\n\nNo. I've got\n\nand no loin pain as well.\n\nOkay. And\n\nhave you had these symptoms before? No. Never?\n\nNo.\n\nAnd was there anything you were doing recently\n\nwhich you think may have contributed to it? Have you have you been doing lots of exercise\n\nbeen dehydrated, been having regular sexual intercourse or anything?\n\nNo.\n\nNope. Okay. And\n\nany any other symptoms? Any vaginal discharge or\n\nanything like that?\n\nNo. Just the blood\n\nspot in my\n\nDo you have regular periods?\n\nYes.\n\nI do. Okay.\n\nAnd and in the past, have you had any medical problems at all?\n\nNo medical. No. Have you had any problems with your kidneys or any\n\ninfections?\n\nI had IBS before.\n\nOkay.\n\nAnd how's that been recently? Any change in your bowel habit? Any blood when you\n\npassed stool?\n\nYeah. I've had spotting in my urine.\n\nIn your okay. Any change in your bowel habit?\n\nNo.\n\nAny weight loss or anything? No.\n\nAny other medical problems or surgery in the past?\n\nNo. Do you take regular medications?\n\nI've had mebepin Pardon? Delivery.\n\nDo you take that regularly?\n\nYes.\n\nOkay. And do you take it three times a day?\n\nYes.\n\nI do.\n\nTwo hundred milligrams?\n\nYes.\n\nAny allergies?\n\nAny allergies?\n\nClindamycin.\n\nYou're allergic to clindamycin. Okay.\n\nAnd anyone in your family had any medical problems?\n\nNo.\n\nThat's fine. And whereabouts do you\n\nlive?\n\nYou live with friends, family?\n\nI live with friends.\n\nOkay.\n\nAnd where do you work? What's your job?\n\nI'm a support worker.\n\nOkay.\n\nDo you drink alcohol\n\nat all?\n\nOccasionally.\n\nSo how much in your average week?\n\nOne glass of wine a week.\n\nOkay. Do you smoke?\n\nNo.\n\nOkay. It sounds very much like you\n\nmight have an infection in your urine. Did you say you haven't felt feverish?\n\nNo fever at all.\n\nHave you got a thermometer at home?\n\nNo.\n\nOkay. It would be helpful if you could get\n\na thermometer from the pharmacy and do check your temp\n\njust to make sure that it isn't going up and down.\n\nOkay. Normally, can treat this infection without having\n\nto test your urine with with a course of antibiotics.\n\nOkay.\n\nHow would you feel about\n\nthat? Are you happy to take a course for antibiotics?\n\nYes. I would be.\n\nIt would just be for three days.\n\nOkay.\n\nSo how get my prescription?\n\nYes. So I can send a prescription through to your requested pharmacy for that.\n\nIf you take them as soon as you can, get them pick them up as soon as you can as\n\nstart taking them. The other thing which is important to do is\n\nto drink lots of water, so two and a half to three liters a day.\n\nYeah. You can get some cranberry juice and take\n\ndrink that as well. That sometimes helps and also some\n\nsachets which you can get from the chemist and sachets which\n\njust help change the acidity of your urine. So I\n\ncan put the details of that on your notes. Okay then.\n\nIf you feel like your pain is getting worse or not\n\nsettling, you get lower back pain,\n\nor you're getting a high temperature or you have any problems\n\nactually passing urine, then it's very important that we speak to you again.\n\nOkay.\n\nAnd the other thing is if it becomes a\n\ncommon thing or a current problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course\n\nantibiotics?\n\nNo. Not if you're better.\n\nOkay.\n\nIf you're if you feel like your symptoms get worse at any point,\n\nor they're not resolving with the treatment or you keep getting a similar\n\nyou keep getting a similar problem\n\nrecurrently, then it's important for us to talk\n\ntalk to you in more detail about that.\n\nOkay then.\n\nHave you got any other questions?\n\nNo. What would be the pharmacy I'll\n\nbe picking\n\nup my medication from?\n\nSo have you already requested a pharmacy through Babylon?\n\nYes. I\n\ndid.\n\nCan I\n\njust check\n\nthat with\n\nyou?\n\nKnightsbridge practice.\n\nOkay. That's fine. So the antibiotic that I'm going to prescribe will go through to that\n\npharmacy.\n\nThen\n\nyou'll be able to pick them up from there.\n\nHow soon is that gonna be at the practice? In five minutes?\n\nI would give it longer than that. Give it an hour or so.\n\nAlright then. Thank you. I'll pick that at lunchtime.\n\nOkay. Alright then.\n\nThank\n\nyou. Take care. Bye. Bye. Sorry. I didn't keep","marks":[{"start":184,"end":193,"said":"two two HZ. Hello.","significant":false},{"start":219,"end":229,"said":"forty oh","significant":false},{"start":234,"end":246,"said":"nineteen seventy four. OK.","significant":true},{"start":397,"end":399,"said":"has that","significant":false},{"start":421,"end":429,"said":"It stays","significant":false},{"start":755,"end":755,"said":"back","significant":true},{"start":996,"end":996,"said":"Seven.","significant":false},{"start":1162,"end":1167,"said":"Spots. OK.","significant":false},{"start":1404,"end":1416,"said":"any","significant":false},{"start":1454,"end":1457,"said":"lower","significant":false},{"start":1789,"end":1800,"said":"No OK.","significant":false},{"start":1907,"end":1907,"said":"No.","significant":false},{"start":2088,"end":2088,"said":"urine","significant":false},{"start":2211,"end":2217,"said":"pass","significant":false},{"start":2311,"end":2314,"said":"","significant":false},{"start":2343,"end":2343,"said":"No.","significant":false},{"start":2449,"end":2456,"said":"Mebeverine Mebeverine. I've had Mebeverine.","significant":true},{"start":2465,"end":2474,"said":"No birth .","significant":false},{"start":2784,"end":2784,"said":"Do","significant":false},{"start":2980,"end":2984,"said":"a","significant":false},{"start":3322,"end":3326,"said":"temperature","significant":false},{"start":3503,"end":3508,"said":"do","significant":false},{"start":3632,"end":3645,"said":"OK. Um.","significant":false},{"start":3826,"end":3828,"said":"and","significant":false},{"start":3945,"end":3951,"said":"litres","significant":false},{"start":4108,"end":4111,"said":"some","significant":false},{"start":4526,"end":4533,"said":"recurrent","significant":true},{"start":4860,"end":4871,"said":"reccurently.","significant":false},{"start":5000,"end":5010,"said":"Uh where will","significant":false},{"start":5229,"end":5239,"said":"antibiotics","significant":false},{"start":5249,"end":5257,"said":"gonna","significant":false},{"start":5302,"end":5302,"said":"How soon And","significant":false},{"start":5473,"end":5480,"said":"All right","significant":false},{"start":5528,"end":5541,"said":"OK. All right","significant":false},{"start":5549,"end":5560,"said":"","significant":false},{"start":5576,"end":5576,"said":"Thank you. .","significant":false},{"start":5591,"end":5602,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Malodorous urine reported\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Suprapubic/lower abdominal pain, midline, 7/10, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Visible spotting of blood in urine\"."],["The note captures: Able to pass urine and maintain oral intake.","partial","\"Able to pass urine\" captured, but maintained eating/drinking is not."],["The note captures: No fever and no loin/lower back pain.","yes","No fever, no low back pain, no loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge; first episode."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS; \"Mebeverine 200 mg, three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Uncomplicated urinary tract infection suspected\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"3-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","no","Advice to obtain a thermometer and monitor temperature is missing."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Hydration target 2.5-3.0 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Seek review if pain worsens, fever, back/loin pain, difficulty passing urine, persistence."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","Re-consult if recur; no routine follow-up if resolved."]],"claims":[["Prognosis: expected improvement with 3-day antibiotic course","No prognosis was stated in the consultation; the clinician only prescribed the course and gave safety-netting."]],"note":"Presenting Condition\n\nDysuria for 6 days\n\nMalodorous urine reported\n\nSuprapubic/lower abdominal pain, midline, 7/10, intermittent\n\nVisible spotting of blood in urine over same 6-day period\n\nAble to pass urine\n\nNo fever reported\n\nNo low back pain\n\nNo loin pain\n\nNo vaginal discharge\n\nFirst episode of these symptoms\n\nReason for visit: urinary symptoms and pain when voiding\n\nAggravating/easing factors: advised hydration; no specific triggers identified\n\n\n\n\nPast Medical History\n\nIBS\n\nRegular menstrual periods\n\nDenies other medical problems or past surgery\n\nFamily history: none reported\n\nAllergy: Clindamycin\n\n\n\n\nMedications\n\nMebeverine 200 mg, three times daily\n\nNew prescription: 3-day course of antibiotics for presumed UTI (sent to nominated pharmacy)\n\n\n\n\nRed Flag/Screening Questions\n\nFever: denies\n\nLow back pain: denies\n\nLoin pain: denies\n\nBowel habit change: denies\n\nWeight loss: denies\n\nVaginal discharge: denies\n\nHydration/sexual activity/exercise as contributors: denies\n\n\n\n\nSocial History\n\nLives with friends\n\nOccupation: Support worker\n\nAlcohol: ~1 glass wine/week\n\nTobacco: non-smoker\n\n\n\n\nGoals\n\nSymptom relief of dysuria and abdominal pain\n\nResolution of haematuria\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nUncomplicated urinary tract infection suspected\n\nPrognosis: expected improvement with 3-day antibiotic course\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nEd:\n\nStart 3-day antibiotic course promptly\n\nHydration target 2.5–3.0 L/day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets (per chemist)\n\nSafety-net: seek review if pain worsens, fever develops, new low back/loin pain, difficulty passing urine, or symptoms persist/recur\n\n\n\n\nPlan\n\nPrescription sent to nominated pharmacy (Knightsbridge practice); allow ~1 hour before collection; patient to collect at lunchtime\n\nNo routine follow-up if symptoms resolve after antibiotics\n\nRe-consult if symptoms worsen, fail to improve after course, or recur frequently\n","review":125.57894736842105,"saved":178.92105263157896,"clean":false,"effort":20.0,"sig":[],"mb":12.663071,"signable":148.85494736842105},{"label":"Run 5","wer":12.201834862385322,"text":"Good morning. I'm doctor Smith from Babylon. Can you just confirm your name, date of birth, and the first line of your address,\n\nplease? Hi. My name is Susan. 30 Redbridge Street,\n\nSW 22 H Zed.\n\nAnd your date of birth? Fourteen o two seven. Okay. Are you in a private place so you can have a consultation today?\n\nYes. I am.\n\nOkay. What can I do for you?\n\nIt\n\nhurts when I pee.\n\nOkay. And how long is\n\nbeen going on for?\n\nSix days\n\nnow.\n\nPardon?\n\nFor six days. Six\n\ndays.\n\nOkay. And just tell me a bit more about that.\n\nHow did it start?\n\nI've got this\n\nthing when I pee, and it hurts when I go to the loo.\n\nI've got this very unpleasant smell that comes out.\n\nOkay.\n\nAnd have you had any other symptoms along with\n\nthat? Have you had any abdominal pain or lower back pain at all?\n\nI've got\n\npain in my tummy.\n\nWhereabouts?\n\nIn my lower tummy. Okay. Is it one-sided or in the middle?\n\nIn the middle. And how bad would you say that is on a scale of one to 10?\n\nWith 10 being the worst pain.\n\nSeven.\n\nAnd is it constant or does it come and go?\n\nComes and goes.\n\nOkay. And have you actually been able\n\npass water okay?\n\nYes. But I've had spotted blood\n\nin my urine. Okay.\n\nAnd is that just over the\n\nlast\n\nsix days?\n\nYes.\n\nRight. And have you been able to eat and drink okay?\n\nYes.\n\nAnd have you had a temperature? Do you feel like you've\n\nbeen feverish or had a temperature with this?\n\nNo. Not at all.\n\nAnd and then you... Did you... You said you didn't have any low back pain?\n\nNo. I've got\n\nand no loin pain as well.\n\nOkay. And\n\nhave you had these symptoms before? No. Never?\n\nNo.\n\nAnd was there anything you were doing recently\n\nwhich you think may have contributed to it? Have you have you been doing lots of exercise\n\nbeen dehydrated, been having regular sexual intercourse or anything?\n\nNo.\n\nNope. Okay. And\n\nany any other symptoms? Any vaginal discharge or\n\nanything like that?\n\nNo. Just the blood\n\nspot in my\n\nDo you have regular periods?\n\nYes.\n\nI do. Okay.\n\nAnd and in the past, have you had any medical problems at all?\n\nNo medical. No. Have you had any problems with your kidneys or any\n\ninfections?\n\nI had IBS before.\n\nOkay.\n\nAnd how's that been recently? Any change in your bowel habit? Any blood when you\n\npassed stool?\n\nYeah. I've had spotting in my urine.\n\nIn your... Okay. Any change in your bowel habit?\n\nNo.\n\nAny weight loss or anything? No.\n\nAny other medical problems or surgery in the past?\n\nNo. Do you take regular medications?\n\nI've had mebepin Pardon? Delivery.\n\nDo you take that regularly?\n\nYes.\n\nOkay. And do you take it three times a day?\n\nYes.\n\nI do.\n\nTwo hundred milligrams?\n\nYes.\n\nAny allergies?\n\nAny allergies?\n\nClindamycin.\n\nYou're allergic to clindamycin. Okay.\n\nAnd anyone in your family had any medical problems?\n\nNo.\n\nThat's fine. And whereabouts do you\n\nlive?\n\nYou live with friends, family?\n\nI live with friends.\n\nOkay.\n\nAnd where do you work? What's your job?\n\nI'm a support worker.\n\nOkay.\n\nDo you drink alcohol\n\nat all?\n\nOccasionally.\n\nSo how much in your average week?\n\nOne glass of wine a week.\n\nOkay. Do you smoke?\n\nNo.\n\nOkay. It sounds very much like you\n\nmight have an infection in your urine. Did you say you haven't felt feverish?\n\nNo fever at all.\n\nHave you got a thermometer at home?\n\nNo.\n\nOkay. It would be helpful if you could get\n\na thermometer from the pharmacy and do check your temp\n\njust to make sure that it isn't going up and down.\n\nOkay. Normally, can treat this infection without having\n\ntest your urine with with the course of antibiotics.\n\nOkay.\n\nHow would you feel about\n\nthat? Are you happy to take a course for antibiotics?\n\nYes. I would be.\n\nIt would just be for three days.\n\nOkay.\n\nSo how...\n\nGet my prescription?\n\nYes. So I can send a prescription through to your requested pharmacy for that.\n\nIf you take them as soon as you can, get them... Pick them up as soon as you can as\n\nstart taking them. The other thing which is important to do is\n\nto drink lots of water, so two and a half to three liters a day.\n\nYeah. You\n\ncan get some cranberry juice and take\n\ndrink that as well. That sometimes helps and also some\n\nsachets which you can get from the chemist and sachets which\n\njust help change the acidity of your urine. So I\n\ncan put the details of that on your notes.\n\nOkay then.\n\nIf you feel like your pain is getting worse or not\n\nsettling, you get lower back pain,\n\nor you're getting a high temperature or you have any problems\n\nactually passing urine, then it's very important that we speak to you again.\n\nOkay.\n\nAnd the other thing is if it becomes a\n\ncommon thing or a current problem, then we need to talk to you again about it.\n\nSo do I have to call after I finish my course\n\nantibiotics?\n\nNo. Not if you're better.\n\nOkay.\n\nIf you're... If you feel like your symptoms get worse at any point,\n\nor they're not resolving with the treatment or you keep getting a similar\n\nyou keep getting a similar problem\n\nrecurrently, then it's important for us to talk\n\ntalk to you in more detail about that.\n\nOkay then.\n\nHave you got any other questions?\n\nNo. What would be the pharmacy I'll\n\nbe picking\n\nup my medication from?\n\nSo have you already requested a pharmacy through Babylon?\n\nYes. I\n\ndid.\n\nCan I\n\njust check\n\nthat with\n\nyou?\n\nKnightsbridge practice.\n\nOkay. That's fine. So the antibiotic that I'm going to prescribe will go through to that\n\npharmacy.\n\nThen\n\nyou'll be able to pick them up from there.\n\nHow soon is that gonna be at the practice? In five minutes?\n\nI would give it longer than that. Give it an hour or so.\n\nAlright then. Thank you. I'll pick that at lunchtime.\n\nOkay. Alright then.\n\nThank\n\nyou. Take care. Bye. Bye. Sorry. I didn't keep","marks":[{"start":184,"end":193,"said":"two two HZ. Hello.","significant":false},{"start":219,"end":229,"said":"forty oh","significant":false},{"start":234,"end":246,"said":"nineteen seventy four. OK.","significant":true},{"start":397,"end":399,"said":"has that","significant":false},{"start":421,"end":429,"said":"It stays","significant":false},{"start":755,"end":755,"said":"back","significant":true},{"start":996,"end":996,"said":"Seven.","significant":false},{"start":1162,"end":1167,"said":"Spots. OK.","significant":false},{"start":1404,"end":1419,"said":"any","significant":false},{"start":1460,"end":1463,"said":"lower","significant":false},{"start":1795,"end":1806,"said":"No OK.","significant":false},{"start":1913,"end":1913,"said":"No.","significant":false},{"start":2094,"end":2094,"said":"urine","significant":false},{"start":2217,"end":2223,"said":"pass","significant":false},{"start":2320,"end":2323,"said":"","significant":false},{"start":2352,"end":2352,"said":"No.","significant":false},{"start":2458,"end":2465,"said":"Mebeverine Mebeverine. I've had Mebeverine.","significant":true},{"start":2474,"end":2483,"said":"No birth .","significant":false},{"start":2793,"end":2793,"said":"Do","significant":false},{"start":2989,"end":2993,"said":"a","significant":false},{"start":3331,"end":3335,"said":"temperature","significant":false},{"start":3511,"end":3516,"said":"do","significant":false},{"start":3640,"end":3656,"said":"OK. Um.","significant":false},{"start":3841,"end":3843,"said":"and","significant":false},{"start":3960,"end":3966,"said":"litres","significant":false},{"start":4124,"end":4127,"said":"some","significant":false},{"start":4543,"end":4550,"said":"recurrent","significant":true},{"start":4880,"end":4891,"said":"reccurently.","significant":false},{"start":5020,"end":5030,"said":"Uh where will","significant":false},{"start":5249,"end":5259,"said":"antibiotics","significant":false},{"start":5269,"end":5277,"said":"gonna","significant":false},{"start":5322,"end":5322,"said":"How soon And","significant":false},{"start":5493,"end":5500,"said":"All right","significant":false},{"start":5548,"end":5561,"said":"OK. All right","significant":false},{"start":5569,"end":5580,"said":"","significant":false},{"start":5596,"end":5596,"said":"Thank you. .","significant":false},{"start":5611,"end":5622,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Pain on urination for 6 days\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"Malodorous urine reported\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Lower abdominal pain, midline, intermittent, severity 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Visible spotting of blood in urine\"."],["The note captures: Able to pass urine and maintain oral intake.","partial","\"Able to pass urine\" captured; oral intake not mentioned."],["The note captures: No fever and no loin/lower back pain.","yes","No fever; no low back or loin pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","No vaginal discharge; first episode."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS; \"Mebeverine 200 mg, three times daily\"."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergy: Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Probable uncomplicated urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Antibiotics prescribed for 3 days\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain a thermometer to monitor temperature\"."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Hydration 2.5-3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Safety-net for worsening pain, back/loin pain, fever, difficulty passing urine."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","No routine follow-up if resolved; re-contact if recurrent."]],"claims":[],"note":"Presenting Condition\n\nPain on urination for 6 days\n\nMalodorous urine reported\n\nLower abdominal pain, midline, intermittent, severity 7/10\n\nVisible spotting of blood in urine over same 6 days\n\nAble to pass urine\n\nNo fever reported\n\nNo low back pain or loin pain\n\nNo vaginal discharge\n\nFirst episode; no identifiable trigger (no ↑exercise, dehydration, or ↑sexual activity)\n\n\n\n\nPast Medical History\n\nIBS\n\nNo kidney problems or prior infections reported\n\nNo past surgeries reported\n\nAllergy: Clindamycin\n\n\n\n\nMedications\n\nMebeverine 200 mg, three times daily\n\n\n\n\nRed Flag/Screening Questions\n\nFever: denies\n\nLow back/loin pain: denies\n\nAbdominal pain: present (lower, intermittent)\n\nVaginal discharge: denies\n\nChange in bowel habit: denies\n\nWeight loss: denies\n\nFamily history: none reported\n\nSmoking: denies\n\nAlcohol: occasional (1 glass wine/week)\n\n\n\n\nSocial History\n\nLives with friends\n\nOccupation: support worker\n\nAlcohol: 1 glass wine/week\n\nNon-smoker\n\n\n\n\nGoals\n\nSymptom relief and resolution with antibiotics\n\n\n\n\nObjective\n\n(Consent obtained)\n\nNo physical exam performed in transcript (telehealth context)\n\n\n\n\nDiagnosis\n\nProbable uncomplicated urinary tract infection\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nAntibiotics prescribed for 3 days, sent to nominated pharmacy (Knightsbridge practice)\n\nEd:\n\nStart antibiotics as soon as collected\n\nHydration 2.5–3 L/day\n\nConsider cranberry juice\n\nConsider urinary alkalinising sachets from pharmacy\n\nObtain a thermometer to monitor temperature\n\nSafety-net: seek review if worsening pain, new low back/loin pain, fever, difficulty passing urine, or non-resolution/recurrent symptoms\n\n// Patient agreeable to antibiotics; plans to collect at lunchtime; no further questions\n\n\n\n\nPlan\n\nNo routine follow-up if symptoms resolve after course\n\nRe-contact service if symptoms worsen, persist after treatment, or recur frequently\n\nPrescription to pharmacy within ~1 hour; patient to collect at lunchtime on 22/09/2026\n","review":96.57894736842105,"saved":207.92105263157896,"clean":false,"effort":3.3333333333333335,"sig":[],"mb":12.846089,"signable":117.57694736842106}],"patientnotes":[{"label":"Run 1","wer":14.220183486238533,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth in the first line of your address, please?\nHi. My name is Susan. 30 Rydbridge Street, SW22HZ.\nAnd your date of birth? 1402. Okay. Are you in a private place? You can have a consultation today? Yes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on? For six days now. Pardon? For six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this sting when I pee and it hurts when I go to the loo. I've got\nthis very unpleasant smell that comes out.\nOkay. And have you had any other things.\nSymptoms along with that, have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water? Okay. Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right. And have you been able to eat and drink? Okay. Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No, not at all. You said you didn't have any.\nLow back pain? No, I've got. And no loin pain as well. Okay. And have you had these symptoms before? No, never. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. Okay. And any other symptoms? Any vaginal discharge or anything like that? No, just the blood spot in my. Do you have regular periods? Yes, I do. Okay. And in the past, have you had any medical problems at all? No. Medical. No. Have you had any problems with your kidneys or any urinary infections? I have.\nHad IBS before. Okay. And how's that been recently? Any change in your bowel habit? Any blood when you pass stool? Yeah, I've had spotting in my urine. Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? Had Mebbevin. Do you take that regularly? Yes. Okay. And do you take it three times a day? Yes, I do. 200 milligrams? Yes. Any allergies? Any allergies? Cleaner? Mycin. You are allergic to Clindamycin. Okay. And anyone in your family had any medical problems? No.\nThat's fine. And whereabouts do you live? Do you live with friends, family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy. And do check your temperature just to make sure that it isn't going up and down. Normally, we can treat this infection without having to test your urine with. Of course.\nOf antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes, I would be. It would just be for three days. Okay. Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can get them, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So two and a half to three liters a day, you can get some cranberry juice and drink that as well. That sometimes helps. And also some sachets which you can get from the chemists, and sachets which just help change the acidity of your urine. So I can put the details of that on your notes. Okay. Then if you feel like your pain is getting worse or not settling, you get lower back pain.\nOr you're getting a high temperature, you have any problems actually passing urine, then it's very important that we speak to you again. Okay? The other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to go after I finish my course of antibiotics? No, not if you're better. Okay. If you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar. You keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? Have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Night bridge practice.\nOkay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy, and you'll be able to pick them up from there. How soon is that going to be at a practice? In five minutes. I would give it longer than that. Give it an hour or so. All right, then. Thank you. I'll pick that at lunchtime. Okay. All right, then. Thank you. Take care. Bye. Bye. Sorry I didn't keep.","marks":[{"start":156,"end":165,"said":"Redbridge","significant":false},{"start":174,"end":181,"said":"SW two two HZ. Hello.","significant":false},{"start":206,"end":217,"said":"forty oh two nineteen seventy four. OK.","significant":true},{"start":389,"end":397,"said":"It stays","significant":false},{"start":513,"end":518,"said":"thing","significant":false},{"start":650,"end":657,"said":"","significant":false},{"start":718,"end":718,"said":"back","significant":true},{"start":946,"end":946,"said":"Seven.","significant":false},{"start":1109,"end":1109,"said":"Spots. 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You're","significant":true},{"start":3301,"end":3306,"said":"do","significant":false},{"start":3425,"end":3430,"said":"OK. Um. get my prescription.","significant":false},{"start":3706,"end":3712,"said":"litres","significant":false},{"start":3756,"end":3756,"said":"take","significant":false},{"start":3848,"end":3861,"said":"chemist some","significant":false},{"start":4101,"end":4101,"said":"or","significant":false},{"start":4341,"end":4343,"said":"call","significant":false},{"start":4411,"end":4416,"said":"If you're","significant":false},{"start":4583,"end":4594,"said":"reccurently.","significant":false},{"start":4625,"end":4625,"said":"talk","significant":false},{"start":4664,"end":4664,"said":"OK. Yeah. OK then. Um","significant":false},{"start":4703,"end":4713,"said":"Uh where will","significant":false},{"start":4868,"end":4880,"said":"Knightsbridge","significant":false},{"start":4938,"end":4946,"said":"gonna","significant":false},{"start":4989,"end":4989,"said":"How soon","significant":false},{"start":4994,"end":4994,"said":"then","significant":false},{"start":5055,"end":5063,"said":"gonna","significant":false},{"start":5236,"end":5246,"said":"","significant":false},{"start":5262,"end":5262,"said":"Thank you. .","significant":false},{"start":5276,"end":5288,"said":".","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria for six days\", \"stinging sensation on urination\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"unpleasant odor\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Lower abdominal midline pain 7/10, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Spotting of blood in urine\"."],["The note captures: Able to pass urine and maintain oral intake.","no","Ability to pass urine and eat/drink is not documented."],["The note captures: No fever and no loin/lower back pain.","yes","\"No fever, no back/loin pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","no","Records \"Past urinary infection history\", contradicting no previous similar symptoms."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","partial","\"Mebbevin 200 mg TID\" misspelled and IBS history omitted."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergic to Clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Likely urinary tract infection (UTI)\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed 3‑day course of antibiotics (unspecified)\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","partial","\"Monitor temperature\" but no advice to obtain a thermometer."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5–3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","partial","Includes fever, worsening pain, urinary retention, persistence, but omits back pain."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","\"Follow‑up if symptoms persist or recur\" but no statement that routine review is unnecessary if better."]],"claims":[["Past urinary infection history","Transcript states she has never had these symptoms before (\"have you had these symptoms before?\" \"No.\")."]],"note":"Subjective\n\nChief Complaint::\n\nDysuria for six days.\n\nHistory of Presenting Complaint::\n\nOnset 6 days ago with stinging sensation on urination and unpleasant odor.\n\nLower abdominal midline pain 7/10, intermittent.\n\nSpotting of blood in urine.\n\nNo fever, no back/loin pain, no vaginal discharge.\n\nNo recent increased exercise, dehydration, or sexual activity.\n\nRegular periods.\n\nPast urinary infection history.\n\nCurrent medication: Mebbevin 200 mg TID.\n\nAllergic to Clindamycin.\n\nSocial: lives with friends, support worker, occasional alcohol (1 glass wine/week), non‑smoker.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely urinary tract infection (UTI).\n\nPlan\n\nMedications::\n\nMebbevin 200 mg three times daily.\n\nPrescribed 3‑day course of antibiotics (unspecified).\n\nIncrease fluid intake to 2.5–3 L/day (water, cranberry juice, urine‑acidifying sachets).\n\nMonitor temperature; seek care if fever, worsening pain, or urinary retention.\n\nPrescription sent to Night Bridge practice pharmacy for pickup within ~1 hour.\n\nFollow‑up if symptoms persist or recur.","review":151.5,"saved":153.0,"clean":false,"effort":33.33333333333333,"sig":[["missing","No vaginal discharge and no previous similar urine infection/symptoms.","Note records past urinary infection history when the patient said she never had these symptoms, implying recurrent UTI."],["partial","Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","Safety-net omits new back pain, the given red flag for upper tract infection."]],"mb":25.520531,"latency":27.126,"signable":178.626},{"label":"Run 2","wer":13.486238532110093,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth in the first line of your address, please?\nHi. My name is Susan. 30 Rydbridge Street, SW2.2HZ.\nAnd your date of birth? 1402. Okay. Are you in a private place? You can have a consultation today? Yes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on? For Six days now. Pardon? Six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this sting when I pee and it hurts when I go to the loo. I've got this very\nunpleasant smell that comes out.\nOkay.\nAnd have\nyou had it.\nAny other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water? Okay. Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right. And have you been able to eat and drink? Okay. Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No, not at all. You said you.\nYou didn't have any low back pain? No, I've got no loin pain as well. Okay. And have you had these symptoms before? No, never. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. Okay. And any other symptoms? Any vaginal discharge or anything like that? No, just the blood spot in my. Do you have regular periods? Yes, I do. Okay. And in the past, have you had any medical problems at all? No. Medical. No. Have you had any problems with your kidneys or any urine infections?\nI had IBS before. Okay, and how's that been recently? Any change in your bowel habit? Any blood when you pass stool? Yeah, I've had spotting in my urine. Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? Had Mebeverine. Do you take that regularly? Yes. Okay. And do you take it three times a day? Yes, I do. 200 milligrams? Yes. Any allergies? Any allergies? Clean the mycin. You're allergic to Clindamycin. Okay. And anyone in your family had any medical problems?\nNo, that's fine. And whereabouts do you live? Do you live with friends, Family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy. And do check your temperature just to make sure that it isn't going up and down. Normally, we can treat this infection without having to test your urine with.\nWith a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes, I would be. It would just be for three days. Okay. Get my prescription. Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So two and a half to three liters a day, you can get some cranberry juice and drink that as well. That sometimes helps. And also some sachets which you can get from the chemists and sachets which just help change the acidity of your urine. So I can put the details of that on your notes. Okay. Then if you feel like your pain is getting worse or not settling, you get lower back pain.\nOr you're getting a high temperature, you have any problems actually passing urine, then it's very important that we speak to you again. Okay? The other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No, not if you're better. If you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar. You keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Ok? Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So, have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knights Bridge practice.\nOkay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy, and you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes. I would give it longer than that. Give it an hour or so. All right, then. Thank you. I'll kick that at lunchtime. Okay. All right, then. Thank you. Take care. Bye.","marks":[{"start":156,"end":165,"said":"Redbridge","significant":false},{"start":174,"end":182,"said":"SW two two HZ. Hello.","significant":false},{"start":207,"end":218,"said":"forty oh two nineteen seventy four. OK.","significant":true},{"start":390,"end":398,"said":"It stays","significant":false},{"start":510,"end":515,"said":"thing","significant":false},{"start":711,"end":711,"said":"back","significant":true},{"start":939,"end":939,"said":"Seven.","significant":false},{"start":1102,"end":1102,"said":"Spots. 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Pardon No birth .","significant":false},{"start":2438,"end":2454,"said":"Clindamycin.","significant":false},{"start":3290,"end":3295,"said":"do","significant":false},{"start":3555,"end":3555,"said":"get them","significant":false},{"start":3707,"end":3713,"said":"litres","significant":false},{"start":3757,"end":3757,"said":"take","significant":false},{"start":3849,"end":3861,"said":"chemist some","significant":false},{"start":4101,"end":4101,"said":"or","significant":false},{"start":4415,"end":4415,"said":"you're if","significant":false},{"start":4579,"end":4590,"said":"reccurently.","significant":false},{"start":4621,"end":4621,"said":"talk","significant":false},{"start":4663,"end":4663,"said":"Yeah. OK then. Um","significant":false},{"start":4703,"end":4713,"said":"Uh where will","significant":false},{"start":4872,"end":4886,"said":"Knightsbridge","significant":false},{"start":4944,"end":4952,"said":"gonna","significant":false},{"start":4995,"end":4995,"said":"How soon","significant":false},{"start":5000,"end":5000,"said":"then","significant":false},{"start":5061,"end":5069,"said":"gonna","significant":false},{"start":5197,"end":5201,"said":"pick","significant":false},{"start":5244,"end":5254,"said":"","significant":false},{"start":5270,"end":5270,"said":"Thank you. . Bye. Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"6-day history of stinging dysuria\"."],["The note captures: Unpleasant or strong urine odour.","yes","\"unpleasant urine odour\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"intermittent midline lower abdominal pain 7/10\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"spotted haematuria\"."],["The note captures: Able to pass urine and maintain oral intake.","no","Ability to pass urine and maintained eating/drinking are not documented."],["The note captures: No fever and no loin/lower back pain.","yes","Denies fever and back pain."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","partial","Prior similar episodes denied, but absence of vaginal discharge is not documented."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","partial","Mebeverine 200 mg three times daily listed, but the IBS diagnosis is not stated."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","no","Clindamycin allergy is not documented."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Likely urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed a three-day course of antibiotics\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","no","Advice to obtain a thermometer and monitor temperature is missing."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Review for worsening pain, fever, back pain or difficulty voiding."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","partial","\"No routine follow-up required if symptoms resolve\" captured, but review of recurrent episodes is omitted."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nDysuria\n\nHistory of Presenting Complaint::\n\n6‑day history of stinging dysuria, unpleasant urine odour, intermittent midline lower abdominal pain 7/10, and spotted haematuria\n\nDenies fever, back pain, recent vigorous exercise, dehydration, recent sexual activity, and prior similar episodes\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely urinary tract infection\n\nPlan\n\nMedications::\n\nMebeverine 200 mg three times daily\n\nPrescribed a three‑day course of antibiotics\n\nCommence antibiotic course immediately\n\nIncrease fluid intake to 2.5–3 L/day; consider cranberry juice and urinary‑acidity sachets\n\nMonitor for worsening pain, fever, back pain, or difficulty voiding; seek review if any develop\n\nNo routine follow‑up required if symptoms resolve","review":132.23684210526315,"saved":172.26315789473685,"clean":false,"effort":30.0,"sig":[["missing","Clindamycin allergy is recorded; do not report no known drug allergies.","Clindamycin allergy omitted while antibiotics are being prescribed."]],"mb":21.309572,"latency":26.147,"signable":158.38384210526314},{"label":"Run 3","wer":13.853211009174313,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth in the first line of your address, please?\nHi. My name is Susan. 30 Rydbridge Street, SW2.2HZ.\nAnd your date of birth? 1402. Okay. Are you in a private place? You can have a consultation today? Yes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on? For? Six days now. Pardon? Six\ndays.\nSix days. Okay. And just tell me a bit more about that. How did it start? I've got this sting when I pee, and it hurts when I go to the loo. I've got this very\nunpleasant smell that comes out.\nOkay.\nAnd have you\nhad any.\nAny other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water? Okay. Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right. And have you been able to eat and drink? Okay. Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No, not at all. You said you.\nYou didn't have any low back pain? No, I've got no loin pain as well. Okay. And have you had these symptoms before? No, never. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. Okay. And any other symptoms? Any vaginal discharge or anything like that? No, just the blood spot in my. Do you have regular periods? Yes, I do. Okay. And in the past, have you had any medical problems at all? No. Medical. No. Have you had any problems with your kidneys or any urine infections?\nI had IBS before. Okay, and how's that been recently? Any change in your bowel habit? Any blood when you pass stool? Yeah, I've had spotting in my urine. Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? Had Mebeverine. Do you take that regularly? Yes. Okay. And do you take it three times a day? Yes, I do. 200 milligrams? Yes. Any allergies? Any allergies? Clean the mycin. You are allergic to Clindamycin. Okay. And anyone in your family had any medical problems?\nNo, that's fine. And whereabouts do you live? Do you live with friends, Family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy. And do check your temperature just to make sure that it isn't going up and down. Normally, we can treat this infection without having to test your urine with.\nWith a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes, I would be. It would just be for three days. Okay. Get my prescription. Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So two and a half to three liters a day, you can get some cranberry juice and drink that as well. That sometimes helps. And also some sachets which you can get from the chemists and sachets which just help change the acidity of your urine. So I can put the details of that on your notes. Okay. Then if you feel like your pain is getting worse or not settling, you get lower back pain.\nOr you're getting a high temperature, you have any problems actually passing urine, then it's very important that we speak to you again. Okay? The other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to go after I finish my course of antibiotics? No, not if you're better. If you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar. You keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So, have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knights Bridge practice.\nOkay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy, and you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes. I would give it longer than that. Give it an hour or so. All right, then. Thank you. I'll kick that at lunchtime. Okay. All right, then. Thank you. Take care. Bye.","marks":[{"start":156,"end":165,"said":"Redbridge","significant":false},{"start":174,"end":182,"said":"SW two two HZ. Hello.","significant":false},{"start":207,"end":218,"said":"forty oh two nineteen seventy four. OK.","significant":true},{"start":391,"end":399,"said":"It stays","significant":false},{"start":511,"end":516,"said":"thing","significant":false},{"start":639,"end":643,"said":"","significant":false},{"start":714,"end":714,"said":"back","significant":true},{"start":942,"end":942,"said":"Seven.","significant":false},{"start":1105,"end":1105,"said":"Spots. OK.","significant":false},{"start":1328,"end":1328,"said":"Um and any did you","significant":false},{"start":1363,"end":1366,"said":"lower","significant":false},{"start":1469,"end":1469,"said":"No.","significant":false},{"start":1569,"end":1569,"said":"have you","significant":false},{"start":1672,"end":1677,"said":"No OK.","significant":false},{"start":1681,"end":1681,"said":"any","significant":false},{"start":1777,"end":1777,"said":"No.","significant":false},{"start":2123,"end":2128,"said":"In your OK. Um","significant":false},{"start":2161,"end":2164,"said":"","significant":false},{"start":2192,"end":2192,"said":"No.","significant":false},{"start":2284,"end":2284,"said":"I've","significant":false},{"start":2301,"end":2301,"said":"Mebeverine. I've had Mebeverine. Pardon No birth .","significant":false},{"start":2441,"end":2465,"said":"Clindamycin. You're","significant":false},{"start":3294,"end":3299,"said":"do","significant":false},{"start":3559,"end":3559,"said":"get them","significant":false},{"start":3711,"end":3717,"said":"litres","significant":false},{"start":3761,"end":3761,"said":"take","significant":false},{"start":3853,"end":3865,"said":"chemist some","significant":false},{"start":4105,"end":4105,"said":"or","significant":false},{"start":4345,"end":4347,"said":"call","significant":false},{"start":4414,"end":4414,"said":"If you're","significant":false},{"start":4581,"end":4592,"said":"reccurently.","significant":false},{"start":4623,"end":4623,"said":"talk","significant":false},{"start":4662,"end":4662,"said":"OK. Yeah. OK then. Um","significant":false},{"start":4701,"end":4711,"said":"Uh where will","significant":false},{"start":4870,"end":4884,"said":"Knightsbridge","significant":false},{"start":4942,"end":4950,"said":"gonna","significant":false},{"start":4993,"end":4993,"said":"How soon","significant":false},{"start":4998,"end":4998,"said":"then","significant":false},{"start":5059,"end":5067,"said":"gonna","significant":false},{"start":5195,"end":5199,"said":"pick","significant":false},{"start":5242,"end":5252,"said":"","significant":false},{"start":5268,"end":5268,"said":"Thank you. . Bye. Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","6 days of dysuria with stinging on voiding."],["The note captures: Unpleasant or strong urine odour.","yes","\"foul odor\"."],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"mid-lower abdominal pain 7/10, intermittent\"."],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"Associated haematuria (spotting)\"."],["The note captures: Able to pass urine and maintain oral intake.","no","Ability to pass urine and oral intake not documented."],["The note captures: No fever and no loin/lower back pain.","yes","\"no fever, no back pain\"."],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","partial","No prior similar episodes captured; absence of vaginal discharge not documented."],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","IBS; Mebeverine 200 mg TID."],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"allergic to clindamycin\"."],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Likely urinary tract infection\"."],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed antibiotics (3-day course)\"."],["The note captures: Advised to obtain a thermometer and monitor temperature.","partial","\"Monitor temperature\" captured but advice to obtain a thermometer omitted."],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3 L/day\"."],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Seek care if pain worsens, back pain, fever, difficulty voiding."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","no","Neither review of recurrent episodes nor no-routine-review advice is documented."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nDysuria (painful urination) for 6 days\n\nHistory of Presenting Complaint::\n\nOnset 6 days ago with stinging on voiding, foul odor and mid‑lower abdominal pain 7/10, intermittent\n\nAssociated haematuria (spotting), no fever, no back pain, no prior similar episodes\n\nPast history of IBS, regularly takes Mebeverine 200 mg TID; allergic to clindamycin\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely urinary tract infection\n\nPlan\n\nMedications::\n\nPrescribed antibiotics (3‑day course)\n\nMebeverine 200 mg three times daily\n\nAllergy: clindamycin\n\nIncrease fluid intake to 2.5–3 L/day; consider cranberry juice and urinary‑acidifying sachets\n\nTake prescribed antibiotics promptly and complete the 3‑day course\n\nMonitor temperature; seek care if pain worsens, back pain develops, fever occurs, or difficulty voiding\n\nPrescription sent to Knights Bridge practice pharmacy for collection","review":106.36842105263159,"saved":198.1315789473684,"clean":false,"effort":20.0,"sig":[],"mb":22.209564,"latency":26.135,"signable":132.50342105263158},{"label":"Run 4","wer":13.486238532110093,"text":"Good morning. I'm Dr. Smith from Babylon. Can you just confirm your name, date of birth in the first line of your address, please?\nHi. My name is Susan. 30 Rydbridge Street, SW2.2HZ.\nAnd your date of birth? 1402. Okay. Are you in a private place? You can have a consultation today? Yes, I am. Okay. What can I do for you? It hurts when I pee. Okay. And how long has that been going on? For Six days now. Pardon? Six days. Six days. Okay. And just tell me a bit more about that. How did it start? I've got this sting when I pee and it hurts when I go to the loo. I've got this very\nunpleasant smell that comes out.\nOkay.\nAnd have\nyou had it.\nAny other symptoms along with that? Have you had any abdominal pain or lower back pain at all? I've got pain in my tummy. Whereabouts? In my lower tummy. Okay. Is it one sided or in the middle? In the middle. And how bad would you say that is on a scale of 1 to 10, with 10 being the worst pain? 7. And is it constant or does it come and go? Comes and goes. Okay. And have you actually been able to pass water? Okay. Yes, but I've had spotted blood in my urine. And is that just over the last six days? Yes. Right. And have you been able to eat and drink? Okay. Yes. And have you had a temperature? Do you feel like you've been feverish or had a temperature with this? No, not at all. You said you.\nYou didn't have any low back pain? No, I've got no loin pain as well. Okay. And have you had these symptoms before? No, never. And was there anything you were doing recently which you think may have contributed to it? Have you been doing lots of exercise, been dehydrated, been having regular sexual intercourse or anything? No. Okay. And any other symptoms? Any vaginal discharge or anything like that? No, just the blood spot in my. Do you have regular periods? Yes, I do. Okay. And in the past, have you had any medical problems at all? No. Medical. No. Have you had any problems with your kidneys or any urine infections?\nI had IBS before. Okay, and how's that been recently? Any change in your bowel habit? Any blood when you pass stool? Yeah, I've had spotting in my urine. Okay. Any change in your bowel habit? No. Any weight loss or anything? No. Any other medical problems or surgery in the past? No. Do you take regular medications? Had Mebeverine. Do you take that regularly? Yes. Okay. And do you take it three times a day? Yes, I do. 200 milligrams? Yes. Any allergies? Any allergies? Clean the mycin. You're allergic to Clindamycin. Okay. And anyone in your family had any medical problems?\nNo, that's fine. And whereabouts do you live? Do you live with friends, Family? I live with friends. Okay. And where do you work? What's your job? I'm a support worker. Okay. Do you drink alcohol at all? Occasionally. So how much in an average week? One glass of wine a week. Okay. Do you smoke? No. Okay. It sounds very much like you might have an infection in your urine. Did you say you haven't felt feverish? No fever at all. Have you got a thermometer at home? No. Okay. It would be helpful if you could get a thermometer from the pharmacy. And do check your temperature just to make sure that it isn't going up and down. Normally, we can treat this infection without having to test your urine with.\nWith a course of antibiotics. Okay. How would you feel about that? Are you happy to take a course of antibiotics? Yes, I would be. It would just be for three days. Okay. Get my prescription. Yes. So I can send a prescription through to your requested pharmacy for that. If you take them as soon as you can, pick them up as soon as you can and start taking them. The other thing which is important to do is to drink lots of water. So two and a half to three liters a day, you can get some cranberry juice and drink that as well. That sometimes helps. And also some sachets which you can get from the chemists and sachets which just help change the acidity of your urine. So I can put the details of that on your notes. Okay. Then if you feel like your pain is getting worse or not settling, you get lower back pain.\nOr you're getting a high temperature, you have any problems actually passing urine, then it's very important that we speak to you again. Okay? The other thing is, if it becomes a common thing or a recurrent problem, then we need to talk to you again about it. So do I have to call after I finish my course of antibiotics? No, not if you're better. If you feel like your symptoms get worse at any point, or they're not resolving with the treatment, or you keep getting a similar. You keep getting a similar problem recurrently, then it's important for us to talk to you in more detail about that. Ok? Have you got any other questions? No. What would be the pharmacy I'll be picking up my medication from? So, have you already requested a pharmacy through Babylon? Yes, I did. Can I just check that with you? Knights Bridge practice.\nOkay, that's fine. So the antibiotics that I'm going to prescribe will go through to that pharmacy, and you'll be able to pick them up from there. How soon is that going to be at the practice? In five minutes. I would give it longer than that. Give it an hour or so. All right, then. Thank you. I'll kick that at lunchtime. Okay. All right, then. Thank you. Take care. Bye.","marks":[{"start":156,"end":165,"said":"Redbridge","significant":false},{"start":174,"end":182,"said":"SW two two HZ. Hello.","significant":false},{"start":207,"end":218,"said":"forty oh two nineteen seventy four. OK.","significant":true},{"start":390,"end":398,"said":"It stays","significant":false},{"start":510,"end":515,"said":"thing","significant":false},{"start":711,"end":711,"said":"back","significant":true},{"start":939,"end":939,"said":"Seven.","significant":false},{"start":1102,"end":1102,"said":"Spots. OK.","significant":false},{"start":1325,"end":1325,"said":"Um and any did you","significant":false},{"start":1360,"end":1363,"said":"lower","significant":false},{"start":1466,"end":1466,"said":"No.","significant":false},{"start":1566,"end":1566,"said":"have you","significant":false},{"start":1669,"end":1674,"said":"No OK.","significant":false},{"start":1678,"end":1678,"said":"any","significant":false},{"start":1774,"end":1774,"said":"No.","significant":false},{"start":2120,"end":2125,"said":"In your OK. Um","significant":false},{"start":2158,"end":2161,"said":"","significant":false},{"start":2189,"end":2189,"said":"No.","significant":false},{"start":2281,"end":2281,"said":"I've","significant":false},{"start":2298,"end":2298,"said":"Mebeverine. I've had Mebeverine. Pardon No birth .","significant":false},{"start":2438,"end":2454,"said":"Clindamycin.","significant":false},{"start":3290,"end":3295,"said":"do","significant":false},{"start":3555,"end":3555,"said":"get them","significant":false},{"start":3707,"end":3713,"said":"litres","significant":false},{"start":3757,"end":3757,"said":"take","significant":false},{"start":3849,"end":3861,"said":"chemist some","significant":false},{"start":4101,"end":4101,"said":"or","significant":false},{"start":4415,"end":4415,"said":"you're if","significant":false},{"start":4579,"end":4590,"said":"reccurently.","significant":false},{"start":4621,"end":4621,"said":"talk","significant":false},{"start":4663,"end":4663,"said":"Yeah. OK then. Um","significant":false},{"start":4703,"end":4713,"said":"Uh where will","significant":false},{"start":4872,"end":4886,"said":"Knightsbridge","significant":false},{"start":4944,"end":4952,"said":"gonna","significant":false},{"start":4995,"end":4995,"said":"How soon","significant":false},{"start":5000,"end":5000,"said":"then","significant":false},{"start":5061,"end":5069,"said":"gonna","significant":false},{"start":5197,"end":5201,"said":"pick","significant":false},{"start":5244,"end":5254,"said":"","significant":false},{"start":5270,"end":5270,"said":"Thank you. . Bye. Sorry I .","significant":false}],"facts":[["The note captures: Six-day history of burning/stinging urination/dysuria.","yes","\"Dysuria (painful urination) for 6 days\" with stinging sensation."],["The note captures: Unpleasant or strong urine odour.","yes","\"unpleasant urine odor.\""],["The note captures: Intermittent central lower abdominal/suprapubic pain rated seven out of ten.","yes","\"Midline lower abdominal pain, intermittent, rated 7/10.\""],["The note captures: Visible spots of blood in urine/haematuria.","yes","\"spotting of blood in urine for six days.\""],["The note captures: Able to pass urine and maintain oral intake.","no","Ability to pass urine and to eat and drink normally is not documented."],["The note captures: No fever and no loin/lower back pain.","yes","\"No fever, no back/loin pain.\""],["The note captures: No vaginal discharge and no previous similar urine infection/symptoms.","yes","\"no prior similar episodes\" and \"no vaginal discharge.\""],["The note captures: History of irritable bowel syndrome treated with mebeverine 200 mg three times daily.","yes","\"Past history of IBS; currently taking Mebeverine 200 mg three times daily.\""],["The note captures: Clindamycin allergy is recorded; do not report no known drug allergies.","yes","\"Allergic to clindamycin.\""],["The note captures: Likely urinary tract infection is the working diagnosis.","yes","\"Likely urinary tract infection.\""],["The note captures: A three-day antibiotic course is offered/prescribed; the antibiotic name/dose is not spoken and is not required.","yes","\"Prescribed a three-day course of antibiotics\"; no drug name invented."],["The note captures: Advised to obtain a thermometer and monitor temperature.","yes","\"Obtain a thermometer and monitor temperature.\""],["The note captures: Advised to increase water intake to roughly 2.5–3 litres daily.","yes","\"Increase fluid intake to 2.5-3 L per day.\""],["The note captures: Recontact for worsening/persistent symptoms, fever, back pain or difficulty passing urine.","yes","Return if pain worsens, back pain, fever or difficulty passing urine; also if symptoms persist."],["The note captures: Review recurrent episodes; no routine post-course review is needed if completely better.","yes","\"No routine follow-up required unless symptoms persist or recur after treatment.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nDysuria (painful urination) for 6 days.\n\nHistory of Presenting Complaint::\n\nStinging sensation on urination, unpleasant urine odor, and spotting of blood in urine for six days.\n\nMidline lower abdominal pain, intermittent, rated 7/10.\n\nNo fever, no back/loin pain, no prior similar episodes, no recent dehydration, vigorous exercise, or sexual activity.\n\nRegular menstrual periods, no vaginal discharge.\n\nPast history of IBS; currently taking Mebeverine 200 mg three times daily.\n\nAllergic to clindamycin.\n\nLives with friends, works as a support worker, drinks occasionally (≈1 glass wine/week), non‑smoker.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely urinary tract infection.\n\nPlan\n\nMedications::\n\nMebeverine 200 mg three times daily (current).\n\nPrescribed a three‑day course of antibiotics (type to be dispensed).\n\nIncrease fluid intake to 2.5–3 L per day; consider cranberry juice and urinary‑acidifying sachets.\n\nObtain a thermometer and monitor temperature; seek care if fever develops.\n\nTake prescribed antibiotics promptly and complete the three‑day course.\n\nReturn for urgent review if pain worsens, back pain develops, fever occurs, or difficulty passing urine.\n\nNo routine follow‑up required unless symptoms persist or recur after treatment.","review":76.36842105263158,"saved":228.13157894736844,"clean":false,"effort":6.666666666666667,"sig":[],"mb":23.053327,"latency":28.149,"signable":104.51742105263158}]}},{"id":"hpi-cardiology","name":"Cardiology dictation","dictation":true,"language":false,"stress":false,"reference":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well. No symptoms of chest pain. No symptoms of dyspnea, orthopnea, dizziness, lightheadedness. No syncope.\n\nWeighs 244 pounds. Blood pressure 120/82. Heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: PMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema.\n\nAssessment: Stable. Assessment: CAD. 2. LV dysfunction.\n\nPlan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 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1","wer":3.2679738562091507,"text":"30-year-old patient with a history of infero LMI post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope. Next paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space, S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema. Assessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in three months.","marks":[{"start":38,"end":48,"said":"inferior wall MI","significant":true},{"start":506,"end":509,"said":"PMI","significant":true},{"start":703,"end":703,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Stents captured, but \"infero LMI\" garbles \"inferior wall MI\" and could read as inferolateral MI."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Feeling well. Denies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Wt 244 lb; BP 120/82 mmHg; HR 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical LAD."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Resp and heart sounds correct, but \"BMI in 5th ICS\" misstates PMI."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","\"Soft, nontender; bowel sounds present; no bruits\"; \"Equal pulses; no LE edema\"."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\" and \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"↑ Coreg to 25 mg BID\", \"↑ Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue ASA 325 mg daily\", \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","\"RTC 3 months\"."]],"claims":[["HEENT: PERRL.","Transcript says only \"Pupils are equal\"; roundness and reactivity to light are not stated."]],"note":"Subjective\nHx infero LMI s/p RCA and circumflex stents.\nFeeling well. Denies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\nObjective\nWt 244 lb; BP 120/82 mmHg; HR 68 bpm, regular.\nHEENT: PERRL. JVP normal. No carotid bruits.\nNeck soft; thyroid not enlarged; trachea midline; no cervical LAD.\nResp: Equal expansion; normal breath sounds.\nCV: BMI in 5th ICS. S1/S2 normal; no rubs, gallops, or murmurs.\nAbd: Soft, nontender; bowel sounds present; no bruits.\nExt: Equal pulses; no LE edema.\nAssessment\nStable CAD — asymptomatic without CP or dyspnea; normal CV exam.\nLV dysfunction.\nPlan\n↑ Coreg to 25 mg BID.\n↑ Vasotec to 20 mg daily.\nContinue ASA 325 mg daily.\nContinue Plavix 25 mg daily.\nRTC 3 months.","review":82.07894736842104,"saved":161.42105263157896,"clean":false,"effort":25.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","'infero LMI' garbles inferior wall MI and can read as inferolateral/lateral MI, misrecording the infarct territory."],["fabrication","HEENT: PERRL.","PERRL adds pupil roundness and light reactivity that were never examined or stated."]]},{"label":"Run 2","wer":1.3071895424836601,"text":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope. Next paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema. Assessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in three months.","marks":[{"start":513,"end":516,"said":"PMI","significant":true},{"start":710,"end":710,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"h/o inferior wall MI, s/p RCA and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Feeling well. Denies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Wt 244 lb. BP 120/82 mmHg. HR 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","\"JVP normal. No carotid bruits... Thyroid not enlarged. Trachea midline. No cervical LAD\"."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal chest expansion, normal breath sounds, PMI 5th ICS, normal S1/S2, no rubs/gallops/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","\"Soft, NT. No bruits. Bowel sounds present\"; \"Pulses equal. No LE edema\"."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\", \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase carvedilol (Coreg) to 25 mg BID\", \"Increase enalapril (Vasotec) to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue ASA 325 mg daily\", \"Continue clopidogrel (Plavix) 25 mg daily\"."],["The note captures: Return in three months.","yes","\"F/u in 3 months\"."]],"claims":[["HEENT: PERRL","Transcript says only \"Pupils are equal\"; round and reactive to light were never stated."]],"note":"Subjective\n30-year-old with h/o inferior wall MI, s/p RCA and circumflex stents.\nFeeling well.\nDenies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\nObjective\nWt 244 lb.\nBP 120/82 mmHg. HR 68 bpm, regular.\nHEENT: PERRL.\nNeck: JVP normal. No carotid bruits. Neck soft. Thyroid not enlarged. Trachea midline. No cervical LAD.\nResp: Equal chest expansion. Normal breath sounds.\nCV: PMI at 5th ICS. Normal S1/S2. No rubs, gallops, or murmurs.\nAbd: Soft, NT. No bruits. Bowel sounds present.\nExt: Pulses equal. No LE edema.\nAssessment\nStable CAD; asymptomatic with normal CV exam.\nLV dysfunction.\nPlan\nIncrease carvedilol (Coreg) to 25 mg BID.\nIncrease enalapril (Vasotec) to 20 mg daily.\nContinue ASA 325 mg daily.\nContinue clopidogrel (Plavix) 25 mg daily.\nF/u in 3 months.","review":53.36842105263158,"saved":190.1315789473684,"clean":false,"effort":15.0,"sig":[],"mb":3.033042,"latency":10.175,"signable":63.54342105263159},{"label":"Run 3","wer":3.9215686274509802,"text":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope. Next paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal, no carotid bruit. Neck is soft. Thyroid is not enlarged. Trachea is midline. No cervical lymphadenopathy. Respiratory: Equal expiration, normal breath sounds. Heart: BMI in the 5th intercostal space, S1, S2 normal. No rub, no gallop, no murmurs. Abdomen is soft, nontender, no bruits. Bowel sounds present. Extremities: Equal pulses, no leg edema. Assessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in three months.","marks":[{"start":479,"end":489,"said":"expansion","significant":false},{"start":520,"end":523,"said":"PMI","significant":true},{"start":720,"end":720,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"hx inferior wall MI, s/p RCA and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Feels well. Denies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Wt 244 lb. BP 120/82 mmHg. HR 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical LAD."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Cardiac findings correct, but \"Equal expiration\" misstates equal expansion."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","\"Soft, NT. BS present. No bruits\"; \"Pulses equal. No LE edema\"."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\", \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg BID\", \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue ASA 325 mg daily\", \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","\"RTC in 3 months\"."]],"claims":[["HEENT: PERRL","Transcript says only \"Pupils are equal\"; round and reactive to light were never stated."]],"note":"Subjective\n30-year-old with hx inferior wall MI, s/p RCA and circumflex stents.\nFeels well.\nDenies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\nObjective\nWt 244 lb. BP 120/82 mmHg. HR 68 bpm, regular.\nHEENT: PERRL. JVP normal. No carotid bruits. Neck soft; thyroid not enlarged; trachea midline; no cervical LAD.\nResp: Equal expiration; normal BS.\nCV: PMI at 5th ICS. Normal S1/S2. No murmurs, rubs, or gallops.\nAbd: Soft, NT. BS present. No bruits.\nExt: Pulses equal. No LE edema.\nAssessment\nStable CAD, s/p inferior wall MI with RCA and circumflex stents; asymptomatic with normal CV exam.\nLV dysfunction.\nPlan\nIncrease Coreg to 25 mg BID.\nIncrease Vasotec to 20 mg daily.\nContinue ASA 325 mg daily.\nContinue Plavix 25 mg daily.\nRTC in 3 months.","review":72.1842105263158,"saved":171.31578947368422,"clean":false,"effort":20.0,"sig":[],"mb":3.025193,"latency":12.191,"signable":84.3752105263158},{"label":"Run 4","wer":5.88235294117647,"text":"30-year-old patient with a history of infero LMI post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope. Next paragraph weight is 244 pounds, blood pressure 120/82, heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea is midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen is soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema. Assessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in three months.","marks":[{"start":38,"end":48,"said":"inferior wall MI","significant":true},{"start":238,"end":247,"said":"Weighs","significant":false},{"start":512,"end":515,"said":"PMI","significant":true},{"start":712,"end":712,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","RCA and circumflex stents captured, but MI recorded as \"inferolateral\" rather than inferior wall."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feels well; denies CP, dyspnoea, orthopnoea, dizziness, lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Wt 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, no cervical LAD, thyroid not enlarged, trachea midline."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, normal S1/S2, no rub/gallop/murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft NT, bowel sounds present, no bruits; pulses equal, no LE oedema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction listed."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Coreg 25 mg BID and Vasotec 20 mg daily increases captured."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","ASA 325 mg daily and Plavix 25 mg daily continued as stated."],["The note captures: Return in three months.","yes","Return in 3 months captured."]],"claims":[["Hx inferolateral MI","Transcript states \"inferior wall MI\"; lateral wall involvement is not mentioned anywhere."],["HEENT: PERRL","Transcript only says \"Pupils are equal\"; roundness and reactivity to light are not stated."]],"note":"Subjective\nHx inferolateral MI s/p RCA and circumflex stents.\nFeeling well.\nDenies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\nObjective\nWt 244 lb.\nBP 120/82 mmHg.\nHR 68 bpm, regular.\nHEENT: PERRL.\nNeck: JVP normal. No carotid bruits. Neck soft. Thyroid not enlarged. Trachea midline. No cervical LAD.\nResp: Equal chest expansion; breath sounds normal.\nCV: PMI at 5th ICS. Normal S1/S2. No rub, gallop, or murmur.\nAbd: Soft, NT. Bowel sounds present. No bruits.\nExt: Pulses equal. No LE edema.\nAssessment\nStable CAD; asymptomatic with no angina or HF symptoms.\nLV dysfunction.\nPlan\nIncrease carvedilol (Coreg) to 25 mg BID.\nIncrease enalapril (Vasotec) to 20 mg daily.\nContinue ASA 325 mg daily.\nContinue clopidogrel (Plavix) 25 mg daily.\nF/u in 3 months.","review":78.10526315789474,"saved":165.39473684210526,"clean":false,"effort":30.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","MI territory recorded as inferolateral instead of inferior wall; wrong cardiac history site."]],"mb":3.024707,"latency":10.45,"signable":88.55526315789474},{"label":"Run 5","wer":3.2679738562091507,"text":"30-year-old patient with a history of infero LMI post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope. Next paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular. HEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space, S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema. Assessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in three months.","marks":[{"start":38,"end":48,"said":"inferior wall MI","significant":true},{"start":506,"end":509,"said":"PMI","significant":true},{"start":703,"end":703,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","RCA and circumflex stents captured, but MI recorded as \"inferolateral\" rather than inferior wall."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feels well; denies CP, dyspnoea, orthopnoea, dizziness, lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Wt 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, no cervical LAD, thyroid not enlarged, trachea midline."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, normal S1/S2, no rub/gallop/murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft NT, bowel sounds present, no bruits; pulses equal, no LE oedema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction listed."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Coreg 25 mg BID and Vasotec 20 mg daily increases captured."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","ASA 325 mg daily and Plavix 25 mg daily continued as stated."],["The note captures: Return in three months.","yes","Return in 3 months captured."]],"claims":[["h/o inferolateral MI","Transcript states \"inferior wall MI\"; lateral wall involvement is not mentioned anywhere."],["HEENT: PERRL","Transcript only says \"Pupils are equal\"; roundness and reactivity to light are not stated."]],"note":"Subjective\n30-year-old with h/o inferolateral MI, s/p RCA and circumflex stenting.\nFeels well.\nDenies CP, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\nObjective\nWt 244 lb. BP 120/82 mmHg. HR 68 bpm, regular.\nHEENT: PERRL.\nNeck: JVP normal. No carotid bruits. Neck soft. Thyroid not enlarged. Trachea midline. No cervical LAD.\nResp: Equal chest expansion; breath sounds normal.\nCV: PMI at 5th ICS. Normal S1/S2. No rubs, gallops, or murmurs.\nAbd: Soft, NT. Bowel sounds present. No bruits.\nExt: Pulses equal. No LE edema.\nAssessment\nStable CAD; asymptomatic with normal CV exam findings.\nLV dysfunction.\nPlan\nIncrease carvedilol (Coreg) to 25 mg BID.\nIncrease enalapril (Vasotec) to 20 mg daily.\nContinue ASA 325 mg daily.\nContinue clopidogrel (Plavix) 25 mg daily.\nRTC in 3 months.","review":79.05263157894737,"saved":164.44736842105263,"clean":false,"effort":30.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","MI territory recorded as inferolateral instead of inferior wall; wrong cardiac history site."]],"mb":3.003142,"latency":11.486,"signable":90.53863157894737}],"heidi":[{"label":"Run 1","wer":18.954248366013072,"text":"Thirty year old patient with a history of inferior OMI post right coronary artery and circumplex stent.\n\nHas, uh, been feeling well. No symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, dizziness, lightheadedness, no syncope. Next para weighs two hundred and forty-four pounds, blood pressure one twenty over eighty-two. Heart rate is sixty-eight, regular, period. HENT, pupils are equals, JVP is normal, no carotid broovy, neck is off, thyroid, not enlarged, trachea, midline, no cervical fadenopathy.\n\nRespiratory equal expansion, normal breath sounds, heart BMI in the fifth center causal space S1 S2 normal. No rub, no gallop, no murmurs. Abdomen, soft, nontender, no bruvies, pulse sounds, present extremities, sequel pulses, no leg edema, period. Assessment stable. Assessment CAD. Number two, LV dysfunction. Plan, increase Corec to twenty five milligram BAD. Increase Vasotec to twenty milligrams daily. Continue with aspirin three twenty five milligrams daily. Plavix twenty five milligrams daily. Return in three months period.","marks":[{"start":51,"end":54,"said":"wall MI","significant":false},{"start":86,"end":96,"said":"circumflex","significant":false},{"start":206,"end":215,"said":"","significant":false},{"start":246,"end":255,"said":"","significant":false},{"start":313,"end":340,"said":"120/82.","significant":false},{"start":385,"end":389,"said":"HEENT","significant":false},{"start":402,"end":408,"said":"equal.","significant":false},{"start":436,"end":442,"said":"bruit.","significant":true},{"start":452,"end":455,"said":"soft.","significant":true},{"start":510,"end":522,"said":"lymphadenopathy.","significant":false},{"start":581,"end":584,"said":"PMI","significant":true},{"start":592,"end":611,"said":"5th intercostal","significant":false},{"start":692,"end":706,"said":"bruits. Bowel","significant":true},{"start":736,"end":742,"said":"Equal","significant":true},{"start":851,"end":856,"said":"Coreg","significant":false},{"start":860,"end":886,"said":"25 mg b.i.d.","significant":true},{"start":914,"end":924,"said":"mg","significant":false},{"start":954,"end":982,"said":"325 mg","significant":false},{"start":997,"end":1019,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"hx of inferior OMI post RCA and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feels well; no chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight: 244 pounds\", \"BP: 120/82\", \"HR: 68, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; PMI 5th ICS, S1 S2 normal, no rubs/gallops/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits, equal pulses, no oedema, but bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\", \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25mg BD\", \"Increase Vasotec to 20mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325mg daily\", \"Continue Plavix 25mg daily\"."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[],"note":"Subjective:\n\n- 30yo with hx of inferior OMI post RCA and circumflex stent.\n\n- Currently feels well.\n\n- No chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope.\n\n\n\n\nObjective:\n\n- Weight: 244 pounds.\n\n- BP: 120/82.\n\n- HR: 68, regular.\n\n- HENT: pupils equal, JVP normal, no carotid bruits, neck supple, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\n- Resp: equal expansion, normal breath sounds.\n\n- Cardiac: PMI in 5th ICS, S1 S2 normal, no rubs, no gallops, no murmurs.\n\n- Abdomen: soft, non-tender, no bruits.\n\n- Pulses: present.\n\n- Extremities: equal pulses, no leg oedema.\n\n\n\n\nAssessment:\n\n- Stable CAD.\n\n- LV dysfunction.\n\n\n\n\nPlan:\n\n- Increase Coreg to 25mg BD.\n\n- Increase Vasotec to 20mg daily.\n\n- Continue aspirin 325mg daily.\n\n- Continue Plavix 25mg daily.\n\n- Return in 3 months.","review":52.25,"saved":191.25,"clean":false,"effort":5.0,"sig":[],"mb":20.496843,"latency":26.056,"signable":78.306},{"label":"Run 2","wer":17.647058823529413,"text":"Thirty year old patient with a history of inferior olive MI post right coronary artery and circumplex stent.\n\nHas, uh, been feeling well. No ch- symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, dizziness, lightheadedness, no syncope. Next pair of weights, two hundred and forty-four pounds, blood pressure one twenty over eighty-two. Heart rate is sixty-eight, regular, period. HENT, pupils are equal, JVP is normal, no carotid brewy, neck is soft, thyroid, not enlarged, trachea, midline, no cervical nephrolenopathy.\n\nRespiratory equal expansion, normal breath sounds, heart BMI in the fifth endococcusal space S1 S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender, no bruvies, pulse sounds present. Extremities equal pulses, no leg edema, period. Assessment stable. Assessment CAD. Number two, LV dysfunction. Plan, increase Corec to twenty five milligram BAD. Increase Vasotec to twenty milligrams daily. Continue with aspirin three twenty five milligrams daily. Plavix twenty five milligrams daily. Return in three months period.","marks":[{"start":51,"end":56,"said":"wall","significant":false},{"start":91,"end":101,"said":"circumflex","significant":false},{"start":141,"end":144,"said":"","significant":false},{"start":215,"end":224,"said":"","significant":false},{"start":255,"end":303,"said":"Weighs 244","significant":false},{"start":327,"end":354,"said":"120/82.","significant":false},{"start":399,"end":403,"said":"HEENT","significant":false},{"start":449,"end":454,"said":"bruit.","significant":false},{"start":523,"end":539,"said":"lymphadenopathy.","significant":true},{"start":598,"end":601,"said":"PMI","significant":true},{"start":609,"end":627,"said":"5th intercostal","significant":false},{"start":707,"end":721,"said":"bruits. Bowel","significant":true},{"start":864,"end":869,"said":"Coreg","significant":false},{"start":873,"end":899,"said":"25 mg b.i.d.","significant":true},{"start":927,"end":937,"said":"mg","significant":false},{"start":967,"end":995,"said":"325 mg","significant":false},{"start":1010,"end":1032,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"hx inferior wall MI post RCA and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","244 lbs, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1 S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, no bruits, bowel sounds present; equal pulses, no oedema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Carvedilol (Coreg) 25 mg BD and enalapril (Vasotec) 20 mg daily."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Aspirin 325 mg daily, clopidogrel 25 mg daily."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[],"note":"Subjective\n\n- 30yo, hx inferior wall MI post RCA and circumflex stent\n\n- Feeling well\n\n- Denies chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, syncope\n\n\n\n\nObjective\n\n- Weight: 110.68 kg (244 lbs)\n\n- BP: 120/82 mmHg\n\n- HR: 68 bpm, regular\n\n- HENT: pupils equal, JVP normal, no carotid bruits, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\n- Resp: equal expansion, normal breath sounds\n\n- Cardiac: PMI 5th ICS, S1 S2 normal, no rub/gallop/murmurs\n\n- Abdomen: soft, non-tender, no bruits, bowel sounds present\n\n- Extremities: equal pulses, no leg oedema\n\n\n\n\nAssessment\n\n- Stable\n\n- CAD\n\n- LV dysfunction\n\n\n\n\nPlan\n\n- Increase Carvedilol to 25 mg BD\n\n- Increase Enalapril to 20 mg daily\n\n- Continue Aspirin 325 mg daily\n\n- Continue Clopidogrel 25 mg daily\n\n- Return in 3 months","review":37.57894736842105,"saved":205.92105263157896,"clean":true,"effort":0.0,"sig":[],"mb":20.091763,"latency":25.949,"signable":63.52794736842105},{"label":"Run 3","wer":17.647058823529413,"text":"Thirty year old patient with a history of inferior RMI post right coronary artery and circumplex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea orthopnea dizziness. Lightheadedness. No syncope. Next pair of weights, two hundred and forty four pounds. Blood pressure one twenty over eighty two. Heart rate is sixty eight. Regular period.\n\nHENT pupils are equal. JVP is normal. No carotid broovy. Neck is soft. Thyroid, not enlarged right midline. No cervical lymphadenopathy. Respiratory equal. Expansion. Normal. Breath sounds heart BMI in the fifth and acoccal space S1, S2 normal. No rub, no gallop, no murmurs. Abdomen, soft, nontender, no broovies, bulk sounds. Present extremities equal pulses. No leg edema period.\n\nAssessment stable. Assessment CAD. Number two LV dysfunction. Plan increase Corec to twenty five milligram BAD. Increase Vasotec to twenty milligrams daily. Continue with aspirin twenty five milligrams daily. Plavix twenty five milligrams daily. Return in three months period.","marks":[{"start":51,"end":54,"said":"wall MI","significant":false},{"start":86,"end":96,"said":"circumflex","significant":false},{"start":226,"end":274,"said":"Weighs 244","significant":false},{"start":298,"end":325,"said":"120/82.","significant":false},{"start":370,"end":374,"said":"HEENT","significant":false},{"start":419,"end":426,"said":"bruit.","significant":true},{"start":463,"end":468,"said":"Trachea","significant":true},{"start":565,"end":568,"said":"PMI","significant":true},{"start":576,"end":593,"said":"5th intercostal","significant":false},{"start":675,"end":689,"said":"bruits. Bowel","significant":true},{"start":830,"end":835,"said":"Coreg","significant":false},{"start":839,"end":865,"said":"25 mg b.i.d.","significant":true},{"start":893,"end":903,"said":"mg","significant":false},{"start":933,"end":955,"said":"325 mg","significant":true},{"start":970,"end":992,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"hx inferior MI post RCA and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Feeling well\"; \"No chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight: 244 lbs\", \"BP: 120/82\", \"HR: 68, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","JVP, carotid, thyroid and lymph nodes captured, but trachea is garbled as \"right midline\"."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, \"PMI 5th ICS. S1, S2 normal. No rub, gallop or murmurs\"."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, no bruits, bowel sounds present; equal pulses, no leg oedema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\" and \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","Carvedilol 25 mg BD is right, but Vasotec is rendered as \"Ramipril to 20 mg daily\", a wrong medication."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Continue Aspirin 25 mg daily\" is the wrong dose (325 mg stated); clopidogrel 25 mg correct."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[["Increase Ramipril to 20 mg daily","Transcript says Vasotec (enalapril); ramipril was never mentioned."],["Continue Aspirin 25 mg daily","Transcript states aspirin 325 mg daily; 25 mg is a wrong dose."]],"note":"Subjective:\n\n- 30yo, hx inferior MI post RCA and circumflex stent.\n\n- Feeling well.\n\n- No chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope.\n\n\n\n\nObjective:\n\n- Weight: 244 lbs.\n\n- BP: 120/82.\n\n- HR: 68, regular.\n\n- HENT: Pupils equal. JVP normal. No carotid bruits. Neck soft. Thyroid not enlarged, right midline. No cervical lymphadenopathy.\n\n- Resp: Equal expansion. Normal breath sounds.\n\n- Cardiac: PMI 5th ICS. S1, S2 normal. No rub, gallop or murmurs.\n\n- Abdomen: Soft, non-tender. No bruits. Bowel sounds present.\n\n- Extremities: Equal pulses. No leg oedema.\n\n\n\n\nAssessment:\n\n- Stable CAD.\n\n- LV dysfunction.\n\n\n\n\nPlan:\n\n- Increase Carvedilol to 25 mg BD.\n\n- Increase Ramipril to 20 mg daily.\n\n- Continue Aspirin 25 mg daily.\n\n- Continue Clopidogrel 25 mg daily.\n\n- Return in 3 months.","review":139.5,"saved":104.0,"clean":false,"effort":45.0,"sig":[["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Vasotec (enalapril) recorded as ramipril 20 mg, a wrong drug that at that dose exceeds ramipril's usual maximum."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Aspirin recorded as 25 mg instead of 325 mg, a wrong antiplatelet dose."]],"mb":24.67504,"latency":21.464,"signable":160.964},{"label":"Run 4","wer":20.26143790849673,"text":"Thirty year old patient with a history of inferior OMI posterior coronary artery and circuits stent.\n\nHas, uh, been feeling well. No symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, dizziness, lightheadedness, no syncope. Next paragraph weighs two hundred and forty-four pounds, blood pressure one twenty over eighty-two. Heart rate is sixty-eight, regular, period. HENT, pupils are equal, JVP is normal, no carotid broovy, neck is soft, thyroid, not enlarged, right? Midline, no cervical nephadenopathy. Respiratory, equal expansion, normal, breath sounds, heart BMI in the fifth and acostal space S1, S2, normal.\n\nNo rub, no gallop, no murmurs. Abdomen, soft, nontender, no bruvous pulse sounds present. Extremity sequel pulses, no leg edema, period. Assessment stable, uh, assessment CAD, number two, LV dysfunction. Plan: Increase Corec to twenty-five milligram BAD. Increase Vasotec to twenty milligrams daily. Uh, continue with aspirin three twenty-five milligrams daily, Plavix twenty-five milligrams daily, return in three months, period.","marks":[{"start":51,"end":64,"said":"wall MI post right","significant":true},{"start":85,"end":93,"said":"circumflex","significant":true},{"start":203,"end":212,"said":"","significant":false},{"start":315,"end":342,"said":"120/82.","significant":false},{"start":387,"end":391,"said":"HEENT","significant":false},{"start":437,"end":443,"said":"bruit.","significant":true},{"start":482,"end":487,"said":"Trachea","significant":true},{"start":510,"end":525,"said":"lymphadenopathy.","significant":false},{"start":585,"end":588,"said":"PMI","significant":true},{"start":596,"end":613,"said":"5th intercostal","significant":false},{"start":697,"end":710,"said":"bruits. Bowel","significant":true},{"start":727,"end":743,"said":"Extremities Equal","significant":false},{"start":856,"end":861,"said":"Coreg","significant":false},{"start":865,"end":891,"said":"25 mg b.i.d.","significant":true},{"start":919,"end":929,"said":"mg","significant":false},{"start":963,"end":991,"said":"325 mg","significant":false},{"start":1006,"end":1028,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","no","\"hx inferior OMI, posterior coronary artery, stent\" misstates the right coronary and circumflex stents."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; no chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","244 lbs, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1/S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits and equal pulses/no oedema, but bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\", \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25mg BD\", \"Increase Vasotec to 20mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","Aspirin 325 mg correct but \"Plavix 75mg daily\" is wrong (source 25 mg)."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[["posterior coronary artery, stent","Source states right coronary artery and circumflex stents; 'posterior coronary artery' is not mentioned."],["Continue Plavix 75mg daily","Source states Plavix 25 mg daily."]],"note":"Subjective:\n\n- 30yo, hx inferior OMI, posterior coronary artery, stent\n\n- Feeling well\n\n- No chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope\n\n\n\n\nObjective:\n\n- Weight: 244 lbs\n\n- BP: 120/82\n\n- HR: 68, regular\n\n- HENT: pupils equal, JVP normal, no carotid bruits. Neck soft, thyroid not enlarged, midline. No cervical lymphadenopathy\n\n- Resp: equal expansion, normal breath sounds\n\n- CVS: PMI 5th ICS, S1/S2 normal, no rub, no gallop, no murmurs\n\n- Abdo: soft, non-tender, no bruits\n\n- Extremities: equal pulses, no leg oedema\n\n\n\n\nAssessment:\n\n- Stable CAD\n\n- LV dysfunction\n\n\n\n\nPlan:\n\n- Increase Coreg to 25mg BD\n\n- Increase Vasotec to 20mg daily\n\n- Continue aspirin 325mg daily\n\n- Continue Plavix 75mg daily\n\n- Return in 3 months","review":137.7236842105263,"saved":105.7763157894737,"clean":false,"effort":45.0,"sig":[["missing","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Wrong stented vessel (posterior instead of RCA) and circumflex stent lost."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Plavix recorded as 75 mg instead of the stated 25 mg."]],"mb":20.367218,"latency":24.852,"signable":162.5756842105263},{"label":"Run 5","wer":20.915032679738562,"text":"Thirty year old patient with a history of inferior OMI post right coronary artery and circumflex stent.\n\nHas, uh, been feeling well. No ch- symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, dizziness, lightheadedness, no syncope. Next pill of weight is two hundred and forty-four pounds, blood pressure one twenty over eighty-two. Heart rate is sixty-eight regular, period. HENT, pupils are equal, JVP is normal, no corrected bruvy. Neck is arthritic, not enlarged, trachea, midline, no cervical-\n\nRespiratory equal expansion normal. Breath sounds hard. PMI in the fifth center causal space S1 S2 normal. No rub. No gallop. No murmurs. Abdomen soft. Nontender. No bruvies. Pulse sounds present. Extremities equal pulses. No leg edema. Period. Assessment. Stable. Assessment CAD. Number two LV dysfunction. Plan. Increase Corec to twenty five milligram BAD. Increase Vasotec to twenty milligrams daily. Continue with aspirin three twenty five milligrams daily. Plavix twenty five milligrams daily. Return in three months period.","marks":[{"start":51,"end":54,"said":"wall MI","significant":false},{"start":136,"end":139,"said":"","significant":false},{"start":210,"end":219,"said":"","significant":false},{"start":250,"end":299,"said":"Weighs 244","significant":false},{"start":323,"end":350,"said":"120/82.","significant":false},{"start":394,"end":398,"said":"HEENT","significant":false},{"start":436,"end":452,"said":"carotid bruit.","significant":false},{"start":461,"end":470,"said":"soft. Thyroid","significant":true},{"start":507,"end":516,"said":"cervical lymphadenopathy.","significant":true},{"start":568,"end":573,"said":"Heart","significant":false},{"start":585,"end":604,"said":"5th intercostal","significant":false},{"start":684,"end":698,"said":"bruits. Bowel","significant":true},{"start":841,"end":846,"said":"Coreg","significant":false},{"start":850,"end":876,"said":"25 mg b.i.d.","significant":true},{"start":904,"end":914,"said":"mg","significant":false},{"start":944,"end":972,"said":"325 mg","significant":false},{"start":987,"end":1009,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","'hx of inferior OMI post RCA and circumflex stent'."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","'Feeling well' and denies chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","JVP normal, no carotid bruit, no lymphadenopathy, trachea midline, but thyroid replaced by 'Neck: Arthritic, not enlarged'."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1 S2 normal, no rub/gallop/murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits and equal pulses without oedema, but bowel sounds present omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","'Stable CAD' and 'LV dysfunction'."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","'Increase Coreg to 25 mg BD' and 'Increase Vasotec to 20 mg daily'."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","'Continue aspirin 325 mg daily' and 'Continue Plavix 25 mg daily'."],["The note captures: Return in three months.","yes","'Return in 3 months'."]],"claims":[["Neck: Arthritic","Source says 'Neck is soft, thyroid not enlarged'; no arthritic neck finding exists."]],"note":"Subjective\n\n- 30-year-old with hx of inferior OMI post RCA and circumflex stent.\n\n- Feeling well.\n\n- No chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope.\n\n\n\n\nObjective\n\n- Weight: 244 lbs.\n\n- BP: 120/82 mmHg.\n\n- HR: 68 bpm, regular.\n\n- HEENT: Pupils equal, JVP normal, no carotid bruit.\n\n- Neck: Arthritic, not enlarged, trachea midline, no cervical lymphadenopathy.\n\n- Resp: Equal expansion, normal breath sounds.\n\n- CVS: PMI 5th ICS, S1 S2 normal, no rub, no gallop, no murmurs.\n\n- Abdomen: Soft, non-tender, no bruits.\n\n- Extremities: Equal pulses, no leg oedema.\n\n\n\n\nAssessment\n\n- Stable CAD.\n\n- LV dysfunction.\n\n\n\n\nPlan\n\n- Increase Coreg to 25 mg BD.\n\n- Increase Vasotec to 20 mg daily.\n\n- Continue aspirin 325 mg daily.\n\n- Continue Plavix 25 mg daily.\n\n- Return in 3 months.","review":79.19736842105263,"saved":164.30263157894737,"clean":false,"effort":20.0,"sig":[["partial","Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","Neck examination replaced with an invented \"arthritic\" finding; thyroid finding lost."]],"mb":25.697597,"latency":23.821,"signable":103.01836842105263},{"label":"Run 6","wer":21.568627450980394,"text":"Thirty year old patient with a history of inferior OMI posterior coronary artery and circumplex stent.\n\nHas, uh, been feeling well. No ch- symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, dizziness, lightheadedness, no syncope. Next para weighs two hundred and forty-four pounds, blood pressure one twenty over eighty-two. Heart rate is sixty-eight, regular, period. HENT, pupils are equal, JVP is normal, no carotid broovy. Neck is arthrodead, not enlarged, right? Midline, no cervical-\n\nRespiratory equal expansion. Normal breath sounds heart BMI in the fifth center causal space S1 S2 normal. No rub. No gallop. No murmurs. Abdomen soft. Nontender. No bruvies. Pulse sounds. Present extremities. Sequel pulses. No leg edema. Period. Assessment. Stable. Assessment CAD. Number two LV dysfunction. Plan. Increase Corec to twenty five milligram BAD. Increase Vasotec to twenty milligrams daily. Continue with aspirin three twenty five milligrams daily. Plavix twenty five milligrams daily. Return in three months period.","marks":[{"start":51,"end":64,"said":"wall MI post right","significant":true},{"start":85,"end":95,"said":"circumflex","significant":false},{"start":135,"end":138,"said":"","significant":false},{"start":209,"end":218,"said":"","significant":false},{"start":249,"end":258,"said":"","significant":false},{"start":316,"end":343,"said":"120/82.","significant":false},{"start":388,"end":392,"said":"HEENT","significant":false},{"start":438,"end":445,"said":"bruit.","significant":true},{"start":454,"end":464,"said":"soft. Thyroid","significant":true},{"start":480,"end":485,"said":"Trachea","significant":true},{"start":499,"end":508,"said":"cervical lymphadenopathy.","significant":true},{"start":566,"end":569,"said":"PMI","significant":true},{"start":577,"end":596,"said":"5th intercostal","significant":false},{"start":676,"end":690,"said":"bruits. Bowel","significant":true},{"start":720,"end":726,"said":"Equal","significant":true},{"start":835,"end":840,"said":"Coreg","significant":false},{"start":844,"end":870,"said":"25 mg b.i.d.","significant":true},{"start":898,"end":908,"said":"mg","significant":false},{"start":938,"end":966,"said":"325 mg","significant":false},{"start":981,"end":1003,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Inferior MI and circumflex stent recorded but RCA rendered as \"posterior coronary artery\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feels well; denies CP, dyspnoea, orthopnoea, dizziness/lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Wt 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","JVP, bruits, midline and LAD recorded, but neck described as \"arthritic\" instead of soft and thyroid not named."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Resp and heart sounds correct but \"BMI at 5th ICS\" instead of PMI."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft NT no bruits, no oedema; bowel sounds omitted and pulses \"present\" not equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Coreg 25 mg BID and Vasotec 20 mg daily."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","Return in 3 months."]],"claims":[["Neck: arthritic","Transcript says \"Neck is soft\"; no arthritic finding stated."],["posterior coronary artery stent","Transcript says right coronary artery stent, not posterior."]],"note":"Subjective\n\n- 30yo, hx inferior OMI, posterior coronary artery, circumflex stent\n\n- Feeling well\n\n- No chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, syncope\n\n\n\n\nObjective\n\n- Weight: 244 lbs\n\n- BP: 120/82\n\n- HR: 68, regular\n\n- HEENT: pupils equal, JVP normal, no carotid bruits\n\n- Neck: arthritic, not enlarged, midline, no cervical lymphadenopathy\n\n- Resp: equal expansion, normal breath sounds\n\n- Heart: BMI at 5th ICS, S1 S2 normal, no rub, no gallop, no murmurs\n\n- Abdomen: soft, non-tender, no bruits\n\n- Extremities: pulses present, no leg oedema\n\n\n\n\nAssessment\n\n- Stable\n\n- CAD\n\n- LV dysfunction\n\n\n\n\nPlan\n\n- Increase Coreg to 25mg b.i.d.\n\n- Increase Vasotec to 20mg daily\n\n- Continue aspirin 325mg daily\n\n- Continue Plavix 25mg daily\n\n- Return in 3 months","review":121.17105263157895,"saved":122.32894736842105,"clean":false,"effort":40.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Stented vessel recorded as posterior coronary artery instead of RCA (wrong site)."],["partial","Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","Neck recorded as 'arthritic' instead of soft."]],"mb":24.791179,"latency":26.122,"signable":147.29305263157895}],"freed":[{"label":"Run 1","wer":17.647058823529413,"text":"30-year-old patient with a history of inferior alveolar postright coronary artery and complex stent has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncopy.\nExpected weight is 244 pounds, blood pressure 120 over 82, heart rate is 68, regular period HGN2, pupils are equal, JVP is normal, no carotid bruin, neck is hard, thyroid not enlarged, trachea midline, no cervix and lymphadenopathy.\nRespiratory equal expansion normal breath sounds, heart BMI in the 5th intercostal space, S1-S2 normal.\nNo rub, no gallop, no murmurs, abdominals soft, non-tender, no groovies, pulse sounds present, extremities equal, pulses, no leg edema, period.\nAssessments stable.\nAssessments CAD, number 2, LV dysfunction, plan increase, correct to 25 mg, BAD.\nIncrease vasotec to 20 mg, daily.\nContinue with aspirin, 325 mg, daily.\nPlavix, 25 mg, daily.\nReturn in 3 months, period.","marks":[{"start":47,"end":65,"said":"wall MI post right","significant":true},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":216,"end":243,"said":"syncope. Weighs","significant":true},{"start":271,"end":282,"said":"120/82.","significant":false},{"start":317,"end":321,"said":"HEENT","significant":false},{"start":367,"end":372,"said":"bruit.","significant":true},{"start":382,"end":386,"said":"soft.","significant":true},{"start":430,"end":440,"said":"cervical","significant":true},{"start":514,"end":517,"said":"PMI","significant":true},{"start":593,"end":603,"said":"Abdomen","significant":false},{"start":610,"end":620,"said":"nontender.","significant":false},{"start":625,"end":640,"said":"bruits. Bowel","significant":true},{"start":706,"end":717,"said":"Assessment","significant":false},{"start":726,"end":737,"said":"Assessment","significant":false},{"start":784,"end":791,"said":"Coreg","significant":true},{"start":802,"end":806,"said":"b.i.d.","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Stent history present but garbled (\"inferior alveolar postright coronary artery and complex stent\"); MI not stated and circumflex rendered as \"complex\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82 and \"heart rate 68 regular\" all captured."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","Only normal JVP captured (in assessment); no carotid bruit, no lymphadenopathy, thyroid and trachea findings omitted."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th intercostal space, S1/S2 normal, no rub, gallop or murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender and equal pulses/no leg edema captured; bowel sounds and abdominal no bruits omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Coronary artery disease and LV dysfunction both listed."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Vasotec 20 mg daily correct, but Coreg rendered as \"correct\"/\"Corrector\" to 25 mg with b.i.d. frequency omitted."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\" and \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","Follow-up/return in 3 months stated."]],"claims":[],"note":"Subjective\nA 30-year-old patient with a history of coronary artery disease and left ventricular dysfunction, presents for follow-up. The patient reports feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nMedical History  \n- Coronary artery disease  \n- Left ventricular dysfunction\n\nSurgical History  \n- Complex stent placement\n\nMedications and Supplements  \n- Aspirin 325 mg PO daily  \n- Plavix 25 mg PO daily  \n- Vasotec 20 mg PO daily  \n- Correct 25 mg PO\n\nObjective\nVital Signs  \n- Blood Pressure: 120/82 mmHg  \n- Heart Rate: 68 bpm  \n- Weight: 244 lbs\n\nPhysical Examination  \n- HEENT: Pupils equal  \n- Cardiovascular: PMI in the 5th intercostal space. S1 and S2 normal. No rub, no gallop, no murmurs  \n- Respiratory: Equal expansion. Normal breath sounds  \n- Abdomen: Soft, non-tender  \n- Extremities: Equal pulses. No leg edema\n\nAssessment & Plan\n30-year-old patient with coronary artery disease status post complex stent, presenting for routine follow-up.\n\nCoronary Artery Disease with LV Dysfunction\nAssessment: Currently asymptomatic with no chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope. History of inferior alveolar postright coronary artery and complex stent placement. Physical examination reveals stable vital signs with blood pressure 120/82 mmHg, heart rate 68 regular, normal heart sounds without rubs, gallops, or murmurs. No signs of heart failure on examination with normal JVP and no lower extremity edema. Patient demonstrates good clinical stability with current medical management.\nPlan:\n- Increase correct to 25 mg\n- Increase Vasotec to 20 mg daily\n- Continue aspirin 325 mg daily\n- Continue Plavix 25 mg daily\n- Return in 3 months\n","review":137.94736842105263,"saved":105.55263157894737,"clean":false,"effort":20.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior inferior MI not stated and circumflex stent garbled/missing, losing key cardiac history."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg misnamed and b.i.d. frequency lost, risking wrong beta-blocker dosing."]],"mb":7.409577,"latency":33.309,"signable":159.66536842105262},{"label":"Run 2","wer":17.647058823529413,"text":"30-year-old patient with a history of inferior alveolar postright coronary artery and complex stent has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncopy.\nExpected weight is 244 pounds, blood pressure 120 over 82, heart rate is 68, regular period HGN2, pupils are equal, JVP is normal, no carotid bruin, neck is hard, thyroid not enlarged, trachea midline, no cervix and lymphadenopathy.\nRespiratory equal expansion normal breath sounds, heart BMI in the 5th intercostal space, S1-S2 normal.\nNo rub, no gallop, no murmurs, abdominals soft, non-tender, no groovies, pulse sounds present, extremities equal, pulses, no leg edema, period.\nAssessments stable.\nAssessments CAD, number 2, LV dysfunction, plan increase, correct to 25 mg, BAD.\nIncrease vasotec to 20 mg, daily.\nContinue with aspirin, 325 mg, daily.\nPlavix, 25 mg, daily.\nReturn in 3 months, period.","marks":[{"start":47,"end":65,"said":"wall MI post right","significant":true},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":216,"end":243,"said":"syncope. Weighs","significant":true},{"start":271,"end":282,"said":"120/82.","significant":false},{"start":317,"end":321,"said":"HEENT","significant":false},{"start":367,"end":372,"said":"bruit.","significant":true},{"start":382,"end":386,"said":"soft.","significant":true},{"start":430,"end":440,"said":"cervical","significant":true},{"start":514,"end":517,"said":"PMI","significant":true},{"start":593,"end":603,"said":"Abdomen","significant":false},{"start":610,"end":620,"said":"nontender.","significant":false},{"start":625,"end":640,"said":"bruits. Bowel","significant":true},{"start":706,"end":717,"said":"Assessment","significant":false},{"start":726,"end":737,"said":"Assessment","significant":false},{"start":784,"end":791,"said":"Coreg","significant":true},{"start":802,"end":806,"said":"b.i.d.","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","\"status post stent to right coronary artery\" and \"inferior involvement with complex stent placement\"; MI not stated and circumflex stent missing."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82, \"heart rate 68 regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","No carotid bruits and no JVD captured; cervical lymphadenopathy, thyroid and trachea findings omitted."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th intercostal space, normal S1/S2, no murmurs, gallops, or rubs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender and equal pulses/no edema captured; bowel sounds and abdominal no bruits omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and \"complicated by left ventricular dysfunction\" both captured."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Vasotec 20 mg daily correct, but Coreg rendered as \"correct\"/\"Corrector\" to 25 mg with b.i.d. frequency omitted."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\" and \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","Follow-up/return in 3 months stated."]],"claims":[],"note":"Subjective\nCliniTech Benchmark be8a8db0, a 30-year-old patient with a history of coronary artery disease and left ventricular dysfunction, presents for follow-up. The patient reports feeling well overall. The patient denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nMedical History  \n- Coronary artery disease  \n- Left ventricular dysfunction\n\nSurgical History  \n- Complex stent placement\n\nMedications and Supplements  \n- Aspirin 325 mg PO daily  \n- Plavix 25 mg PO daily  \n- Vasotec 20 mg PO daily  \n- Corrector 25 mg PO\n\nObjective\nVital Signs  \n- Blood Pressure: 120/82 mmHg  \n- Heart Rate: 68 bpm  \n- Weight: 244 lbs\n\nPhysical Examination  \n- HEENT: Pupils equal. No carotid bruits  \n- Cardiovascular: PMI in the 5th intercostal space. Regular rate and rhythm. Normal S1, S2. No murmurs, gallops, or rubs. No JVD  \n- Respiratory: Equal expansion. Normal breath sounds  \n- Abdomen: Soft, non-tender  \n- Extremities: No edema. Pulses equal bilaterally\n\nAssessment & Plan\n30-year-old patient with coronary artery disease status post stent to right coronary artery, presenting for routine follow-up.\n\nCoronary Artery Disease  \nAssessment: Currently asymptomatic with no chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope. Blood pressure today is 120/82 mmHg with heart rate 68 regular. Physical examination reveals normal heart sounds without rubs, gallops, or murmurs. No evidence of heart failure with normal JVP and no lower extremity edema. Patient has history of inferior involvement with complex stent placement, complicated by left ventricular dysfunction.  \nPlan:  \n- Continue aspirin 325 mg daily  \n- Continue Plavix 25 mg daily  \n- Increase Vasotec to 20 mg daily  \n- Increase correct to 25 mg  \n- Follow up in 3 months\n","review":138.57894736842104,"saved":104.92105263157896,"clean":false,"effort":20.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior inferior MI not stated and circumflex stent garbled/missing, losing key cardiac history."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg misnamed and b.i.d. frequency lost, risking wrong beta-blocker dosing."]],"mb":4.912704,"latency":36.143,"signable":163.16194736842104},{"label":"Run 3","wer":17.647058823529413,"text":"30-year-old patient with a history of inferior alveolar postright coronary artery and complex stent has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncopy.\nExpected weight is 244 pounds, blood pressure 120 over 82, heart rate is 68, regular period HGN2, pupils are equal, JVP is normal, no carotid bruin, neck is hard, thyroid not enlarged, trachea midline, no cervix and lymphadenopathy.\nRespiratory equal expansion normal breath sounds, heart BMI in the 5th intercostal space, S1-S2 normal.\nNo rub, no gallop, no murmurs, abdominals soft, non-tender, no groovies, pulse sounds present, extremities equal, pulses, no leg edema, period.\nAssessments stable.\nAssessments CAD, number 2, LV dysfunction, plan increase, correct to 25 mg, BAD.\nIncrease vasotec to 20 mg, daily.\nContinue with aspirin, 325 mg, daily.\nPlavix, 25 mg, daily.\nReturn in 3 months, period.","marks":[{"start":47,"end":65,"said":"wall MI post right","significant":true},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":216,"end":243,"said":"syncope. Weighs","significant":true},{"start":271,"end":282,"said":"120/82.","significant":false},{"start":317,"end":321,"said":"HEENT","significant":false},{"start":367,"end":372,"said":"bruit.","significant":true},{"start":382,"end":386,"said":"soft.","significant":true},{"start":430,"end":440,"said":"cervical","significant":true},{"start":514,"end":517,"said":"PMI","significant":true},{"start":593,"end":603,"said":"Abdomen","significant":false},{"start":610,"end":620,"said":"nontender.","significant":false},{"start":625,"end":640,"said":"bruits. Bowel","significant":true},{"start":706,"end":717,"said":"Assessment","significant":false},{"start":726,"end":737,"said":"Assessment","significant":false},{"start":784,"end":791,"said":"Coreg","significant":true},{"start":802,"end":806,"said":"b.i.d.","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Mentions RCA involvement and \"Complex stent placement of the right coronary artery\" but omits the inferior-wall MI and the circumflex stent."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Reports feeling well overall. Denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\""],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82, and \"heart rate 68 regular\" in the assessment."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","Notes \"No JVD\"/normal JVP but omits carotid bruit, cervical lymphadenopathy, thyroid and trachea findings."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th intercostal space, S1/S2 normal, no rub, gallop or murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits and equal pulses without edema, but bowel sounds are omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Coronary Artery Disease with LV Dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Vasotec 20 mg daily correct, but \"Increase coreg to 25 mg\" omits twice daily and med list names it \"Corrector 25 mg PO\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg daily and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","\"Follow up in 3 months\"."]],"claims":[["Complex stent placement of the right coronary artery","Transcript says RCA and circumflex stent; nothing describes the stent procedure as \"complex\"."],["Corrector 25 mg PO","No medication named \"Corrector\" in the transcript; the drug stated is Coreg 25 mg b.i.d."]],"note":"Subjective\nA 30-year-old patient with a history of coronary artery disease involving the right coronary artery and left ventricular dysfunction presents for follow-up. Reports feeling well overall. Denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nMedical History  \n- Coronary artery disease involving the right coronary artery  \n- Left ventricular dysfunction\n\nSurgical History  \n- Complex stent placement of the right coronary artery\n\nMedications and Supplements  \n- Aspirin 325 mg PO daily  \n- Plavix 25 mg PO daily  \n- Vasotec 20 mg PO daily  \n- Corrector 25 mg PO\n\nObjective\nVital Signs  \n- Blood Pressure: 120/82 mmHg  \n- Heart Rate: 68 bpm  \n- Weight: 244 lbs\n\nPhysical Examination  \n- HEENT: Pupils equal  \n- Cardiovascular: PMI in the 5th intercostal space. S1 and S2 normal. No rub, no gallop, no murmurs. Pulses present and equal. No JVD  \n- Respiratory: Equal expansion. Normal breath sounds  \n- Abdomen: Soft, non-tender. No bruits  \n- Extremities: No edema. Pulses equal\n\nAssessment & Plan\n30-year-old patient with coronary artery disease status post complex stent to right coronary artery, presenting for routine follow-up.\n\nCoronary Artery Disease with LV Dysfunction\nAssessment: Currently asymptomatic with no chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope. Physical examination reveals stable vital signs with blood pressure 120/82 mmHg and heart rate 68 regular. Normal heart sounds without rubs, gallops, or murmurs. No evidence of heart failure on examination with normal JVP and no peripheral edema.\nPlan:\n- Increase Vasotec to 20 mg daily\n- Increase coreg to 25 mg\n- Continue aspirin 325 mg daily\n- Continue Plavix 25 mg daily\n- Follow up in 3 months\n","review":162.57894736842104,"saved":80.92105263157896,"clean":false,"effort":40.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Omits the prior inferior-wall MI and the circumflex stent, key cardiac history for a CAD/LV dysfunction patient."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg increase lacks b.i.d. frequency and the med list names a nonexistent drug \"Corrector\"."]],"mb":7.273923,"latency":35.613,"signable":187.63894736842104},{"label":"Run 4","wer":17.647058823529413,"text":"30-year-old patient with a history of inferior alveolar postright coronary artery and complex stent has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncopy.\nExpected weight is 244 pounds, blood pressure 120 over 82, heart rate is 68, regular period HGN2, pupils are equal, JVP is normal, no carotid bruin, neck is hard, thyroid not enlarged, trachea midline, no cervix and lymphadenopathy.\nRespiratory equal expansion normal breath sounds, heart BMI in the 5th intercostal space, S1-S2 normal.\nNo rub, no gallop, no murmurs, abdominals soft, non-tender, no groovies, pulse sounds present, extremities equal, pulses, no leg edema, period.\nAssessments stable.\nAssessments CAD, number 2, LV dysfunction, plan increase, correct to 25 mg, BAD.\nIncrease vasotec to 20 mg, daily.\nContinue with aspirin, 325 mg, daily.\nPlavix, 25 mg, daily.\nReturn in 3 months, period.","marks":[{"start":47,"end":65,"said":"wall MI post right","significant":true},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":216,"end":243,"said":"syncope. Weighs","significant":true},{"start":271,"end":282,"said":"120/82.","significant":false},{"start":317,"end":321,"said":"HEENT","significant":false},{"start":367,"end":372,"said":"bruit.","significant":true},{"start":382,"end":386,"said":"soft.","significant":true},{"start":430,"end":440,"said":"cervical","significant":true},{"start":514,"end":517,"said":"PMI","significant":true},{"start":593,"end":603,"said":"Abdomen","significant":false},{"start":610,"end":620,"said":"nontender.","significant":false},{"start":625,"end":640,"said":"bruits. Bowel","significant":true},{"start":706,"end":717,"said":"Assessment","significant":false},{"start":726,"end":737,"said":"Assessment","significant":false},{"start":784,"end":791,"said":"Coreg","significant":true},{"start":802,"end":806,"said":"b.i.d.","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Stent history present but garbled (\"inferior alveolar postright coronary artery and complex stent\"); MI not stated and circumflex rendered as \"complex\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82 and \"heart rate 68 regular\" all captured."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","Only normal JVP captured (in assessment); no carotid bruit, no lymphadenopathy, thyroid and trachea findings omitted."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th intercostal space, S1/S2 normal, no rub, gallop or murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, bowel sounds present, equal pulses, no leg edema; abdominal \"no bruits\" omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Coronary artery disease and LV dysfunction both listed."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","Coreg given as \"Corrector 25 mg PO daily\" (transcript: 25 mg b.i.d.) and misnamed; Vasotec 20 mg daily correct."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\" and \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","Follow-up/return in 3 months stated."]],"claims":[["Corrector 25 mg PO daily","Transcript states Coreg 25 mg b.i.d.; once-daily frequency is not supported anywhere in the transcript."]],"note":"Subjective\nA 30-year-old patient with a history of coronary artery disease and left ventricular dysfunction, presents for follow-up. The patient reports feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nMedical History  \n- Coronary artery disease  \n- Left ventricular dysfunction\n\nSurgical History  \n- Complex stent placement\n\nMedications and Supplements  \n- Aspirin 325 mg PO daily  \n- Plavix 25 mg PO daily  \n- Vasotec 20 mg PO daily  \n- Corrector 25 mg PO daily\n\nObjective\nVital Signs  \n- Blood Pressure: 120/82 mmHg  \n- Heart Rate: 68 bpm  \n- Weight: 244 lbs\n\nPhysical Examination  \n- HEENT: Pupils equal  \n- Cardiovascular: PMI in the 5th intercostal space. S1 and S2 normal. No rub, no gallop, no murmurs. Pulses present  \n- Respiratory: Equal expansion. Normal breath sounds  \n- Abdomen: Soft, non-tender. Bowel sounds present  \n- Extremities: Equal pulses. No leg edema\n\nAssessment & Plan\n30-year-old patient with coronary artery disease status post complex stent, presenting for routine follow-up.\n\nCoronary Artery Disease with LV Dysfunction\nAssessment: Currently asymptomatic with no chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope. History of inferior alveolar postright coronary artery and complex stent placement. Physical examination reveals stable vital signs with blood pressure 120/82 mmHg and heart rate 68 regular. Normal heart sounds without rubs, gallops, or murmurs. No evidence of heart failure on examination with normal JVP and no lower extremity edema. Patient demonstrates good clinical stability with current medical management.\nPlan:\n- Increase correct to 25 mg\n- Increase Vasotec to 20 mg daily\n- Continue aspirin 325 mg daily\n- Continue Plavix 25 mg daily\n- Follow up in 3 months\n","review":162.2236842105263,"saved":81.2763157894737,"clean":false,"effort":35.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior inferior MI not stated and circumflex stent garbled/missing, losing key cardiac history."],["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg misnamed as Corrector and given daily instead of b.i.d."]],"mb":7.252605,"latency":34.5,"signable":185.9536842105263},{"label":"Run 5","wer":17.647058823529413,"text":"30-year-old patient with a history of inferior alveolar postright coronary artery and complex stent has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncopy.\nExpected weight is 244 pounds, blood pressure 120 over 82, heart rate is 68, regular period HGN2, pupils are equal, JVP is normal, no carotid bruin, neck is hard, thyroid not enlarged, trachea midline, no cervix and lymphadenopathy.\nRespiratory equal expansion normal breath sounds, heart BMI in the 5th intercostal space, S1-S2 normal.\nNo rub, no gallop, no murmurs, abdominals soft, non-tender, no groovies, pulse sounds present, extremities equal, pulses, no leg edema, period.\nAssessments stable.\nAssessments CAD, number 2, LV dysfunction, plan increase, correct to 25 mg, BAD.\nIncrease vasotec to 20 mg, daily.\nContinue with aspirin, 325 mg, daily.\nPlavix, 25 mg, daily.\nReturn in 3 months, period.","marks":[{"start":47,"end":65,"said":"wall MI post right","significant":true},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":216,"end":243,"said":"syncope. Weighs","significant":true},{"start":271,"end":282,"said":"120/82.","significant":false},{"start":317,"end":321,"said":"HEENT","significant":false},{"start":367,"end":372,"said":"bruit.","significant":true},{"start":382,"end":386,"said":"soft.","significant":true},{"start":430,"end":440,"said":"cervical","significant":true},{"start":514,"end":517,"said":"PMI","significant":true},{"start":593,"end":603,"said":"Abdomen","significant":false},{"start":610,"end":620,"said":"nontender.","significant":false},{"start":625,"end":640,"said":"bruits. Bowel","significant":true},{"start":706,"end":717,"said":"Assessment","significant":false},{"start":726,"end":737,"said":"Assessment","significant":false},{"start":784,"end":791,"said":"Coreg","significant":true},{"start":802,"end":806,"said":"b.i.d.","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Stent history present but garbled (\"inferior alveolar postright coronary artery and complex stent\"); MI not stated and circumflex rendered as \"complex\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lbs, BP 120/82 and \"heart rate 68 regular\" all captured."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","Only normal JVP captured (in assessment); no carotid bruit, no lymphadenopathy, thyroid and trachea findings omitted."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th intercostal space, S1/S2 normal, no rub, gallop or murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, bowel sounds present, equal pulses, no leg edema; abdominal \"no bruits\" omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Coronary artery disease and LV dysfunction both listed."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Vasotec 20 mg daily correct, but Coreg rendered as \"correct\"/\"Corrector\" to 25 mg with b.i.d. frequency omitted."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\" and \"Continue Plavix 25 mg daily\"."],["The note captures: Return in three months.","yes","Follow-up/return in 3 months stated."]],"claims":[],"note":"Subjective\nCliniTech Benchmark fdd279f2, a 30-year-old patient with a history of coronary artery disease and left ventricular dysfunction, presents for follow-up. The patient reports feeling well overall, with no symptoms of chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nMedical History  \n- Coronary artery disease  \n- Left ventricular dysfunction\n\nSurgical History  \n- Complex stent placement\n\nMedications and Supplements  \n- Aspirin 325 mg PO daily  \n- Plavix 25 mg PO daily  \n- Vasotec  \n- Correct\n\nObjective\nVital Signs  \n- Blood Pressure: 120/82 mmHg  \n- Heart Rate: 68 bpm  \n- Weight: 244 lbs\n\nPhysical Examination  \n- HEENT: Pupils equal  \n- Cardiovascular: PMI in the 5th intercostal space. S1 and S2 normal. No rub, no gallop, no murmurs  \n- Respiratory: Equal expansion. Normal breath sounds  \n- Abdomen: Soft, non-tender. Bowel sounds present  \n- Extremities: Equal pulses. No leg edema\n\nAssessment & Plan\n30-year-old patient with coronary artery disease status post complex stent, presenting for routine follow-up.\n\nCoronary Artery Disease with LV Dysfunction\nAssessment: Patient has stable coronary artery disease with history of inferior alveolar postright coronary artery and complex stent placement. Currently asymptomatic with no chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope. Physical examination reveals stable vital signs with blood pressure 120/82 mmHg, heart rate 68 regular, normal heart sounds without rubs, gallops, or murmurs. No evidence of heart failure on examination with normal JVP and no lower extremity edema. Patient demonstrates good clinical stability.\nPlan:\n- Increase correct to 25 mg\n- Increase Vasotec to 20 mg daily\n- Continue aspirin 325 mg daily\n- Continue Plavix 25 mg daily\n- Follow up in 3 months\n","review":138.89473684210526,"saved":104.60526315789474,"clean":false,"effort":20.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior inferior MI not stated and circumflex stent garbled/missing, losing key cardiac history."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg misnamed as correct with b.i.d. frequency omitted; med list also lacks doses."]],"mb":7.248461,"latency":36.764,"signable":165.00173684210526}],"cliniscripts":[{"label":"Run 1","wer":1.9607843137254901,"text":"Uh, 30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope.\nNext paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular.\nHEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space, S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses, no leg edema.\nAssessment: Stable CAD. 2.\nLV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 months.","marks":[{"start":517,"end":520,"said":"PMI","significant":true},{"start":714,"end":714,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","Inferior wall MI with right coronary artery and circumflex stent placement."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 pounds, BP 120/82, heart rate 68 bpm regular rhythm."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; PMI 5th intercostal space, S1/S2 normal, no rub, gallop or murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, no bruits, bowel sounds present; equal pulses, no leg edema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction listed in assessment."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg b.i.d.\" and \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg daily and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","\"Return in 3 months for follow-up.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 30-year-old individual with a history of inferior wall myocardial infarction (MI).\n- They have previously undergone right coronary artery and circumflex stent placement.\n- The patient reports feeling well with no current symptoms.\n- They deny experiencing chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nO (Objective):\n- Weight: 244 pounds.\n- Blood Pressure: 120/82 mmHg.\n- Heart Rate: 68 bpm, regular rhythm.\n- HEENT: Pupils are equal, JVP is normal, no carotid bruit, neck is soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n- Respiratory: Equal expansion, normal breath sounds.\n- Heart: PMI in the 5th intercostal space, S1, S2 normal, no rub, no gallop, no murmurs.\n- Abdomen: Soft, non-tender, no bruits, bowel sounds present.\n- Extremities: Equal pulses, no leg edema.\n\nA (Assessment):\n- Stable Coronary Artery Disease (CAD).\n- Left Ventricular (LV) dysfunction.\n\nP (Plan):\n- Increase Coreg to 25 mg b.i.d.\n- Increase Vasotec to 20 mg daily.\n- Continue Aspirin 325 mg daily.\n- Continue Plavix 25 mg daily.\n- Return in 3 months for follow-up.\n","review":53.05263157894737,"saved":190.44736842105263,"clean":true,"effort":0.0,"sig":[],"mb":5.977345,"latency":25.982,"signable":65.06463157894737},{"label":"Run 2","wer":1.3071895424836601,"text":"Uh, 30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope.\nNext paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular.\nHEENT: Pupils are equal. JVP is normal, no carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space, S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender, no bruits. Bowel sounds present. Extremities: Equal pulses, no leg edema.\nAssessment: Stable. Assessment: CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 months.","marks":[{"start":517,"end":520,"said":"PMI","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior wall MI, post right coronary artery and circumflex stent placement\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well, no chest pain; denies dyspnea, orthopnea, dizziness, lightheadedness, or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 pounds, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Equal expansion and heart sounds correct, but \"BMI in the 5th intercostal space\" misstates PMI."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, nontender, no bruits, bowel sounds present; equal pulses, no leg edema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Assessment lists CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg b.i.d.\" and \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg daily and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","\"Return in 3 months.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 30-year-old individual with a history of inferior wall MI, post right coronary artery and circumflex stent placement.\n- The patient reports feeling well with no symptoms of chest pain.\n- They deny symptoms of dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nO (Objective):\n- Weight: 244 pounds.\n- Blood pressure: 120/82.\n- Heart rate: 68, regular.\n- HEENT: Pupils are equal, JVP is normal, no carotid bruit, neck is soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n- Respiratory: Equal expansion, normal breath sounds.\n- Heart: BMI in the 5th intercostal space, S1, S2 normal, no rub, no gallop, no murmurs.\n- Abdomen: Soft, nontender, no bruits, bowel sounds present.\n- Extremities: Equal pulses, no leg edema.\n\nA (Assessment):\n- Stable condition.\n- Coronary Artery Disease (CAD).\n- Left Ventricular (LV) dysfunction.\n\nP (Plan):\n- Increase Coreg to 25 mg b.i.d.\n- Increase Vasotec to 20 mg daily.\n- Continue aspirin 325 mg daily.\n- Continue Plavix 25 mg daily.\n- Return in 3 months.\n","review":68.39473684210526,"saved":175.10526315789474,"clean":false,"effort":5.0,"sig":[],"mb":5.839544,"latency":37.037,"signable":91.43773684210527},{"label":"Run 3","wer":1.9607843137254901,"text":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope.\nNext paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular.\nHEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expansion, normal breath sounds. Heart: BMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema.\nStable. CAD. 2.\nLV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 months.","marks":[{"start":513,"end":516,"said":"PMI","significant":true},{"start":691,"end":691,"said":"Assessment","significant":false},{"start":699,"end":699,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior wall MI, post right coronary artery and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well, no chest pain; denies dyspnea, orthopnea, dizziness, lightheadedness, or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 pounds, BP 120/82, heart rate 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Respiratory and heart sounds correct, but PMI written as \"BMI in the 5th intercostal space\"."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, nontender, no bruits, bowel sounds present; equal pulses, no leg edema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction listed in assessment."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg b.i.d.\" and \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg daily and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","\"Return in 3 months.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 30-year-old individual with a history of inferior wall MI, post right coronary artery and circumflex stent.\n- The patient reports feeling well with no symptoms of chest pain.\n- They deny symptoms of dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nO (Objective):\n- Weight: 244 pounds.\n- Blood pressure: 120/82.\n- Heart rate: 68, regular.\n- HEENT: Pupils equal, JVP normal, no carotid bruit, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n- Respiratory: Equal expansion, normal breath sounds.\n- Heart: BMI in the 5th intercostal space, S1, S2 normal, no rub, gallop, or murmurs.\n- Abdomen: Soft, nontender, no bruits, bowel sounds present.\n- Extremities: Equal pulses, no leg edema.\n\nA (Assessment):\n- Coronary Artery Disease (CAD).\n- Left Ventricular (LV) dysfunction.\n\nP (Plan):\n- Increase Coreg to 25 mg b.i.d.\n- Increase Vasotec to 20 mg daily.\n- Continue aspirin 325 mg daily.\n- Continue Plavix 25 mg daily.\n- Return in 3 months.\n","review":66.1842105263158,"saved":177.31578947368422,"clean":false,"effort":5.0,"sig":[],"mb":5.85161,"latency":23.533,"signable":75.1552105263158},{"label":"Run 4","wer":2.6143790849673203,"text":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope.\nNext paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular.\nHEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expiration, normal breath sounds. Heart: BMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema.\nStable. CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 months.","marks":[{"start":473,"end":483,"said":"expansion","significant":false},{"start":514,"end":517,"said":"PMI","significant":true},{"start":692,"end":692,"said":"Assessment","significant":false},{"start":700,"end":700,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior wall MI, post right coronary artery and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, and syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 pounds, BP 120/82, heart rate 68 bpm regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","\"Equal expiration\" instead of expansion and \"BMI in the 5th intercostal space\" instead of PMI; heart sounds otherwise correct."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, no bruits, bowel sounds present; equal pulses, no leg edema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction listed in assessment."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg b.i.d.\" and \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg daily and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","\"Return in 3 months.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 30-year-old individual with a history of inferior wall MI, post right coronary artery and circumflex stent.\n- The patient reports feeling well with no current symptoms.\n- The patient denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, and syncope.\n\nO (Objective):\n- Weight: 244 pounds.\n- Blood Pressure: 120/82 mmHg.\n- Heart Rate: 68 bpm, regular.\n- HEENT: Pupils equal, JVP normal, no carotid bruit, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n- Respiratory: Equal expiration, normal breath sounds.\n- Heart: BMI in the 5th intercostal space, S1, S2 normal, no rub, no gallop, no murmurs.\n- Abdomen: Soft, non-tender, no bruits, bowel sounds present.\n- Extremities: Equal pulses, no leg edema.\n\nA (Assessment):\n- Stable Coronary Artery Disease (CAD).\n- Left Ventricular (LV) dysfunction.\n\nP (Plan):\n- Increase Coreg to 25 mg b.i.d.\n- Increase Vasotec to 20 mg daily.\n- Continue Aspirin 325 mg daily.\n- Continue Plavix 25 mg daily.\n- Return in 3 months.\n","review":67.44736842105263,"saved":176.05263157894737,"clean":false,"effort":5.0,"sig":[],"mb":5.927849,"latency":29.333,"signable":76.42336842105263},{"label":"Run 5","wer":1.9607843137254901,"text":"30-year-old patient with a history of inferior wall MI, post right coronary artery and circumflex stent, has been feeling well, no symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness, lightheadedness, no syncope.\nNext paragraph weighs 244 pounds, blood pressure 120/82, heart rate is 68, regular.\nHEENT: Pupils are equal. JVP is normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory: Equal expiration, normal breath sounds. Heart: BMI in the 5th intercostal space. S1, S2 normal. No rub, no gallop, no murmurs. Abdomen soft, nontender. No bruits. Bowel sounds present. Extremities: Equal pulses. No leg edema.\nAssessment: Stable CAD. 2. LV dysfunction. Plan: Increase Coreg to 25 mg b.i.d. Increase Vasotec to 20 mg daily. Continue with aspirin 325 mg daily, Plavix 25 mg daily. Return in 3 months.","marks":[{"start":473,"end":483,"said":"expansion","significant":false},{"start":514,"end":517,"said":"PMI","significant":true},{"start":711,"end":711,"said":"Assessment","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior wall myocardial infarction (MI) and post right coronary artery (RCA) and circumflex stent placement\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Reports feeling well; denies chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 pounds, BP 120/82, HR 68 regular all recorded."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","\"JVP is normal, no carotid bruit... thyroid not enlarged, trachea midline, no cervical lymphadenopathy\"."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Heart sounds captured, but \"Equal expiration\" replaces equal expansion and \"BMI in the 5th intercostal space\" replaces PMI."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, no bruits, bowel sounds present; equal pulses, no leg edema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Assessment lists CAD (\"Stable\") and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg b.i.d.\" and \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue Aspirin 325 mg daily and Plavix 25 mg daily, doses as stated."],["The note captures: Return in three months.","yes","\"Return for follow-up in 3 months\"."]],"claims":[],"note":"S (Subjective):\n- The patient is a 30-year-old individual with a history of inferior wall myocardial infarction (MI) and post right coronary artery (RCA) and circumflex stent placement.\n- The patient reports feeling well with no current symptoms.\n- The patient denies experiencing chest pain, dyspnea, orthopnea, dizziness, lightheadedness, or syncope.\n\nO (Objective):\n- Weight: 244 pounds.\n- Blood Pressure: 120/82 mmHg.\n- Heart Rate: 68 beats per minute, regular.\n- HEENT: Pupils are equal, JVP is normal, no carotid bruit, neck is soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n- Respiratory: Equal expiration, normal breath sounds.\n- Heart: BMI in the 5th intercostal space, S1 and S2 normal, no rub, no gallop, no murmurs.\n- Abdomen: Soft, non-tender, no bruits, bowel sounds present.\n- Extremities: Equal pulses, no leg edema.\n\nA (Assessment):\n- Stable Coronary Artery Disease (CAD).\n- Left Ventricular (LV) dysfunction.\n\nP (Plan):\n- Increase Coreg to 25 mg b.i.d.\n- Increase Vasotec to 20 mg daily.\n- Continue Aspirin 325 mg daily.\n- Continue Plavix 25 mg daily.\n- Return for follow-up in 3 months.\n","review":72.18421052631578,"saved":171.31578947368422,"clean":false,"effort":5.0,"sig":[],"mb":5.924886,"latency":32.349,"signable":82.16321052631578}],"lyrebird":[{"label":"Run 1","wer":20.915032679738562,"text":"30 year old patient with a history of inferior OMI post right coronary artery and circumflex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea or orthopnea, dizziness, lightheadedness. No syncope. Next paragraph. 244 pounds. Blood pressure, 1 20 over 82. Heart rate is 68 regular, period. HEENT, pupils, equal. JVP,\n\nNormal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory, equal. Expansion, normal. Breath sounds. Heart BMI in the fifth intercostal space. S 1 s 2 normal. No rub. No gallop. No murmurs. Abdomen, soft. No tenderness. No bruit. Spell sounds. Eczema, pulses. No leg edema, period. Assessment, stable. Assessment, CAD. Number 2, LV dysfunction. Plan, increase Coreg to 25 milligram BID. Increase Vasotec to 20 milligrams daily. Continue with aspirin 3\n\n25 milligrams, Cetiplavix, 25 milligrams, Cetirizine in 3 months, period.","marks":[{"start":47,"end":50,"said":"wall MI","significant":false},{"start":172,"end":174,"said":"","significant":false},{"start":225,"end":225,"said":"Weighs","significant":false},{"start":270,"end":283,"said":"120/82.","significant":false},{"start":514,"end":517,"said":"PMI","significant":true},{"start":525,"end":530,"said":"5th","significant":false},{"start":550,"end":557,"said":"S1 S2","significant":false},{"start":611,"end":611,"said":"nontender.","significant":true},{"start":615,"end":642,"said":"bruits. Bowel","significant":false},{"start":651,"end":657,"said":"present. Extremities Equal","significant":true},{"start":779,"end":793,"said":"mg b.i.d.","significant":false},{"start":817,"end":827,"said":"mg","significant":false},{"start":857,"end":858,"said":"325 mg daily Plavix","significant":true},{"start":863,"end":912,"said":"mg daily. Return","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior OMI post right coronary artery and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight: 244 lbs\", \"BP: 120/82 mmHg\", \"HR: 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; \"PMI in 5th intercostal space, S1 S2 normal, no rub, no gallop, no murmurs\"."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen fully captured, but \"Pulses present\" rather than equal pulses."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable coronary artery disease\", \"Left ventricular dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Carvedilol 25 mg BD and enalapril 20 mg daily increases."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Continue clopidogrel 75 mg daily\" is the wrong dose (25 mg stated); aspirin correct."],["The note captures: Return in three months.","yes","\"Review in 3 months\"."]],"claims":[["Continue clopidogrel 75 mg daily","Transcript says \"Plavix 25 mg daily\"; dose silently changed to 75 mg."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n30-year-old patient with history of inferior OMI post right coronary artery and circumflex stent\n\nCardiology follow-up\n\nFeeling well\n\nDenies chest pain\n\nDenies dyspnoea or orthopnoea\n\nDenies dizziness or lightheadedness\n\nDenies syncope\n\n\n\n\nObjective:\n\nWeight: 244 lbs\n\nBP: 120/82 mmHg\n\nHR: 68 bpm, regular\n\nHEENT: Pupils equal, JVP normal, no carotid bruit, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\nRespiratory: Equal expansion, normal breath sounds\n\nCardiovascular: PMI in 5th intercostal space, S1 S2 normal, no rub, no gallop, no murmurs\n\nAbdomen: Soft, non-tender, no bruit, normal bowel sounds\n\nExtremities: Pulses present, no leg oedema\n\n\n\n\nAssessment:\n\nStable coronary artery disease\n\nLeft ventricular dysfunction\n\n\n\n\nPlan:\n\nIncrease carvedilol to 25 mg BD\n\nIncrease enalapril to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 75 mg daily\n\nReview in 3 months","review":112.82894736842105,"saved":130.67105263157896,"clean":false,"effort":25.0,"sig":[["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Clopidogrel dose written as 75 mg instead of the stated 25 mg."]],"mb":9.688085,"latency":18.756,"signable":131.58494736842107},{"label":"Run 2","wer":18.954248366013072,"text":"30 year old patient with a history of inferior OMI post right coronary artery and circumflex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea or orthopnea, dizziness, lightheadedness. No syncope. Next paragraph. 244 pounds. Blood pressure, 1 20 over 82. Heart rate is 68 regular, period. HEENT, pupils are equal. JVP,\n\nIs normal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory, equal. Expansion, normal. Breath sounds. Heart BMI in the fifth intercostal space. S 1 s 2, normal. No rub. No gallop. No murmurs. Abdominal, soft. No tendon. No bruised bowel sounds present. Extremity, sequal pulses. No leg edema, period. Assessment, stable. Assessment, CAD. Number 2, LV dysfunction. Plan, increase Corec to 25 milligram BAD. Increase Vasotec to 20 milligrams daily. Continue with aspirin 3\n\n25 milligrams, Celeplavix, 25 milligrams daily routine in 3 months, period.","marks":[{"start":47,"end":50,"said":"wall MI","significant":false},{"start":172,"end":174,"said":"","significant":false},{"start":225,"end":225,"said":"Weighs","significant":false},{"start":270,"end":283,"said":"120/82.","significant":false},{"start":520,"end":523,"said":"PMI","significant":true},{"start":531,"end":536,"said":"5th","significant":false},{"start":556,"end":563,"said":"S1 S2","significant":false},{"start":604,"end":613,"said":"Abdomen","significant":false},{"start":620,"end":620,"said":"nontender.","significant":true},{"start":624,"end":642,"said":"bruits.","significant":false},{"start":665,"end":682,"said":"Extremities Equal","significant":false},{"start":791,"end":796,"said":"Coreg","significant":false},{"start":803,"end":817,"said":"mg b.i.d.","significant":true},{"start":841,"end":851,"said":"mg","significant":false},{"start":881,"end":924,"said":"325 mg","significant":true},{"start":931,"end":938,"said":"Plavix 25 mg daily. Return","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior OMI post right coronary artery and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; no chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","244 lbs, 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1 S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen and extremities captured but abdominal \"no bruits\" omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and left ventricular dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg BD\", \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","Aspirin correct but \"Continue clopidogrel 75 mg daily\" contradicts the stated 25 mg."],["The note captures: Return in three months.","yes","\"Routine review in 3 months\"."]],"claims":[["Continue clopidogrel 75 mg daily","Source states \"Plavix 25 mg daily\"; 75 mg is a silently corrected dose."]],"note":"Subjective:\n\n30-year-old patient with history of inferior OMI post right coronary artery and circumflex stent\n\nFeeling well\n\nNo chest pain\n\nNo dyspnoea or orthopnoea\n\nNo dizziness or lightheadedness\n\nNo syncope\n\n\n\n\nObjective:\n\nWeight: 244 lbs\n\nBlood pressure: 120/82 mmHg\n\nHeart rate: 68 bpm, regular\n\nHEENT: Pupils equal\n\nCardiovascular: JVP normal, no carotid bruit, PMI 5th intercostal space, S1 S2 normal, no rub, no gallop, no murmurs\n\nNeck: Soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\nRespiratory: Equal expansion, normal breath sounds\n\nAbdomen: Soft, no tenderness, bowel sounds present\n\nExtremities: Equal pulses, no leg oedema\n\n\n\n\nAssessment:\n\nStable coronary artery disease\n\nLeft ventricular dysfunction\n\n\n\n\nPlan:\n\nIncrease Coreg to 25 mg BD\n\nIncrease Vasotec to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 75 mg daily\n\nRoutine review in 3 months","review":111.25,"saved":132.25,"clean":false,"effort":25.0,"sig":[["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Clopidogrel dose recorded as 75 mg when 25 mg was dictated."]],"mb":6.182153,"latency":20.676,"signable":131.926},{"label":"Run 3","wer":20.915032679738562,"text":"30 year old patient with a history of inferior OMI post right coronary artery and circumflex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea or orthopnea, dizziness, lightheadedness. No syncope. Next paragraph. 244 pounds. Blood pressure, 1 20 over 82. Heart rate is 68 regular, period. HEENT, pupils, equal. JVP,\n\nNormal. No carotid bruit. Neck is soft. Thyroid not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory, equal. Expansion, normal. Breath sounds. Heart BMI in the fifth intercostal space. S 1 s 2 normal. No rub. No gallop. No murmurs. Abdomen, soft. No tenderness. No bruit. Spell sounds. Eczema, pulses. No leg edema, period. Assessment, stable. Assessment, CAD. Number 2, LV dysfunction. Plan, increase Coreg to 25 milligram BID. Increase Vasotec to 20 milligrams daily. Continue with aspirin 3\n\n25 milligrams, Cetiplavix, 25 milligrams, Cetirizine in 3 months, period.","marks":[{"start":47,"end":50,"said":"wall MI","significant":false},{"start":172,"end":174,"said":"","significant":false},{"start":225,"end":225,"said":"Weighs","significant":false},{"start":270,"end":283,"said":"120/82.","significant":false},{"start":514,"end":517,"said":"PMI","significant":true},{"start":525,"end":530,"said":"5th","significant":false},{"start":550,"end":557,"said":"S1 S2","significant":false},{"start":611,"end":611,"said":"nontender.","significant":true},{"start":615,"end":642,"said":"bruits. Bowel","significant":false},{"start":651,"end":657,"said":"present. Extremities Equal","significant":true},{"start":779,"end":793,"said":"mg b.i.d.","significant":false},{"start":817,"end":827,"said":"mg","significant":false},{"start":857,"end":858,"said":"325 mg daily Plavix","significant":true},{"start":863,"end":912,"said":"mg daily. Return","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior OMI post RCA and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; no chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight: 244 lbs\", \"BP: 120/82 mmHg\", \"HR: 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1 S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdominal findings and no oedema captured, but pulses recorded as \"present\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable coronary artery disease\", \"Left ventricular dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Coreg to 25 mg BD\", \"Increase Vasotec to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Continue clopidogrel 75 mg daily\" silently corrects the stated 25 mg dose."],["The note captures: Return in three months.","yes","\"Review in 3 months\"."]],"claims":[["Continue clopidogrel 75 mg daily","Transcript states Plavix 25 mg daily; 75 mg is a wrong dose."]],"note":"SOAP Notes\n\n\n\n\nConsultation Date: 22/09/2026 at 4:53 pm\n\n\n\n\nSubjective:\n\n30-year-old patient with history of inferior OMI post RCA and circumflex stent\n\nFeeling well\n\nNo chest pain\n\nNo dyspnoea or orthopnoea\n\nNo dizziness or lightheadedness\n\nNo syncope\n\n\n\n\nObjective:\n\nWeight: 244 lbs\n\nBP: 120/82 mmHg\n\nHR: 68 bpm, regular\n\nHEENT: Pupils equal, JVP normal, no carotid bruit, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\nRespiratory: Equal expansion, normal breath sounds\n\nCardiovascular: PMI in 5th intercostal space, S1 S2 normal, no rub, no gallop, no murmurs\n\nAbdomen: Soft, no tenderness, no bruit, normal bowel sounds\n\nExtremities: Pulses present, no leg oedema\n\n\n\n\nAssessment:\n\nStable coronary artery disease\n\nLeft ventricular dysfunction\n\n\n\n\nPlan:\n\nIncrease Coreg to 25 mg BD\n\nIncrease Vasotec to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 75 mg daily\n\nReview in 3 months","review":114.09210526315789,"saved":129.4078947368421,"clean":false,"effort":25.0,"sig":[["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Clopidogrel recorded as 75 mg when 25 mg was dictated; silently changes the prescribed dose."]],"mb":9.78654,"latency":18.779,"signable":132.8711052631579},{"label":"Run 4","wer":20.915032679738562,"text":"30 year old patient with a history of inferior OMI with post right coronary artery and circumflex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea or orthopnea, dizziness, lightheadedness. No syncope. Next paragraph. 244 pounds. Blood pressure, 1 20 over 82. Heart rate is 68 regular, period. HEENT, pupils, are equal. JVP,\n\nIs normal. No carotid bruit. Neck is soft. Thyroid, not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory, equal. Expansion, normal. Breath sounds. Heart BMI in fifth intercostal space. S 1 s 2, normal. No rub. No gallop. No murmurs. Abdomen, soft. No tenderness. No bruitous bowel sounds present. Pulses, leg edema, period. Assessment, stable. Assessment, CAD. Number 2, LV dysfunction. Plan, increase Corec to 25 milligram BID. Increase Vasotec to 20 milligrams daily. Continue with aspirin 3\n\n25 milligrams, Cinaplavix, 25 milligrams, dilator 10 and 3 months, period.","marks":[{"start":47,"end":55,"said":"wall MI","significant":false},{"start":177,"end":179,"said":"","significant":false},{"start":230,"end":230,"said":"Weighs","significant":false},{"start":275,"end":288,"said":"120/82.","significant":false},{"start":527,"end":530,"said":"PMI","significant":true},{"start":534,"end":539,"said":"the 5th","significant":false},{"start":559,"end":566,"said":"S1 S2","significant":false},{"start":621,"end":621,"said":"nontender.","significant":true},{"start":625,"end":648,"said":"bruits.","significant":false},{"start":670,"end":670,"said":"Extremities Equal","significant":false},{"start":677,"end":677,"said":"No","significant":true},{"start":776,"end":781,"said":"Coreg","significant":false},{"start":788,"end":802,"said":"mg b.i.d.","significant":false},{"start":826,"end":836,"said":"mg","significant":false},{"start":866,"end":867,"said":"325 mg daily Plavix","significant":true},{"start":872,"end":925,"said":"mg daily. Return in","significant":true}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"inferior OMI with post-RCA and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Denies chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","244 pounds, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1 S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen fully captured, but pulses \"present\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable coronary artery disease\", \"Left ventricular dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase Carvedilol to 25 mg BD\", \"Increase Enalapril to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","Aspirin 325 mg correct but \"clopidogrel 75 mg daily\" is wrong (source 25 mg)."],["The note captures: Return in three months.","yes","\"Review in 3 months\"."]],"claims":[["Continue clopidogrel 75 mg daily","Source states Plavix 25 mg daily."],["Continue diltiazem 10 mg daily","Diltiazem is never mentioned in the source."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n30-year-old patient with history of inferior OMI with post-RCA and circumflex stents\n\nReports feeling well\n\nDenies chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness, or syncope\n\n\n\n\nObjective:\n\nWeight: 244 pounds\n\nBP: 120/82 mmHg\n\nHR: 68 bpm, regular\n\nHEENT: Pupils equal, JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\nRespiratory: Equal expansion, normal breath sounds\n\nCardiovascular: PMI 5th intercostal space, S1 S2 normal, no rub, gallop, or murmurs\n\nAbdomen: Soft, non-tender, bowel sounds present, no bruits\n\nExtremities: Pulses present, no leg oedema\n\n\n\n\nAssessment:\n\nStable coronary artery disease\n\nLeft ventricular dysfunction\n\n\n\n\nPlan:\n\nIncrease Carvedilol to 25 mg BD\n\nIncrease Enalapril to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 75 mg daily\n\nContinue diltiazem 10 mg daily\n\nReview in 3 months","review":122.9342105263158,"saved":120.5657894736842,"clean":false,"effort":40.0,"sig":[["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Clopidogrel recorded as 75 mg instead of the stated 25 mg."],["fabrication","Continue diltiazem 10 mg daily","Invented diltiazem, a rate-limiting drug with interactions alongside a beta-blocker."]],"mb":9.807403,"latency":20.901,"signable":143.8352105263158},{"label":"Run 5","wer":22.22222222222222,"text":"30 year old patient with a history of inferior OMI with post right coronary artery and circumflex stent has been feeling well. No symptoms of chest pain. No symptoms of dyspnea or orthopnea, dizziness, lightheadedness. No syncope. Next paragraph. 244 pounds. Blood pressure, 1 20 over 82. Heart rate is 68 regular, period. HEENT, pupils, equal. JVP,\n\nNormal. No carotid bruit. Neck is soft. Thyroid, not enlarged. Trachea midline. No cervical lymphadenopathy. Respiratory, equal. Expansion, normal. Breath sounds. Heart BMI in fifth intercostal space. S 1 s 2, normal. No rub. No gallop. No murmurs. Abdomen, soft. No tenderness. No bruit. Spell sounds. Eczema, pulses. No leg edema, period. Assessment, stable. Assessment, CAD. Number 2, LV dysfunction. Plan, increase Coreg to 25 milligram BID. Increase Vasotec to 20 milligrams daily. Continue with aspirin 3\n\nMilligrams, Celebrate 25 milligrams daily routine in 3 months, period.","marks":[{"start":47,"end":55,"said":"wall MI","significant":false},{"start":177,"end":179,"said":"","significant":false},{"start":230,"end":230,"said":"Weighs","significant":false},{"start":275,"end":288,"said":"120/82.","significant":false},{"start":520,"end":523,"said":"PMI","significant":true},{"start":527,"end":532,"said":"the 5th","significant":false},{"start":552,"end":559,"said":"S1 S2","significant":false},{"start":614,"end":614,"said":"nontender.","significant":true},{"start":618,"end":645,"said":"bruits. Bowel","significant":false},{"start":654,"end":660,"said":"present. Extremities Equal","significant":true},{"start":782,"end":796,"said":"mg b.i.d.","significant":false},{"start":820,"end":830,"said":"mg","significant":false},{"start":860,"end":898,"said":"325 mg","significant":true},{"start":905,"end":912,"said":"Plavix 25 mg daily. Return","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior OMI with post-RCA and circumflex stent\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; no chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight: 244 pounds\", \"BP: 120/82\", \"HR: 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; PMI fifth ICS; S1 S2 normal, no rub, gallop or murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen fully captured, but extremities say \"Pulses present\" rather than equal pulses."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\" and \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Increase carvedilol to 25 mg BD\", \"Increase enalapril to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","Wrong doses: \"aspirin 300 mg\" and \"clopidogrel 75 mg\" vs stated 325 mg and 25 mg."],["The note captures: Return in three months.","yes","\"Routine review in 3 months\"."]],"claims":[["Continue aspirin 300 mg daily","Source states aspirin 325 mg daily."],["Continue clopidogrel 75 mg daily","Source states Plavix 25 mg daily; 75 mg is a silent correction."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n30-year-old patient with history of inferior OMI with post-RCA and circumflex stent\n\nFeeling well\n\nNo chest pain\n\nNo dyspnoea or orthopnoea\n\nNo dizziness or lightheadedness\n\nNo syncope\n\n\n\n\nObjective:\n\nWeight: 244 pounds\n\nBP: 120/82 mmHg\n\nHR: 68 bpm, regular\n\nHEENT: Pupils equal, JVP normal, no carotid bruit, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy\n\nRespiratory: Equal expansion, normal breath sounds\n\nCardiovascular: PMI fifth intercostal space, S1 S2 normal, no rub, gallop or murmurs\n\nAbdomen: Soft, no tenderness, no bruit, normal bowel sounds\n\nExtremities: Pulses present, no leg oedema\n\n\n\n\nAssessment:\n\nStable CAD\n\nLV dysfunction\n\n\n\n\nPlan:\n\nIncrease carvedilol to 25 mg BD\n\nIncrease enalapril to 20 mg daily\n\nContinue aspirin 300 mg daily\n\nContinue clopidogrel 75 mg daily\n\nRoutine review in 3 months","review":122.30263157894737,"saved":121.19736842105263,"clean":false,"effort":35.0,"sig":[["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Both antiplatelet doses differ from the source (aspirin 300 vs 325, clopidogrel 75 vs 25)."]],"mb":9.809052,"latency":16.703,"signable":139.00563157894737}],"preve":[{"label":"Run 1","wer":25.49019607843137,"text":"30 year old location\n\nwith a history of, inferior OMI post right\n\ncoronary artery and circumflex stent. Has\n\nbeen feeling well. No symptoms of chest pain. No symptoms of dyspnea or\n\northopnea, dizziness, lightheadedness. No syncope. Next paragraph, two hundred and forty four pounds. Blood pressure, one twenty over 82. Heart rate is 68 regular, period.\n\nHE and two people say equal. JVP is normal. No carotid\n\nbruit. Neck is soft, thyroid not enlarged. Okay. Midline. No cervical lymph\n\nadenopathy. Respiratory, equal expansion, normal. Blood sounds. Heart pain, minor\n\nfifth intercostal spaces. One s two, normal. No rub\n\nNo gallop. No murmurs. Abdomen, soft. Not tender. No bruised bowel sounds present. Exterior\n\nsequel pulses, leg edema, period.\n\nAssessment, stable. Assessment, CAD, number two, LV dysfunction.\n\nIncrease Corec to twenty five milligram BAT. Increase Vasotec to twenty milligrams daily.\n\nContinue with aspirin, three twenty five milligrams daily. Plavix, twenty five milligrams daily. Return in three months,\n\nperiod.","marks":[{"start":0,"end":20,"said":"30-year-old patient","significant":false},{"start":50,"end":53,"said":"wall MI","significant":false},{"start":178,"end":180,"said":"","significant":false},{"start":249,"end":275,"said":"Weighs 244","significant":false},{"start":300,"end":319,"said":"120/82.","significant":false},{"start":355,"end":376,"said":"HEENT Pupils are","significant":true},{"start":454,"end":459,"said":"Trachea","significant":true},{"start":481,"end":499,"said":"lymphadenopathy.","significant":false},{"start":538,"end":543,"said":"breath","significant":true},{"start":558,"end":576,"said":"PMI in the 5th","significant":true},{"start":589,"end":606,"said":"space. S1 S2","significant":false},{"start":662,"end":673,"said":"nontender.","significant":false},{"start":677,"end":684,"said":"bruits.","significant":true},{"start":707,"end":723,"said":"Extremities Equal","significant":true},{"start":730,"end":730,"said":"No","significant":true},{"start":816,"end":816,"said":"Plan","significant":false},{"start":827,"end":832,"said":"Coreg","significant":false},{"start":836,"end":862,"said":"25 mg b.i.d.","significant":true},{"start":890,"end":900,"said":"mg","significant":false},{"start":932,"end":960,"said":"325 mg","significant":false},{"start":976,"end":998,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"prior inferior MI post right coronary artery and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"244 lb; BP 120/82 mmHg; HR 68 bpm regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; \"PMI mid-5th ICS; S1/S2 normal; no rub; no gallop; no murmurs\"."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen fully captured, but pulses recorded as \"distal pulses present\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\" and \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Coreg 25 mg BID and Vasotec 20 mg daily increases captured."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\" and \"clopidogrel (Plavix) 25 mg daily\"."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[["HEENT: PERRLA and EOMI","Transcript says only \"Pupils are equal\"; reactivity, accommodation and extraocular movements were never examined or stated."],["(Consent obtained)","No mention of consent anywhere in the transcript."]],"note":"Presenting Condition\n\n30-year-old with prior inferior MI post right coronary artery and circumflex stents\n\nCurrently feeling well\n\nDenies chest pain\n\nDenies dyspnoea, orthopnoea, dizziness, light‑headedness, syncope\n\n\n\n\nRadiology\n\nHEENT: PERRLA and EOMI (eyes equal per report)\n\n\n\n\nPast Medical History\n\nCoronary artery disease (post RCA and circumflex stents)\n\nLeft ventricular dysfunction\n\n\n\n\nMedications\n\nPlan to increase carvedilol (Coreg) to 25 mg BID\n\nPlan to increase enalapril (Vasotec) to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel (Plavix) 25 mg daily\n\n\n\n\nObjective\n\n(Consent obtained)\n\nVitals: 244 lb; BP 120/82 mmHg; HR 68 bpm regular\n\nJVP normal\n\nNo carotid bruit\n\nNeck soft; thyroid not enlarged; midline; no cervical lymphadenopathy\n\nRespiratory: equal expansion; normal breath sounds\n\nCardiac: PMI mid‑5th ICS; S1/S2 normal; no rub; no gallop; no murmurs\n\nAbdomen: soft; non‑tender; bowel sounds present; no bruit\n\nPeripheral: distal pulses present; no leg oedema\n\n\n\n\nDiagnosis\n\nStable CAD\n\nLV dysfunction\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nMedications adjusted as above\n\n// Patient currently asymptomatic; exam stable\n\n\n\n\nPlan\n\nReturn in 3 months\n","review":93.30263157894737,"saved":150.19736842105263,"clean":false,"effort":35.0,"sig":[["fabrication","HEENT: PERRLA and EOMI","Pupil reactivity, accommodation and EOMI were never examined; only pupils equal stated."],["fabrication","(Consent obtained)","Invented consent statement alters the legal record of what happened."]],"mb":4.70003,"signable":112.70363157894737},{"label":"Run 2","wer":27.450980392156865,"text":"30 year old patient\n\nwith a history of, inferior OMI post right\n\ncoronary artery and circumflex stent. Has\n\nbeen feeling well. No symptoms of chest pain. No symptoms of dyspnea or\n\northopnea, dizziness, lightheadedness. No syncope. Next by the way, two hundred and forty four pounds. Blood pressure, one twenty over 82. Heart rate is 68 regular, period.\n\nHE and two people say equal. JVP is normal. No\n\ncarotid bruit. Neck is soft, thyroid, not enlarged. Okay. Midline. No cervical,\n\nadenopathy. Respiratory, equal expansion. Normal. Blood sounds. Heart pain, minor\n\nfifth intercostal space. S one s two, normal. No rub\n\nNo gallop. No murmurs. Abdomen, soft. Not tender. No bruised bowel sounds present.\n\nXMT, sequel pulses, leg edema, period.\n\nAssessment, stable. Assessment, CAD, number two, LV dysfunction.\n\nPlan, increase core act to twenty five milligram BAT. Increase\n\nto twenty milligrams daily. Continue with aspirin three five milligrams daily. Plavix twenty five milligrams daily. Return in three months, period.","marks":[{"start":49,"end":52,"said":"wall MI","significant":false},{"start":177,"end":179,"said":"","significant":false},{"start":232,"end":275,"said":"Weighs 244","significant":false},{"start":300,"end":319,"said":"120/82.","significant":false},{"start":355,"end":376,"said":"HEENT Pupils are","significant":true},{"start":455,"end":460,"said":"Trachea","significant":true},{"start":484,"end":495,"said":"lymphadenopathy.","significant":false},{"start":534,"end":539,"said":"breath","significant":true},{"start":554,"end":572,"said":"PMI in the 5th","significant":true},{"start":592,"end":603,"said":"S1 S2","significant":false},{"start":659,"end":670,"said":"nontender.","significant":false},{"start":674,"end":681,"said":"bruits.","significant":true},{"start":705,"end":716,"said":"Extremities Equal","significant":false},{"start":723,"end":723,"said":"No","significant":true},{"start":826,"end":834,"said":"Coreg to 25 mg b.i.d. Increase Vasotec","significant":true},{"start":845,"end":895,"said":"mg","significant":false},{"start":925,"end":946,"said":"325 mg","significant":true},{"start":961,"end":983,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"inferior MI post right coronary artery and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Currently well; no chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lb; BP 120/82; HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","JVP, carotid bruit, thyroid, adenopathy captured; trachea midline omitted."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Most captured but PMI described as \"midline 5th ICS\", which is not what was stated."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","yes","Abdomen soft, non-tender, bowel sounds, no bruits; equal pulses, no oedema."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","Stable CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Coreg 25 mg BID captured but Vasotec rendered as \"[Unspecified medication] increase to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Aspirin 325 mg daily and clopidogrel 25 mg daily."],["The note captures: Return in three months.","yes","\"Review in 3 months\"."]],"claims":[["HEENT: PERRLA","Source says only \"Pupils are equal\"; reactivity to light and accommodation was never stated."],["PMI midline 5th ICS","Source gives \"PMI in the 5th intercostal space\" with no midline location."]],"note":"Presenting Condition\n\n30-year-old with history of inferior MI post right coronary artery and circumflex stents\n\nCurrently well; no chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, or syncope\n\n\n\n\nRadiology\n\nStents in right coronary artery and circumflex (historical)\n\n\n\n\nPast Medical History\n\nCoronary artery disease (CAD)\n\nLeft ventricular dysfunction\n\nInferior myocardial infarction (post-PCI with RCA and circumflex stents)\n\n\n\n\nMedications\n\nAspirin 325 mg daily (continue)\n\nClopidogrel 25 mg daily (continue)\n\nCoreg (carvedilol) increase to 25 mg BID\n\n[Unspecified medication] increase to 20 mg daily\n\n\n\n\nObjective\n\n(Consent obtained)\n\nVitals: Weight 244 lb; BP 120/82 mmHg; HR 68 bpm, regular\n\nHEENT: PERRLA; JVP normal; no carotid bruit; neck soft; thyroid not enlarged; no cervical adenopathy\n\nRespiratory: Equal expansion; normal breath sounds\n\nCardiac: PMI midline 5th ICS; S1 S2 normal; no rub, gallop, or murmurs\n\nAbdomen: Soft, non-tender; bowel sounds present; no bruits\n\nExtremities: Equal pulses; no leg oedema\n\n\n\n\nDiagnosis\n\nStable CAD\n\nLV dysfunction\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nMedication adjustments per plan\n\n\n\n\nPlan\n\nIncrease Coreg to 25 mg BID\n\nIncrease [unspecified] to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 25 mg daily\n\nReview in 3 months\n","review":129.98684210526315,"saved":113.51315789473685,"clean":false,"effort":40.0,"sig":[["partial","Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","PMI location altered to 'midline' in a patient with LV dysfunction where apex position matters."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Vasotec dose increase recorded against an unnamed drug."]],"mb":4.679522,"signable":152.34284210526314},{"label":"Run 3","wer":25.49019607843137,"text":"30 year old location\n\nwith a history of, inferior OMI post right\n\ncoronary artery and circumflex stent. Has\n\nbeen feeling well. No symptoms of chest pain. No symptoms of dyspnea or\n\northopnea, dizziness, lightheadedness. No syncope. Next paragraph, two hundred and forty four pounds. Blood pressure, one twenty over 82. Heart rate is 68 regular, period.\n\nHE and two people say equal. JVP is normal. No carotid\n\nbruit. Neck is soft, thyroid not enlarged. Okay. Midline. No cervical lymph\n\nadenopathy. Respiratory, equal expansion, normal. Blood sounds. Heart pain, minor\n\nfifth intercostal spaces. One s two, normal. No rub\n\nNo gallop. No murmurs. Abdomen, soft. Not tender. No bruised bowel sounds present. Exterior\n\nsequel pulses, leg edema, period.\n\nAssessment, stable. Assessment, CAD, number two, LV dysfunction,\n\nincrease Corec to twenty five milligram BAT. Increase Vasotec to twenty milligrams daily.\n\nContinue with aspirin, three twenty five milligrams daily. Plavix, twenty five milligrams daily. Return in three months,\n\nperiod.","marks":[{"start":0,"end":20,"said":"30-year-old patient","significant":false},{"start":50,"end":53,"said":"wall MI","significant":false},{"start":178,"end":180,"said":"","significant":false},{"start":249,"end":275,"said":"Weighs 244","significant":false},{"start":300,"end":319,"said":"120/82.","significant":false},{"start":355,"end":376,"said":"HEENT Pupils are","significant":true},{"start":454,"end":459,"said":"Trachea","significant":true},{"start":481,"end":499,"said":"lymphadenopathy.","significant":false},{"start":538,"end":543,"said":"breath","significant":true},{"start":558,"end":576,"said":"PMI in the 5th","significant":true},{"start":589,"end":606,"said":"space. S1 S2","significant":false},{"start":662,"end":673,"said":"nontender.","significant":false},{"start":677,"end":684,"said":"bruits.","significant":true},{"start":707,"end":723,"said":"Extremities Equal","significant":true},{"start":730,"end":730,"said":"No","significant":true},{"start":815,"end":815,"said":"Plan","significant":false},{"start":827,"end":832,"said":"Coreg","significant":false},{"start":836,"end":862,"said":"25 mg b.i.d.","significant":true},{"start":890,"end":900,"said":"mg","significant":false},{"start":932,"end":960,"said":"325 mg","significant":false},{"start":976,"end":998,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","Inferior wall MI with RCA and circumflex stents."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","partial","Denials recorded but \"feeling well\" not stated."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Wt 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical LAD."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; PMI 5th ICS, S1/S2 normal, no rub/gallop/murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, NT, bowel sounds present; abdominal bruits omitted and pulses \"present\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","Coreg 25 mg BID and Vasotec 20 mg daily."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","Continue aspirin 325 mg and Plavix 25 mg daily."],["The note captures: Return in three months.","yes","Return in 3 months."]],"claims":[["HEENT: PERRLA","Transcript only says \"Pupils are equal\"; reactivity to light/accommodation was not stated."]],"note":"Past Medical History\n\nCAD with prior inferior MI; RCA and circumflex stents\n\nLV dysfunction\n\n\n\n\nMedications\n\nAspirin 325 mg daily (continue)\n\nClopidogrel (Plavix) 25 mg daily (continue)\n\nCarvedilol (Coreg) increased to 25 mg BID\n\nEnalapril (Vasotec) increased to 20 mg daily\n\n\n\n\nRed Flag/Screening Questions\n\nChest pain: denies\n\nDyspnoea/orthopnoea: denies\n\nDizziness/lightheadedness: denies\n\nSyncope: denies\n\n\n\n\nObjective\n\n(Consent obtained)\n\nVitals: BP 120/82 mmHg; HR 68 bpm regular; weight 244 lb\n\nObservation:\n\nHEENT: PERRLA; JVP normal; no carotid bruit; neck soft; thyroid not enlarged; midline; no cervical lymphadenopathy\n\nRespiratory:\n\nEqual expansion\n\nNormal breath sounds\n\nCardiac:\n\nPMI at 5th intercostal space\n\nS1, S2 normal\n\nNo rubs\n\nNo gallops\n\nNo murmurs\n\nAbdomen:\n\nSoft\n\nNon‑tender\n\nBowel sounds present\n\nPeripheral vascular:\n\nPeripheral pulses present\n\nNo leg oedema\n\n\n\n\nDiagnosis\n\nStable CAD\n\nLV dysfunction\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nMeds adjusted:\n\nIncrease Coreg to 25 mg BID\n\nIncrease Vasotec to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue Plavix 25 mg daily\n\n\n\n\nPlan\n\nReview in 3 months\n","review":92.77631578947368,"saved":150.7236842105263,"clean":false,"effort":25.0,"sig":[["fabrication","HEENT: PERRLA","PERRLA asserts pupil reactivity/accommodation never examined."]],"mb":4.764143,"signable":117.53031578947369},{"label":"Run 4","wer":25.49019607843137,"text":"30 year old location\n\nwith a history of, inferior OMI post right\n\ncoronary artery and circumflex stent. Has\n\nbeen feeling well. No symptoms of chest pain. No symptoms of dyspnea or\n\northopnea, dizziness, lightheadedness. No syncope. Next paragraph, two hundred and forty four pounds. Blood pressure, one twenty over 82. Heart rate is 68 regular, period.\n\nHE and two people say equal. JVP is normal. No carotid\n\nbruit. Neck is soft, thyroid not enlarged. Okay. Midline. No cervical lymph\n\nadenopathy. Respiratory, equal expansion, normal. Blood sounds. Heart pain, minor\n\nfifth intercostal spaces. One s two, normal. No rub\n\nNo gallop. No murmurs. Abdomen, soft. Not tender. No bruised bowel sounds present.\n\nSequel pulses, leg edema, period.\n\nAssessment, stable. Assessment, CAD, number two, LV dysfunction,\n\nincrease Corec to twenty five milligram BAT. Increase Vasotec to twenty milligrams daily.\n\nContinue with aspirin, three twenty five milligrams daily. Plavix, twenty five milligrams daily. Return in three months,\n\nperiod.","marks":[{"start":0,"end":20,"said":"30-year-old patient","significant":false},{"start":50,"end":53,"said":"wall MI","significant":false},{"start":178,"end":180,"said":"","significant":false},{"start":249,"end":275,"said":"Weighs 244","significant":false},{"start":300,"end":319,"said":"120/82.","significant":false},{"start":355,"end":376,"said":"HEENT Pupils are","significant":true},{"start":454,"end":459,"said":"Trachea","significant":true},{"start":481,"end":499,"said":"lymphadenopathy.","significant":false},{"start":538,"end":543,"said":"breath","significant":true},{"start":558,"end":576,"said":"PMI in the 5th","significant":true},{"start":589,"end":606,"said":"space. S1 S2","significant":false},{"start":662,"end":673,"said":"nontender.","significant":false},{"start":677,"end":684,"said":"bruits.","significant":true},{"start":708,"end":714,"said":"Extremities Equal","significant":false},{"start":721,"end":721,"said":"No","significant":true},{"start":806,"end":806,"said":"Plan","significant":false},{"start":818,"end":823,"said":"Coreg","significant":false},{"start":827,"end":853,"said":"25 mg b.i.d.","significant":true},{"start":881,"end":891,"said":"mg","significant":false},{"start":923,"end":951,"said":"325 mg","significant":false},{"start":967,"end":989,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"history of inferior MI post right coronary artery and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"Currently well; no chest pain, dyspnoea, orthopnoea, dizziness, light-headedness, or syncope\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"110.7 kg (244 lb), BP 120/82 mmHg, HR 68 bpm, regular\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","Normal JVP, no carotid bruit, no cervical lymphadenopathy; thyroid not enlarged, trachea midline."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, apical impulse 5th ICS, S1/S2 normal, no murmurs/rubs/gallops."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, bowel sounds, no leg oedema captured; no bruits and equal pulses omitted (\"pulses palpable\")."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD\", \"LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"increase carvedilol to 25 mg BID; increase enalapril to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Continue aspirin 325 mg daily\", \"Continue clopidogrel 25 mg daily\"."],["The note captures: Return in three months.","yes","\"Review in 3 months\"."]],"claims":[],"note":"Presenting Condition\n\n30-year-old with history of inferior MI post right coronary artery and circumflex stents\n\nCurrently well; no chest pain, dyspnoea, orthopnoea, dizziness, light‑headedness, or syncope\n\n\n\n\nPast Medical History\n\nCoronary artery disease\n\nLeft ventricular dysfunction\n\nInferior myocardial infarction with RCA and circumflex stents\n\nNo cervical lymphadenopathy, normal JVP, no carotid bruit\n\nAbdomen soft, non‑tender; normal bowel sounds\n\nNo leg oedema\n\nVitals: 110.7 kg (244 lb), BP 120/82 mmHg, HR 68 bpm, regular\n\nCardiopulmonary exam: normal breath sounds, equal expansion; heart sounds S1/S2 normal, no rub, gallop, or murmurs\n\n\n\n\nMedications\n\nCarvedilol (Coreg) increased to 25 mg twice daily\n\nEnalapril (Vasotec) increased to 20 mg daily\n\nAspirin 325 mg daily\n\nClopidogrel (Plavix) 25 mg daily\n\n\n\n\nObjective\n\n(Consent obtained)\n\nHEENT: Pupils equal; neck soft; thyroid not enlarged; trachea midline\n\nCardiovascular: Apical impulse 5th ICS; S1/S2 normal; no murmurs/rubs/gallops; peripheral pulses palpable\n\nRespiratory: Equal chest expansion; normal breath sounds\n\nAbdomen: Soft, non‑tender\n\nExtremities: No leg oedema\n\n\n\n\nDiagnosis\n\nStable CAD\n\nLV dysfunction\n\nPost‑stent status (RCA and circumflex)\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nMedication adjustment: increase carvedilol to 25 mg BID; increase enalapril to 20 mg daily\n\nContinue aspirin 325 mg daily\n\nContinue clopidogrel 25 mg daily\n\n\n\n\nPlan\n\nReview in 3 months\n","review":81.30263157894737,"saved":162.19736842105263,"clean":false,"effort":5.0,"sig":[],"mb":4.590002,"signable":102.83463157894737},{"label":"Run 5","wer":25.49019607843137,"text":"30 year old location\n\nwith a history of, inferior OMI post right\n\ncoronary artery and circumflex stent. Has\n\nbeen feeling well. No symptoms of chest pain. No symptoms of dyspnea or\n\northopnea, dizziness, lightheadedness. No syncope. Next paragraph, two hundred and forty four pounds. Blood pressure, one twenty over 82. Heart rate is 68 regular, period.\n\nHE and two people say equal. JVP is normal. No carotid\n\nbruit. Neck is soft, thyroid not enlarged. Okay. Midline. No cervical lymph\n\nadenopathy. Respiratory, equal expansion, normal. Blood sounds. Heart pain, minor\n\nfifth intercostal spaces. One s two, normal. No rub\n\nNo gallop. No murmurs. Abdomen, soft. Not tender. No bruised bowel sounds present.\n\nSequel pulses, leg edema, period.\n\nAssessment, stable. Assessment, CAD, number two, LV dysfunction.\n\nIncrease Corec to twenty five milligram BAT. Increase Vasotec to twenty milligrams daily.\n\nContinue with aspirin, three twenty five milligrams daily. Plavix, twenty five milligrams daily. Return in three months,\n\nperiod.","marks":[{"start":0,"end":20,"said":"30-year-old patient","significant":false},{"start":50,"end":53,"said":"wall MI","significant":false},{"start":178,"end":180,"said":"","significant":false},{"start":249,"end":275,"said":"Weighs 244","significant":false},{"start":300,"end":319,"said":"120/82.","significant":false},{"start":355,"end":376,"said":"HEENT Pupils are","significant":true},{"start":454,"end":459,"said":"Trachea","significant":true},{"start":481,"end":499,"said":"lymphadenopathy.","significant":false},{"start":538,"end":543,"said":"breath","significant":true},{"start":558,"end":576,"said":"PMI in the 5th","significant":true},{"start":589,"end":606,"said":"space. S1 S2","significant":false},{"start":662,"end":673,"said":"nontender.","significant":false},{"start":677,"end":684,"said":"bruits.","significant":true},{"start":708,"end":714,"said":"Extremities Equal","significant":false},{"start":721,"end":721,"said":"No","significant":true},{"start":807,"end":807,"said":"Plan","significant":false},{"start":818,"end":823,"said":"Coreg","significant":false},{"start":827,"end":853,"said":"25 mg b.i.d.","significant":true},{"start":881,"end":891,"said":"mg","significant":false},{"start":923,"end":951,"said":"325 mg","significant":false},{"start":967,"end":989,"said":"25 mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","yes","\"post-inferior MI ... with prior right coronary artery and circumflex stents\"."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Denies chest pain, dyspnoea, orthopnoea, dizziness, lightheadedness, syncope; \"Well\"."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","no","BP recorded as \"110/82\" instead of 120/82."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","partial","JVP, bruit, thyroid and lymph nodes captured, but trachea midline omitted and PERRLA/EOMI added."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, PMI 5th ICS, S1/S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","States \"no bruising\" instead of no bruits, and pulses \"present\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and \"Left ventricular dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","yes","\"Carvedilol increased to 25 mg BID\", \"Enalapril increased to 20 mg daily\"."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","yes","\"Aspirin 325 mg daily\", \"Clopidogrel 25 mg daily\"."],["The note captures: Return in three months.","yes","\"Return in 3 months\"."]],"claims":[["Vitals: 110/82 mmHg","Source BP is 120/82."],["HEENT: PERRLA, EOMI","Source only says 'Pupils are equal'; reactivity and extraocular movements were not examined/recorded."],["Abdomen: ... no bruising","Source says 'No bruits'; bruising is a different, unrecorded finding."]],"note":"Objective\n\n(Consent obtained)\n\nVitals: 110/82 mmHg, HR 68 regular, weight 244 lb\n\nGeneral: Well, no distress\n\nHEENT: PERRLA, EOMI; neck soft; thyroid not enlarged; no cervical lymphadenopathy; JVP normal; no carotid bruit\n\nRespiratory: Equal expansion; normal breath sounds\n\nCardiac: PMI at 5th ICS midclavicular line; S1/S2 normal; no rub; no gallop; no murmurs\n\nAbdomen: Soft; non-tender; bowel sounds present; no bruising\n\nPeripheral vascular: Distal pulses present; no leg oedema\n\n\n\n\nDiagnosis\n\nCoronary artery disease (post-inferior MI) with prior right coronary artery and circumflex stents; stable\n\nLeft ventricular dysfunction\n\n\n\n\nMedications\n\nAspirin 325 mg daily\n\nClopidogrel 25 mg daily\n\nCarvedilol increased to 25 mg BID\n\nEnalapril increased to 20 mg daily\n\n\n\n\nPlan\n\nReturn in 3 months\n\n\n\n\nRed Flag/Screening Questions\n\nDenies chest pain\n\nDenies dyspnoea, orthopnoea\n\nDenies dizziness, lightheadedness\n\nDenies syncope\n","review":129.43421052631578,"saved":114.06578947368422,"clean":false,"effort":50.0,"sig":[["missing","Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","Systolic BP recorded as 110 instead of 120, a wrong key vital sign in an antihypertensive titration visit."],["partial","Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","Adds PERRLA/EOMI findings that were not examined; trachea omission is minor."]],"mb":4.703095,"signable":150.1452105263158}],"patientnotes":[{"label":"Run 1","wer":21.568627450980394,"text":"A 30 year old patient with a history of inferior MI post right coronary artery and sickuplex stent has been feeling well. No symptoms of chest pain no symptoms of dyspnea, orthopnea, dizziness lightheadedness no syncope. Next pair of weights 244 lb blood pressure 120 over 82 heart rate is 68 regular period he&t people say equal JVPs normal no carotid bruits Neck is soft thyroid not enlarged trachea midline no cervical lymphadenopathy Respiratory equal expansion normal wet sounds Heart bmi in the fifth intercostal space S1 S2 normal no rub, no gallop, no murmurs Abdominal soft non tender no bruits pulse sounds present extremity equal pulses no leg edema period assessment stable assessment CAD number 2 LV dysfunction plan increase Coreg to 25 milligram bad increase Vasotec to 20 milligrams daily. Continue with.\n25 milligrams daily. Plavix 25 milligrams daily. Return in three months period.","marks":[{"start":0,"end":13,"said":"30-year-old","significant":false},{"start":48,"end":48,"said":"wall","significant":false},{"start":83,"end":92,"said":"circumflex","significant":true},{"start":221,"end":241,"said":"Weighs","significant":false},{"start":246,"end":248,"said":"pounds.","significant":false},{"start":264,"end":275,"said":"120/82.","significant":false},{"start":308,"end":323,"said":"HEENT Pupils are","significant":true},{"start":330,"end":334,"said":"JVP is","significant":false},{"start":353,"end":359,"said":"bruit.","significant":false},{"start":473,"end":476,"said":"breath","significant":true},{"start":490,"end":493,"said":"PMI","significant":true},{"start":501,"end":506,"said":"5th","significant":false},{"start":568,"end":577,"said":"Abdomen","significant":false},{"start":583,"end":593,"said":"nontender.","significant":false},{"start":604,"end":609,"said":"Bowel","significant":true},{"start":625,"end":634,"said":"Extremities","significant":false},{"start":751,"end":764,"said":"mg b.i.d.","significant":true},{"start":788,"end":798,"said":"mg","significant":false},{"start":821,"end":834,"said":"aspirin 325 mg","significant":true},{"start":852,"end":862,"said":"mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","Inferior MI captured but only \"right coronary artery stent\"; circumflex stent omitted."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","\"no chest pain, dyspnoea, orthopnoea, dizziness or syncope\", feeling well."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","\"Weight 244 lb, BP 120/82 mmHg, HR 68 bpm regular rhythm\"."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Respiratory and heart sounds captured but PMI in 5th intercostal space omitted."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits and equal pulses/no oedema, but bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","partial","CAD and LV dysfunction present but garbled as \"CAD classified as number 2\" and \"Stable assessment\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","\"Coreg increased to 25 mg daily\" is the wrong frequency (twice daily stated)."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","partial","\"Plavix 25 mg daily\" listed but aspirin 325 mg omitted entirely."],["The note captures: Return in three months.","yes","\"Return in three months for review.\""]],"claims":[["Coreg increased to 25 mg daily","Transcript says \"Increase Coreg to 25 mg b.i.d.\"; once-daily frequency is wrong."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports feeling well with no chest pain, dyspnoea, orthopnoea, dizziness or syncope.\n\nHistory of Presenting Complaint::\n\nHistory of inferior myocardial infarction with right coronary artery stent; currently asymptomatic.\n\nObjective\n\nWeight 244 lb, BP 120/82 mmHg, HR 68 bpm regular rhythm.\n\nJVPs equal and normal, no carotid bruits, neck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\nRespiratory exam: equal chest expansion, normal breath sounds.\n\nCardiac exam: S1 S2 normal, no rub, gallop or murmurs.\n\nAbdomen soft, non‑tender, no bruits; peripheral pulses equal, no leg oedema.\n\nWeight: 244 lb.\n\nBlood pressure: 120/82 mmHg.\n\nHeart rate: 68 bpm.\n\nAssessment\n\nStable assessment.\n\nCoronary artery disease (CAD) classified as number 2.\n\nLeft ventricular dysfunction noted.\n\nPlan\n\nMedications::\n\nCoreg increased to 25 mg daily.\n\nVasotec increased to 20 mg daily.\n\nPlavix 25 mg daily.\n\nReturn in three months for review.","review":164.4078947368421,"saved":79.09210526315789,"clean":false,"effort":45.0,"sig":[["partial","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Circumflex stent omitted, understating the patient's coronary intervention history."],["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg frequency written as daily instead of b.i.d., halving the intended dose."],["partial","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Aspirin 325 mg daily omitted from the plan in a post-stent patient."]],"mb":6.787812,"latency":24.204,"signable":188.61189473684212},{"label":"Run 2","wer":21.568627450980394,"text":"30 year old patient with a history of inferior MI post right coronary artery and sacral plexus Stent has been feeling well no symptoms of chest pain no symptoms of dyspnea, orthopnea, dizziness lightheadedness no syncope next pair of weights 244 lb blood pressure 120 over 82 heart rate is 68 regular period he and T people say equal JVP is normal no carotid bruits Neck is soft Thyroid not enlarged trachea midline no cervical lymphadenopathy Respiratory equal expansion normal wet sounds Heart bmi in the fifth intercostal space S1 S2 normal no rub, no gallop no murmurs Abdominal soft non tender no bruits spell sounds present extremity sequential pulses no leg edema period assessment stable assessment CAD number 2 LV dysfunction plan increase Coreg to 25 milligrams. Increase Vasotec to 20 milligrams daily. Continue with Aspirin 320.\nPlavix 25mg daily written in 3 months period.","marks":[{"start":46,"end":46,"said":"wall","significant":false},{"start":81,"end":94,"said":"circumflex","significant":true},{"start":221,"end":241,"said":"Weighs","significant":false},{"start":246,"end":248,"said":"pounds.","significant":false},{"start":264,"end":275,"said":"120/82.","significant":false},{"start":308,"end":327,"said":"HEENT Pupils are","significant":true},{"start":359,"end":365,"said":"bruit.","significant":false},{"start":479,"end":482,"said":"breath","significant":true},{"start":496,"end":499,"said":"PMI","significant":true},{"start":507,"end":512,"said":"5th","significant":false},{"start":573,"end":582,"said":"Abdomen","significant":false},{"start":588,"end":598,"said":"nontender.","significant":false},{"start":609,"end":614,"said":"Bowel","significant":false},{"start":630,"end":650,"said":"Extremities Equal","significant":false},{"start":761,"end":772,"said":"mg b.i.d.","significant":true},{"start":796,"end":806,"said":"mg","significant":false},{"start":836,"end":852,"said":"325 mg","significant":true},{"start":859,"end":866,"said":"Plavix 25 mg daily. Return","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","no","No mention of inferior MI or RCA/circumflex stents."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","no","History recorded as \"Not discussed\"; symptom denials absent."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Expansion, breath sounds and heart sounds captured; PMI 5th ICS omitted."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen fully captured but pulses written as \"sequential pulses\" rather than equal."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","partial","CAD and LV dysfunction captured but CAD given an unstated \"class 2\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","partial","Vasotec 20 mg daily correct; Coreg 25 mg lacks the twice-daily frequency."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Continue Aspirin 320 mg\" is the wrong dose and Plavix given a \"for three months\" duration."],["The note captures: Return in three months.","no","Follow-up section says \"Not discussed\"; 3-month return not captured as a review."]],"claims":[["coronary artery disease (CAD) class 2","No class or grade of CAD is stated in the source."],["Continue Aspirin 320 mg","Source states aspirin 325 mg daily."],["Plavix 25 mg daily for three months","No Plavix duration was stated; three months was the return interval."]],"note":"Subjective\n\nChief Complaint::\n\nNot discussed\n\nHistory of Presenting Complaint::\n\nNot discussed\n\nObjective\n\nWeight 244 lb.\n\nBlood pressure 120/82 mmHg.\n\nHeart rate 68 bpm, regular.\n\nJugular venous pressure normal.\n\nNo carotid bruits heard.\n\nNeck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\nRespiratory: equal chest expansion, normal vesicular breath sounds.\n\nCardiac: S1 S2 normal, no rub, gallop, or murmurs.\n\nAbdomen soft, non‑tender, no bruits, bowel sounds present.\n\nExtremities: sequential pulses, no leg edema.\n\nWeight: 244 lb.\n\nBlood pressure: 120/82 mmHg.\n\nHeart rate: 68 bpm.\n\nAge: 30 years.\n\nAssessment\n\nPatient assessed as stable.\n\nDiagnoses: coronary artery disease (CAD) class 2 and left ventricular dysfunction.\n\nPlan\n\nMedications::\n\nIncrease Coreg to 25 mg.\n\nIncrease Vasotec to 20 mg daily.\n\nContinue Aspirin 320 mg.\n\nPlavix 25 mg daily for three months.\n\nNot discussed","review":236.18421052631578,"saved":7.3157894736842195,"clean":false,"effort":90.0,"sig":[["missing","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior MI and stents entirely absent."],["missing","Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","History marked 'Not discussed'; documented cardiac symptom denials lost."],["partial","Assessment: coronary artery disease and left ventricular dysfunction.","Unstated 'class 2' grading added to CAD diagnosis."],["partial","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Carvedilol increase lacks twice-daily frequency."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Wrong aspirin dose and an invented stop date for clopidogrel."],["missing","Return in three months.","3-month return appointment not recorded as follow-up."]],"mb":7.189002,"latency":31.343,"signable":267.5272105263158},{"label":"Run 3","wer":22.22222222222222,"text":"A 30 year old patient with a history of inferior or MI post right coronary artery and sickuplex stent has been feeling well. No symptoms of chest pain no symptoms of dyspnea, orthopnea, dizziness lightheadedness no syncope. Next pair of waist 244 lb blood pressure 120 over 82 heart rate is 68 regular period he&t people say equal jvps normal, no carotid bruits Neck is soft thyroid not enlarged trachea midline no cervical lymphadenopathy Respiratory equal expansion normal but sounds heart bmi in the fifth intercostal space S1, S2 normal no rub, no gallop, no murmurs Abdominal soft, non tender no bruits pulse sounds present extremity equal pulses no leg edema period assessment stable assessment CAD number 2 LV dysfunction plan increase Corec to 25 milligram VAD. Increase Vasotech to 20 milligrams daily. Continue with.\nAspirin 3.25 milligrams daily. Plavix 25 milligrams daily. Return in three months period.","marks":[{"start":0,"end":13,"said":"30-year-old","significant":false},{"start":49,"end":51,"said":"wall","significant":false},{"start":86,"end":95,"said":"circumflex","significant":true},{"start":224,"end":242,"said":"Weighs","significant":false},{"start":247,"end":249,"said":"pounds.","significant":false},{"start":265,"end":276,"said":"120/82.","significant":false},{"start":309,"end":324,"said":"HEENT Pupils are","significant":true},{"start":331,"end":335,"said":"JVP is","significant":false},{"start":355,"end":361,"said":"bruit.","significant":false},{"start":475,"end":478,"said":"breath","significant":false},{"start":492,"end":495,"said":"PMI","significant":true},{"start":503,"end":508,"said":"5th","significant":false},{"start":571,"end":580,"said":"Abdomen","significant":false},{"start":587,"end":597,"said":"nontender.","significant":false},{"start":608,"end":613,"said":"Bowel","significant":true},{"start":629,"end":638,"said":"Extremities","significant":false},{"start":743,"end":748,"said":"Coreg","significant":false},{"start":755,"end":769,"said":"mg b.i.d.","significant":true},{"start":779,"end":787,"said":"Vasotec","significant":false},{"start":794,"end":804,"said":"mg","significant":false},{"start":835,"end":850,"said":"325 mg","significant":true},{"start":868,"end":878,"said":"mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","no","No mention of inferior MI or RCA/circumflex stents."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feels well; denies CP, dyspnoea, orthopnoea, dizziness/lightheadedness, syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Wt 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruit, thyroid not enlarged, trachea midline, no cervical LAD."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds; PMI 5th ICS, S1/S2 normal, no rub/gallop/murmur."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, NT, no bruits, pulses equal, no oedema; bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","CAD and LV dysfunction."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","\"Corec increased to 25 mg daily\" is the wrong frequency (should be b.i.d.)."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Aspirin 3.25 mg daily\" is the wrong dose (325 mg)."],["The note captures: Return in three months.","yes","Return in 3 months."]],"claims":[["Aspirin 3.25 mg daily","Transcript states aspirin 325 mg daily."],["Corec increased to 25 mg daily","Transcript states \"Increase Coreg to 25 mg b.i.d.\"; once-daily is the wrong frequency."]],"note":"Subjective\n\nChief Complaint::\n\nRoutine follow‑up; patient reports feeling well.\n\nHistory of Presenting Complaint::\n\nNo chest pain, dyspnoea, orthopnoea, dizziness, light‑headedness or syncope reported.\n\nObjective\n\nWeight 244 lb.\n\nBP 120/82 mmHg.\n\nHR 68 regular.\n\nJVP normal, no carotid bruits.\n\nNeck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\nRespiratory: equal expansion, normal breath sounds.\n\nCardiac: apex at 5th intercostal space, S1/S2 normal, no rub, gallop or murmur.\n\nAbdomen soft, non‑tender, no bruits.\n\nPeripheral pulses equal, no leg oedema.\n\nWeight: 244 lb.\n\nBlood pressure: 120/82 mmHg.\n\nHeart rate: 68 bpm.\n\nAssessment\n\nAssessment: stable CAD #2 with LV dysfunction.\n\nPlan\n\nMedications::\n\nAspirin 3.25 mg daily.\n\nPlavix 25 mg daily.\n\nCorec increased to 25 mg daily.\n\nVasotech increased to 20 mg daily.\n\nIncrease Corec to 25 mg daily.\n\nIncrease Vasotech to 20 mg daily.\n\nContinue aspirin and Plavix as prescribed.\n\nReturn in 3 months for review.","review":176.1184210526316,"saved":67.38157894736841,"clean":false,"effort":55.00000000000001,"sig":[["missing","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Entire history of inferior MI and RCA/circumflex stents omitted."],["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Coreg 25 mg recorded daily instead of b.i.d."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Aspirin dose recorded as 3.25 mg instead of 325 mg."]],"mb":7.028704,"latency":24.143,"signable":200.2614210526316},{"label":"Run 4","wer":21.568627450980394,"text":"A 30 year old patient with a history of inferior or MI post right coronary artery and sickuplex stent has been feeling well. No symptoms of chest pain no symptoms of dyspnea, orthopnea, dizziness lightheadedness no syncope. Next pair of waist 244 lb blood pressure 120 over 82 heart rate is 68 regular period he&t people say equal jvps normal, no carotid bruits Neck is soft thyroid not enlarged trachea midline no cervical lymphadenopathy Respiratory equal expansion normal but sounds heart bmi in the fifth intercostal space S1, S2 normal no rub, no gallop, no murmurs Abdominal soft, non tender no bruits pulse sounds present extremity equal pulses no leg edema period assessment stable assessment CAD number 2 LV dysfunction plan increase Corec to 25 milligram VAD. Increase Vasotech to 20 milligrams daily. Continue with.\nAspirin 3. 25 milligrams daily. Plavix 25 milligrams daily. Return in three months period.","marks":[{"start":0,"end":13,"said":"30-year-old","significant":false},{"start":49,"end":51,"said":"wall","significant":false},{"start":86,"end":95,"said":"circumflex","significant":true},{"start":224,"end":242,"said":"Weighs","significant":false},{"start":247,"end":249,"said":"pounds.","significant":false},{"start":265,"end":276,"said":"120/82.","significant":false},{"start":309,"end":324,"said":"HEENT Pupils are","significant":true},{"start":331,"end":335,"said":"JVP is","significant":false},{"start":355,"end":361,"said":"bruit.","significant":false},{"start":475,"end":478,"said":"breath","significant":false},{"start":492,"end":495,"said":"PMI","significant":true},{"start":503,"end":508,"said":"5th","significant":false},{"start":571,"end":580,"said":"Abdomen","significant":false},{"start":587,"end":597,"said":"nontender.","significant":false},{"start":608,"end":613,"said":"Bowel","significant":true},{"start":629,"end":638,"said":"Extremities","significant":false},{"start":743,"end":748,"said":"Coreg","significant":false},{"start":755,"end":769,"said":"mg b.i.d.","significant":true},{"start":779,"end":787,"said":"Vasotec","significant":false},{"start":794,"end":804,"said":"mg","significant":false},{"start":835,"end":851,"said":"325 mg","significant":true},{"start":869,"end":879,"said":"mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","no","No history of inferior MI or stents recorded."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","no","Subjective says \"Not discussed\"; feeling well and denied symptoms are omitted."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","Weight 244 lb, BP 120/82, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","yes","Equal expansion, normal breath sounds, apex 5th ICS, S1 S2 normal, no rub/gallop/murmurs."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits, equal pulses without oedema, but bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"Stable CAD ... with LV dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","\"Corec 25 mg daily\" has the wrong frequency (source b.i.d.)."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Aspirin 25 mg daily\" is wrong (source 325 mg)."],["The note captures: Return in three months.","yes","\"Return for review in 3 months\"."]],"claims":[["Corec 25 mg daily increased.","Source says Coreg 25 mg b.i.d."],["Aspirin 25 mg daily continued.","Source says aspirin 325 mg daily."]],"note":"Subjective\n\nChief Complaint::\n\nNot discussed\n\nHistory of Presenting Complaint::\n\nNot discussed\n\nObjective\n\nWeight 244 lb.\n\nBP 120/82 mmHg.\n\nHR 68 regular.\n\nJVP equal, no carotid bruits.\n\nNeck soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\nRespiratory: equal expansion, normal breath sounds.\n\nCardiac: apex at 5th intercostal space, S1 S2 normal, no rub, gallop or murmurs.\n\nAbdomen soft, non‑tender, no bruits.\n\nPeripheral pulses equal, no leg edema.\n\nWeight: 244 lb.\n\nBlood pressure: 120/82 mmHg.\n\nHeart rate: 68 bpm.\n\nAssessment\n\nStable CAD (number 2) with LV dysfunction.\n\nPlan\n\nMedications::\n\nCorec 25 mg daily increased.\n\nVasotech 20 mg daily increased.\n\nAspirin 25 mg daily continued.\n\nPlavix 25 mg daily continued.\n\nIncrease Corec to 25 mg daily.\n\nIncrease Vasotech to 20 mg daily.\n\nContinue Aspirin 25 mg daily.\n\nContinue Plavix 25 mg daily.\n\nReturn for review in 3 months.","review":195.64473684210526,"saved":47.85526315789474,"clean":false,"effort":65.0,"sig":[["missing","History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","Prior MI and stent history are absent entirely."],["missing","Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","Symptom review marked 'Not discussed' although all key cardiac symptoms were denied."],["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Carvedilol frequency is wrong (daily instead of b.i.d.)."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Aspirin dose recorded as 25 mg instead of 325 mg."]],"mb":6.810189,"latency":25.137,"signable":220.78173684210526},{"label":"Run 5","wer":21.568627450980394,"text":"A 30 year old patient with a history of inferior or MI post right coronary artery and complex stent has been feeling well. No symptoms of chest pain, no symptoms of dyspnea, orthopnea, dizziness lightheadedness no syncope. Next pair of weighs 244lbs blood pressure 120 over 82 heart rate is 68 regular period he&t people say equal JVPs normal, no carotid bruits Neck is soft, thyroid not enlarged trachea midline no cervical lymphadenopathy Respiratory equal expansion normal but sounds heart bmi in the fifth intercostal space S1, S2 normal no rub, no gallop, no murmurs. Abdominal soft non tendon no bruits pulse sounds present extremity equal pulses no leg edema period assessment stable assessment CAD number 2 LV dysfunction plan increase Coreg to 25 milligram bad increase Vasotec to 20 milligrams daily. Continue that.\nAspirin 3. 25 milligrams daily. Plavix 25 milligrams daily. Return in three months period.","marks":[{"start":0,"end":13,"said":"30-year-old","significant":false},{"start":49,"end":51,"said":"wall","significant":false},{"start":86,"end":93,"said":"circumflex","significant":true},{"start":223,"end":235,"said":"","significant":false},{"start":243,"end":249,"said":"244 pounds.","significant":false},{"start":265,"end":276,"said":"120/82.","significant":false},{"start":309,"end":324,"said":"HEENT Pupils are","significant":true},{"start":331,"end":335,"said":"JVP is","significant":false},{"start":355,"end":361,"said":"bruit.","significant":false},{"start":476,"end":479,"said":"breath","significant":false},{"start":493,"end":496,"said":"PMI","significant":true},{"start":504,"end":509,"said":"5th","significant":false},{"start":573,"end":582,"said":"Abdomen","significant":false},{"start":588,"end":598,"said":"nontender.","significant":false},{"start":609,"end":614,"said":"Bowel","significant":true},{"start":630,"end":639,"said":"Extremities","significant":false},{"start":756,"end":769,"said":"mg b.i.d.","significant":true},{"start":793,"end":803,"said":"mg","significant":false},{"start":834,"end":850,"said":"325 mg","significant":true},{"start":868,"end":878,"said":"mg","significant":false}],"facts":[["The note captures: History of inferior-wall myocardial infarction and right coronary artery/circumflex stents.","partial","\"prior inferior MI post-right coronary artery stent\" omits the circumflex stent."],["The note captures: Currently feeling well; denies chest pain, dyspnoea, orthopnoea, dizziness/lightheadedness and syncope.","yes","Feeling well with no chest pain, dyspnoea, orthopnoea, dizziness, light-headedness or syncope."],["The note captures: Weight 244 pounds, blood pressure 120/82, regular heart rate 68.","yes","244 lbs, 120/82 mmHg, HR 68 regular."],["The note captures: Normal JVP, no carotid bruit or cervical lymphadenopathy; normal thyroid/tracheal examination.","yes","JVP normal, no carotid bruits, thyroid not enlarged, trachea midline, no cervical lymphadenopathy."],["The note captures: Equal respiratory expansion/normal breath sounds; PMI fifth intercostal space, normal S1/S2 without rub, gallop or murmur.","partial","Respiratory and heart sounds captured but PMI location omitted."],["The note captures: Abdomen soft and nontender, bowel sounds present, no bruits; equal extremity pulses without leg oedema.","partial","Abdomen soft, non-tender, no bruits and equal pulses without oedema, but bowel sounds omitted."],["The note captures: Assessment: coronary artery disease and left ventricular dysfunction.","yes","\"stable coronary artery disease ... with left ventricular dysfunction\"."],["The note captures: Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","no","\"Increase Coreg to 25 mg daily\" has the wrong frequency (source b.i.d.)."],["The note captures: Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","no","\"Aspirin 25 mg daily\" is wrong (source 325 mg); Plavix 25 mg correct."],["The note captures: Return in three months.","yes","\"Return in three months for review\"."]],"claims":[["Increase Coreg to 25 mg daily.","Source says 25 mg b.i.d.; daily frequency is wrong."],["Aspirin 25 mg daily.","Source says aspirin 325 mg daily."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents for routine follow‑up, reports feeling well with no chest pain, dyspnoea, orthopnoea, dizziness, light‑headedness or syncope.\n\nHistory of Presenting Complaint::\n\n30‑year‑old with prior inferior MI post‑right coronary artery stent; currently asymptomatic with no new symptoms since last review.\n\nObjective\n\nWeight is 244 lbs.\n\nBlood pressure is 120/82 mmHg.\n\nHeart rate is 68 beats per minute, regular.\n\nJVPs are equal and normal.\n\nNo carotid bruits detected.\n\nNeck is soft, thyroid not enlarged, trachea midline, no cervical lymphadenopathy.\n\nRespiratory examination shows equal expansion with normal breath sounds.\n\nCardiac examination reveals S1 and S2 normal, no rub, gallop, or murmurs.\n\nAbdomen is soft, non‑tender, no bruits.\n\nExtremity pulses are present and equal, no leg edema.\n\nWeight: 244 lbs.\n\nBlood pressure: 120/82 mmHg.\n\nHeart rate: 68 beats per minute, regular.\n\nAssessment\n\nAssessment: stable coronary artery disease (CAD) category 2 with left ventricular dysfunction.\n\nPlan\n\nMedications::\n\nIncrease Coreg to 25 mg daily.\n\nIncrease Vasotec to 20 mg daily.\n\nAspirin 25 mg daily.\n\nPlavix 25 mg daily.\n\nReturn in three months for review.","review":195.0921052631579,"saved":48.40789473684211,"clean":false,"effort":55.00000000000001,"sig":[["missing","Increase Coreg to 25 mg twice daily and Vasotec to 20 mg daily.","Carvedilol frequency is wrong (daily instead of b.i.d.), which halves the dose."],["missing","Continue aspirin 325 mg daily and Plavix 25 mg daily as stated in the published key; medication-dose item provisional pending direct audio validation.","Aspirin dose recorded as 25 mg instead of 325 mg."]],"mb":7.736909,"latency":24.105,"signable":219.19710526315788}]}},{"id":"hpi-pain-management","name":"Pain management dictation","dictation":true,"language":false,"stress":false,"reference":"Diagnosis: low back pain with left lower extremity numbness, lumbar disk herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection, right, with 80% improvement in right-sided low back pain. Patient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4-5. As a result, we decided to proceed with a lumbar epidural steroid injection. In the end, plan: if patient is doing well, no further intervention will be done. Thanks.","results":{"products":[{"id":"hanah","name":"Hanah","values":{"review":{"runs":[32.039,36.461,35.513,37.408,34.882],"mean":35.26052631578948,"min":32.03947368421053,"max":37.40789473684211},"saved":{"runs":[115.461,111.039,111.987,110.092,112.618],"mean":112.23947368421052,"min":110.09210526315789,"max":115.46052631578948},"signable":{"runs":[42.875,42.693,43.851,42.372],"mean":42.947539473684216,"min":42.37157894736843,"max":43.85089473684211},"clean":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0},"effort":{"runs":[7.143,7.143,7.143,7.143,7.143],"mean":7.142857142857142,"min":7.142857142857142,"max":7.142857142857142},"noteSig":{"runs":[1,1,1,1,1],"mean":1,"min":1,"max":1},"wer":{"runs":[9.302,9.302,8.14,9.302,9.302],"mean":9.069767441860465,"min":8.13953488372093,"max":9.30232558139535},"transcriptSig":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0},"coverage":{"runs":[92.857,92.857,92.857,92.857,92.857],"mean":92.85714285714286,"min":92.85714285714286,"max":92.85714285714286},"fab":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0},"mb":{"runs":[2.477,2.474,2.49,2.526],"mean":2.49172925,"min":2.473838,"max":2.525511},"latency":{"runs":[6.414,7.18,6.443,7.49],"mean":6.88175,"min":6.414,"max":7.49},"full":{"runs":[6,6,6,6,6],"mean":6,"min":6,"max":6},"partial":{"runs":[1,1,1,1,1],"mean":1,"min":1,"max":1},"missing":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0}}},{"id":"heidi","name":"Heidi","values":{"review":{"runs":[56.329,47.145,29.829,30.145,28.566,28.882],"mean":36.81578947368421,"min":28.565789473684212,"max":56.328947368421055},"saved":{"runs":[91.171,100.355,117.671,117.355,118.934,118.618],"mean":110.68421052631578,"min":91.17105263157895,"max":118.93421052631578},"signable":{"runs":[79.493,70.934,49.723,52.51,51.258,54.34],"mean":59.70945614035088,"min":49.72294736842105,"max":79.49294736842106},"clean":{"runs":[0,0,0,0,0,0],"mean":0,"min":0,"max":0},"effort":{"runs":[21.429,14.286,7.143,7.143,7.143,7.143],"mean":10.714285714285714,"min":7.142857142857142,"max":21.428571428571427},"noteSig":{"runs":[1,2,0,0,0,1],"mean":0.6666666666666666,"min":0,"max":2},"wer":{"runs":[8.14,9.302,11.628,11.628,6.977,13.953],"mean":10.271317829457365,"min":6.976744186046512,"max":13.953488372093023},"transcriptSig":{"runs":[2,2,1,1,1,2],"mean":1.5,"min":1,"max":2},"coverage":{"runs":[78.571,85.714,92.857,92.857,92.857,92.857],"mean":89.28571428571429,"min":78.57142857142857,"max":92.85714285714286},"fab":{"runs":[0,0,0,0,0,0],"mean":0,"min":0,"max":0},"mb":{"runs":[23.796,23.441,22.97,19.814,19.72,23.426],"mean":22.194612833333334,"min":19.719523,"max":23.796396},"latency":{"runs":[23.164,23.789,19.894,22.365,22.692,25.458],"mean":22.893666666666668,"min":19.894,"max":25.458},"full":{"runs":[4,5,6,6,6,6],"mean":5.5,"min":4,"max":6},"partial":{"runs":[3,2,1,1,1,1],"mean":1.5,"min":1,"max":3},"missing":{"runs":[0,0,0,0,0,0],"mean":0,"min":0,"max":0}}},{"id":"freed","name":"Freed","values":{"review":{"runs":[109.224,93.171,95.066,108.645,93.803],"mean":99.98157894736842,"min":93.17105263157895,"max":109.22368421052632},"saved":{"runs":[38.276,54.329,52.434,38.855,53.697],"mean":47.51842105263158,"min":38.276315789473685,"max":54.328947368421055},"signable":{"runs":[129.278,112.86,115.924,129.348,115.515],"mean":120.58477894736842,"min":112.86005263157895,"max":129.34773684210526},"clean":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0},"effort":{"runs":[21.429,14.286,14.286,28.571,14.286],"mean":18.57142857142857,"min":14.285714285714285,"max":28.57142857142857},"noteSig":{"runs":[1,1,1,1,1],"mean":1,"min":1,"max":1},"wer":{"runs":[15.116,15.116,15.116,15.116,15.116],"mean":15.11627906976744,"min":15.11627906976744,"max":15.11627906976744},"transcriptSig":{"runs":[3,3,3,3,3],"mean":3,"min":3,"max":3},"coverage":{"runs":[78.571,85.714,85.714,85.714,85.714],"mean":84.28571428571428,"min":78.57142857142857,"max":85.71428571428571},"fab":{"runs":[0,0,0,1,0],"mean":0.2,"min":0,"max":1},"mb":{"runs":[6.841,6.919,6.855,6.893,6.896],"mean":6.880951,"min":6.840744,"max":6.919202},"latency":{"runs":[29.598,30.297,31.438,32.39,31.39],"mean":31.0226,"min":29.598,"max":32.39},"full":{"runs":[4,5,5,5,5],"mean":4.8,"min":4,"max":5},"partial":{"runs":[3,2,2,2,2],"mean":2.2,"min":2,"max":3},"missing":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0}}},{"id":"cliniscripts","name":"CliniScripts","values":{"review":{"runs":[39.934,47.197,59.776,43.724,38.039],"mean":45.73421052631579,"min":38.03947368421053,"max":59.776315789473685},"saved":{"runs":[107.566,100.303,87.724,103.776,109.461],"mean":101.76578947368421,"min":87.72368421052632,"max":109.46052631578948},"signable":{"runs":[48.946,57.207,72.775,54.712,48.023],"mean":56.33281052631579,"min":48.02347368421053,"max":72.77531578947368},"clean":{"runs":[0,0,0,0,0],"mean":0,"min":0,"max":0},"effort":{"runs":[7.143,7.143,21.429,7.143,7.143],"mean":10.0,"min":7.142857142857142,"max":21.428571428571427},"noteSig":{"runs":[1,1,1,1,1],"mean":1,"min":1,"max":1},"wer":{"runs":[8.14,8.14,6.977,8.1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1","wer":9.30232558139535,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain. The patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result, we decided to proceed with lumbar epidural steroid injection. In the end, the plan is if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Subjective \"left LE pain and numbness\"; assessment lists LBP, disc herniation and foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old White female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right SIJ injection resulted in 80% improvement of right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left LE pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"Lumbar MRI: L4-5 foraminal stenosis\" omits that the stenosis is left-sided."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar ESI\", no drug/dose invented."],["The note captures: No further intervention if doing well.","yes","\"If doing well after injection, no further intervention planned\"."]],"claims":[],"note":"Subjective\n55-year-old White female with left LE pain and numbness.\nPrior right SIJ injection resulted in 80% improvement of right-sided low back pain.\nObjective\nLumbar MRI: L4-5 foraminal stenosis.\nAssessment\nLow back pain with left LE numbness.\nLumbar disc herniation.\nLumbar foraminal stenosis at L4-5, consistent with left LE symptoms.\nPlan\nProceed with lumbar ESI.\nIf doing well after injection, no further intervention planned.","review":32.03947368421053,"saved":115.46052631578948,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI stenosis laterality (left) omitted ahead of a planned epidural injection."]]},{"label":"Run 2","wer":9.30232558139535,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain. The patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result, we decided to proceed with lumbar epidural steroid injection. In the end, the plan is if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with LLE numbness/pain, lumbar disc herniation, L4-5 foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old White female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"80% improvement in right-sided low back pain following right SIJ injection\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"LLE pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured but the LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar ESI\"."],["The note captures: No further intervention if doing well.","yes","\"If doing well following injection, no further intervention planned\"."]],"claims":[],"note":"Subjective\n55-year-old White female presents to pain clinic with LLE pain and numbness.\nReports 80% improvement in right-sided low back pain following right SIJ injection.\nObjective\nLumbar MRI demonstrates L4-5 foraminal stenosis.\nAssessment\nLow back pain with LLE numbness/pain.\nLumbar disc herniation.\nL4-5 lumbar foraminal stenosis, consistent with current LLE symptoms.\nRight-sided low back pain improved 80% s/p right SIJ injection.\nPlan\nProceed with lumbar ESI.\nIf doing well following injection, no further intervention planned.","review":36.46052631578948,"saved":111.03947368421052,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and side guides the planned epidural injection."]],"mb":2.477169,"latency":6.414,"signable":42.87452631578948},{"label":"Run 3","wer":8.13953488372093,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain. The patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result. We decided to proceed with a lumbar epidural steroid injection. In the end, the plan is if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with LLE numbness/pain, lumbar disc herniation, foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old White female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"80% improvement in right-sided LBP following right SIJ injection\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"LLE pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured but the LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar ESI\"."],["The note captures: No further intervention if doing well.","yes","\"If doing well following injection, no further intervention planned\"."]],"claims":[],"note":"Subjective\n55-year-old White female presents to pain clinic with LLE pain and numbness.\nReports 80% improvement in right-sided LBP following right SIJ injection.\nObjective\nLumbar MRI: L4-5 foraminal stenosis, associated with lumbar disc herniation.\nAssessment\nLBP with LLE numbness/pain.\nLumbar disc herniation with L4-5 foraminal stenosis, correlating with LLE symptoms.\nRight-sided LBP improved 80% s/p right SIJ injection.\nPlan\nProceed with lumbar ESI.\nIf doing well following injection, no further intervention planned.","review":35.51315789473684,"saved":111.98684210526315,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and side guides the planned epidural injection."]],"mb":2.473838,"latency":7.18,"signable":42.69315789473684},{"label":"Run 4","wer":9.30232558139535,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain. The patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result, we decided to proceed with lumbar epidural steroid injection. In the end, the plan is if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with LLE numbness/pain, lumbar disc herniation and foraminal stenosis listed."],["The note captures: 55-year-old female.","yes","55-year-old female."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","80% improvement in right-sided LBP after right SIJ injection."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current LLE pain and numbness, laterality correct."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis recorded but the LEFT side is not stated explicitly."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar ESI\" with no drug/dose invented."],["The note captures: No further intervention if doing well.","yes","No further intervention planned if doing well."]],"claims":[],"note":"Subjective\n55-year-old White female presents to pain clinic with LLE pain and numbness.\nReports 80% improvement in right-sided LBP following right SIJ injection.\nObjective\nLumbar MRI: L4–5 foraminal stenosis.\nAssessment\nLBP with LLE numbness/pain.\nLumbar disc herniation.\nLumbar foraminal stenosis at L4–5, correlating with current LLE symptoms.\nRight-sided LBP improved 80% s/p right SIJ injection.\nPlan\nProceed with lumbar ESI for LLE symptoms associated with L4–5 foraminal stenosis.\nIf doing well after injection, no further intervention planned.","review":37.40789473684211,"saved":110.09210526315789,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of L4-5 foraminal stenosis omitted, relevant to side of epidural injection."]],"mb":2.490399,"latency":6.443,"signable":43.85089473684211},{"label":"Run 5","wer":9.30232558139535,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain. The patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result. We decided to proceed with lumbar epidural steroid injection. In the end, the plan is if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with LLE numbness/pain, lumbar disc herniation and foraminal stenosis listed."],["The note captures: 55-year-old female.","yes","55-year-old female."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","80% improvement in right-sided LBP after right SIJ injection."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current LLE pain and numbness, laterality correct."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis recorded but the LEFT side is not stated explicitly."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar ESI\" with no drug/dose invented."],["The note captures: No further intervention if doing well.","yes","No further intervention planned if doing well."]],"claims":[],"note":"Subjective\n55-year-old White female presents to pain clinic with LLE pain and numbness.\nReports 80% improvement in right-sided LBP following right SIJ injection.\nObjective\nLumbar MRI demonstrates L4-5 foraminal stenosis.\nAssessment\nLBP with LLE numbness.\nLumbar disc herniation.\nLumbar foraminal stenosis at L4-5, correlating with current LLE pain/numbness.\nRight-sided LBP improved 80% s/p right SIJ injection.\nPlan\nProceed with lumbar ESI.\nIf doing well after injection, no further intervention planned.","review":34.881578947368425,"saved":112.61842105263158,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of L4-5 foraminal stenosis omitted and ESI side unspecified."]],"mb":2.525511,"latency":7.49,"signable":42.37157894736843}],"heidi":[{"label":"Run 1","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower exemption. Numbness. Lumbar disc herniation. Lumbar foraminosis. Fifty five year old white female who underwent sacroili joint injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of dictation, thanks.","marks":[{"start":41,"end":51,"said":"extremity","significant":true},{"start":69,"end":73,"said":"disk","significant":false},{"start":93,"end":125,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":153,"end":161,"said":"sacroiliac","significant":false},{"start":189,"end":203,"said":"80%","significant":false},{"start":396,"end":402,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","partial","LBP with LLE numbness and disc herniation listed, but stenosis appears as the garbled \"Lumbar foraminosis\" in the assessment (stenosis only in MRI line)."],["The note captures: 55-year-old female.","yes","\"55yo female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"; laterality preserved."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI: foraminal stenosis L4-L5\" omits LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"; nothing invented."],["The note captures: No further intervention if doing well.","partial","\"If symptoms resolve, no further intervention planned\" shifts the condition from doing well to symptom resolution."]],"claims":[],"note":"Subjective:\n\n- 55yo female\n\n- Presents to pain clinic with left lower extremity pain and numbness\n\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n\n\n\nObjective:\n\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment:\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar disc herniation\n\n- Lumbar foraminosis\n\n\n\n\nPlan:\n\n- Proceed with lumbar epidural steroid injection\n\n- If symptoms resolve, no further intervention planned","review":56.328947368421055,"saved":91.17105263157895,"clean":false,"effort":21.428571428571427,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis is dropped, and that side guides where the planned epidural injection goes."]],"mb":23.796396,"latency":23.164,"signable":79.49294736842106},{"label":"Run 2","wer":9.30232558139535,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disconnection, lumbar foraminosis. Fifty five years old white female who underwent sacroilaric joint injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of dictation, thanks.","marks":[{"start":68,"end":81,"said":"disk herniation","significant":true},{"start":90,"end":123,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":151,"end":162,"said":"sacroiliac","significant":false},{"start":190,"end":204,"said":"80%","significant":false},{"start":397,"end":403,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","partial","LBP with LLE numbness captured, but herniation and stenosis garbled as \"Lumbar discopathy\" and \"Lumbar foraminosis\"."],["The note captures: 55-year-old female.","yes","\"55yo female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI: foraminal stenosis L4/5\" without left side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If doing well ... no further intervention planned\"."]],"claims":[],"note":"Subjective\n\n- 55yo female, presents to pain clinic with left lower extremity pain and numbness\n\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n\n\n\nObjective\n\n- MRI: foraminal stenosis L4/5\n\n\n\n\nAssessment\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar discopathy\n\n- Lumbar foraminosis\n\n\n\n\nPlan\n\n- Proceed with lumbar epidural steroid injection\n\n- If doing well post-procedure, no further intervention planned","review":47.14473684210526,"saved":100.35526315789474,"clean":false,"effort":14.285714285714285,"sig":[["partial","Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","Disc herniation and foraminal stenosis diagnoses replaced by vague/nonexistent terms."],["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis that the planned injection targets is lost."]],"mb":23.441481,"latency":23.789,"signable":70.93373684210526},{"label":"Run 3","wer":11.627906976744185,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen dysmosis. Fifty five years old white female who underwent sacroiliac joint injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of the patient, thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":130,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":196,"end":210,"said":"80%","significant":false},{"start":403,"end":409,"said":"decided","significant":false},{"start":544,"end":562,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Assessment lists LBP with left LE numbness, disc herniation, foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Right SIJ injection with 80% improvement in right-sided LBP."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured, but laterality (LEFT) of the stenosis is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If good response, no further intervention planned\"."]],"claims":[],"note":"Subjective\n\n- 55-year-old female\n\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n- New onset left lower extremity pain and numbness\n\n\n\n\nObjective\n\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar disc herniation\n\n- Lumbar foraminal stenosis\n\n\n\n\nPlan\n\n- Proceed with lumbar epidural steroid injection\n\n- If good response, no further intervention planned","review":29.828947368421055,"saved":117.67105263157895,"clean":false,"effort":7.142857142857142,"sig":[],"mb":22.970089,"latency":19.894,"signable":49.72294736842105},{"label":"Run 4","wer":11.627906976744185,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen dysmosis. Fifty five years old white female who underwent sacroiliac joint injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of the patient, thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":130,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":196,"end":210,"said":"80%","significant":false},{"start":403,"end":409,"said":"decided","significant":false},{"start":544,"end":562,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left lower extremity numbness, disc herniation, foraminal stenosis; LLE pain also noted."],["The note captures: 55-year-old female.","yes","\"55yo female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection.\""],["The note captures: No further intervention if doing well.","yes","\"If doing well post-procedure, no further intervention planned.\""]],"claims":[],"note":"Subjective:\n\n- 55yo female\n\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n- Now presents with left lower extremity pain and numbness\n\n\n\n\nObjective:\n\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment:\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar disc herniation\n\n- Lumbar foraminal stenosis\n\n\n\n\nPlan:\n\n- Proceed with lumbar epidural steroid injection\n\n- If doing well post-procedure, no further intervention planned","review":30.14473684210526,"saved":117.35526315789474,"clean":false,"effort":7.142857142857142,"sig":[],"mb":19.81428,"latency":22.365,"signable":52.509736842105255},{"label":"Run 5","wer":6.976744186046512,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminasmosis. Fifty five years old white female who underwent sacroiliac joint injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of dictation, thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":128,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":194,"end":208,"said":"80%","significant":false},{"start":401,"end":407,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left lower extremity numbness, disc herniation, MRI foraminal stenosis (assessment garbled as \"foraminosis\")."],["The note captures: 55-year-old female.","yes","\"55yo female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right SIJ injection with 80% improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection.\""],["The note captures: No further intervention if doing well.","yes","\"If doing well, no further intervention.\""]],"claims":[],"note":"Subjective\n\n- 55yo female\n\n- Prior right SIJ injection with 80% improvement in right-sided low back pain\n\n- Now presents with left lower extremity pain and numbness\n\n\n\n\nObjective\n\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar disc herniation\n\n- Lumbar foraminosis\n\n\n\n\nPlan\n\n- Proceed with lumbar epidural steroid injection\n\n- If doing well, no further intervention","review":28.565789473684212,"saved":118.93421052631578,"clean":false,"effort":7.142857142857142,"sig":[],"mb":19.719523,"latency":22.692,"signable":51.25778947368421},{"label":"Run 6","wer":13.953488372093023,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen cosmosis. Fifty five years old white female who underwent sacroiliary gland injection right with eighty percent improvement in right sided low back pain.\n\nPatient now presents to the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis L4 five. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further intervention will be done. End of the patient, thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":130,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":158,"end":175,"said":"sacroiliac joint","significant":true},{"start":197,"end":211,"said":"80%","significant":false},{"start":404,"end":410,"said":"decided","significant":false},{"start":545,"end":563,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with LLE numbness/pain, lumbar disc herniation, lumbar foraminal stenosis listed."],["The note captures: 55-year-old female.","yes","\"55yo white female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured but the LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Lumbar epidural steroid injection\" planned; no drug/dose invented."],["The note captures: No further intervention if doing well.","yes","\"No further intervention if pain resolves\"."]],"claims":[],"note":"Subjective\n\n- 55yo white female\n\n- Prior right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\n- Now presents with left lower extremity pain and numbness\n\n\n\n\nObjective\n\n- MRI: foraminal stenosis L4-L5\n\n\n\n\nAssessment\n\n- Low back pain with left lower extremity numbness\n\n- Lumbar disc herniation\n\n- Lumbar foraminal stenosis\n\n\n\n\nPlan\n\n- Lumbar epidural steroid injection\n\n- No further intervention if pain resolves","review":28.88157894736842,"saved":118.61842105263158,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and side guides the planned epidural injection."]],"mb":23.425908,"latency":25.458,"signable":54.33957894736842}],"freed":[{"label":"Run 1","wer":15.11627906976744,"text":"Diagnosis, low back pain with left lower extremity numbness-lumbar disc herniation-lumbar foraminosis, 55-year-old white female who underwent sacroiliac joint injection right with 80 percent improvement in right-sided low back pain.\nPatient now presents to pain clinic with left lower extremity pain and numbness.\nPatients MRI shows foraminosis L4-5.\nAs a result, we decide to proceed with a lumbar epidural injection.\nIn the end plan.\nIf patient is doing well, no further intervention will be done.\nEnd of discussion, thanks.","marks":[{"start":51,"end":101,"said":"numbness lumbar disk herniation lumbar foraminal stenosis.","significant":true},{"start":180,"end":190,"said":"80%","significant":false},{"start":314,"end":322,"said":"Patient's","significant":false},{"start":333,"end":344,"said":"foraminal stenosis","significant":true},{"start":367,"end":373,"said":"decided","significant":false},{"start":407,"end":407,"said":"steroid","significant":true},{"start":500,"end":517,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","partial","Captures LBP with LLE numbness and disc herniation, but foraminal stenosis is rendered as \"lumbar foraminosis\" and the history list drops the LLE numbness."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"Foraminal stenosis at L4-5\" on MRI but the LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","partial","\"Proceed with lumbar epidural injection\" captures the decision but omits that it is a steroid injection."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"Subjective\nA 55-year-old female with a history of low back pain, lumbar disc herniation, and lumbar foraminosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left lower extremity pain and numbness.\n\nMedical History  \n- Low back pain  \n- Lumbar disc herniation  \n- Lumbar foraminosis\n\nSurgical History  \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results  \n- MRI lumbar spine: Foraminal stenosis at L4-5\n\nAssessment & Plan\n55-year-old female with history of low back pain and recent sacroiliac joint injection, presenting with left lower extremity pain and numbness.\n\nLow Back Pain  \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminosis. MRI demonstrates foraminosis at L4-5 level. Patient previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain, but now presents with left-sided symptoms involving the lower extremity with pain and numbness.  \nPlan:  \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness  \n- If patient responds well to injection, no further intervention will be performed\n","review":109.22368421052632,"saved":38.276315789473685,"clean":false,"effort":21.428571428571427,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted; side of foraminal stenosis guides the injection target."]],"mb":6.840744,"latency":29.598,"signable":129.2776842105263},{"label":"Run 2","wer":15.11627906976744,"text":"Diagnosis, low back pain with left lower extremity numbness-lumbar disc herniation-lumbar foraminosis, 55-year-old white female who underwent sacroiliac joint injection right with 80 percent improvement in right-sided low back pain.\nPatient now presents to pain clinic with left lower extremity pain and numbness.\nPatients MRI shows foraminosis L4-5.\nAs a result, we decide to proceed with a lumbar epidural injection.\nIn the end plan.\nIf patient is doing well, no further intervention will be done.\nEnd of discussion, thanks.","marks":[{"start":51,"end":101,"said":"numbness lumbar disk herniation lumbar foraminal stenosis.","significant":true},{"start":180,"end":190,"said":"80%","significant":false},{"start":314,"end":322,"said":"Patient's","significant":false},{"start":333,"end":344,"said":"foraminal stenosis","significant":true},{"start":367,"end":373,"said":"decided","significant":false},{"start":407,"end":407,"said":"steroid","significant":true},{"start":500,"end":517,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Medical history and assessment list low back pain with left LE numbness, lumbar disc herniation and lumbar foraminal stenosis, plus left LE pain."],["The note captures: 55-year-old female.","yes","\"A 55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"now presents with contralateral left-sided symptoms\"; left LE pain and numbness stated correctly."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","Objective garbles it as \"Foraminosis at L4-5\"; assessment gives \"foraminal stenosis at L4-5\" but LEFT side is never stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","partial","\"Proceed with lumbar epidural injection\" drops \"steroid\", though no drug, dose or completion is invented."],["The note captures: No further intervention if doing well.","yes","\"If patient responds well to injection, no further intervention will be performed.\""]],"claims":[],"note":"Subjective\nA 55-year-old female with a history of low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left lower extremity pain and numbness.\n\nMedical History  \n- Low back pain with left lower extremity numbness  \n- Lumbar disc herniation  \n- Lumbar foraminal stenosis\n\nSurgical History  \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results  \n- MRI lumbar spine: Foraminosis at L4-5\n\nAssessment & Plan\n55-year-old female with low back pain and lumbar disc herniation, presenting with left lower extremity pain and numbness.\n\nLow Back Pain  \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminal stenosis. MRI demonstrates foraminal stenosis at L4-5 level. Patient previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain, but now presents with contralateral left-sided symptoms.  \nPlan:  \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness  \n- If patient responds well to injection, no further intervention will be performed\n","review":93.17105263157895,"saved":54.328947368421055,"clean":false,"effort":14.285714285714285,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Left side of the L4-5 stenosis is never stated and the objective finding is garbled as 'Foraminosis', which leaves the side for the injection ambiguous."]],"mb":6.919202,"latency":30.297,"signable":112.86005263157895},{"label":"Run 3","wer":15.11627906976744,"text":"Diagnosis, low back pain with left lower extremity numbness-lumbar disc herniation-lumbar foraminosis, 55-year-old white female who underwent sacroiliac joint injection right with 80 percent improvement in right-sided low back pain.\nPatient now presents to pain clinic with left lower extremity pain and numbness.\nPatients MRI shows foraminosis L4-5.\nAs a result, we decide to proceed with a lumbar epidural injection.\nIn the end plan.\nIf patient is doing well, no further intervention will be done.\nEnd of discussion, thanks.","marks":[{"start":51,"end":101,"said":"numbness lumbar disk herniation lumbar foraminal stenosis.","significant":true},{"start":180,"end":190,"said":"80%","significant":false},{"start":314,"end":322,"said":"Patient's","significant":false},{"start":333,"end":344,"said":"foraminal stenosis","significant":true},{"start":367,"end":373,"said":"decided","significant":false},{"start":407,"end":407,"said":"steroid","significant":true},{"start":500,"end":517,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI lumbar spine: Foraminosis at L4-5\" - level given but LEFT side omitted and term garbled."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","partial","\"Proceed with lumbar epidural injection\" captures the decision but omits that it is a steroid injection."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"Subjective\nA 55-year-old female with a history of low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left-sided symptoms. MRI demonstrates foraminal stenosis at L4-5.\n\nMedical History  \n- Low back pain with left lower extremity numbness  \n- Lumbar disc herniation  \n- Lumbar foraminal stenosis\n\nSurgical History  \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results  \n- MRI lumbar spine: Foraminosis at L4-5\n\nAssessment & Plan\n55-year-old female with history of low back pain, presenting with left lower extremity pain and numbness.\n\nLow back pain with left lower extremity numbness  \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminal stenosis at L4-5 as demonstrated on MRI. Previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain. Now presenting with left-sided symptoms requiring targeted intervention.  \nPlan:  \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness  \n- If patient responds well to injection, no further intervention will be performed\n","review":95.06578947368422,"saved":52.43421052631578,"clean":false,"effort":14.285714285714285,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted and term garbled as foraminosis; side of foraminal stenosis guides the injection target."]],"mb":6.855463,"latency":31.438,"signable":115.92378947368422},{"label":"Run 4","wer":15.11627906976744,"text":"Diagnosis, low back pain with left lower extremity numbness-lumbar disc herniation-lumbar foraminosis, 55-year-old white female who underwent sacroiliac joint injection right with 80 percent improvement in right-sided low back pain.\nPatient now presents to pain clinic with left lower extremity pain and numbness.\nPatients MRI shows foraminosis L4-5.\nAs a result, we decide to proceed with a lumbar epidural injection.\nIn the end plan.\nIf patient is doing well, no further intervention will be done.\nEnd of discussion, thanks.","marks":[{"start":51,"end":101,"said":"numbness lumbar disk herniation lumbar foraminal stenosis.","significant":true},{"start":180,"end":190,"said":"80%","significant":false},{"start":314,"end":322,"said":"Patient's","significant":false},{"start":333,"end":344,"said":"foraminal stenosis","significant":true},{"start":367,"end":373,"said":"decided","significant":false},{"start":407,"end":407,"said":"steroid","significant":true},{"start":500,"end":517,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI lumbar spine: Foraminosis at L4-5\" - level given but LEFT side omitted and term garbled."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","partial","\"Proceed with lumbar epidural injection\" captures the decision but omits that it is a steroid injection."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[["MRI demonstrates foraminal stenosis at L4-5 level causing nerve root compression.","Transcript MRI only reports \"foraminal stenosis, L4-5 left\"; nerve root compression is an imaging finding never stated."]],"note":"Subjective\nA 55-year-old female with a history of low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in 80 percent improvement in right-sided low back pain. She now reports left lower extremity pain and numbness.\n\nMedical History  \n- Low back pain with left lower extremity numbness  \n- Lumbar disc herniation  \n- Lumbar foraminal stenosis\n\nSurgical History  \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results  \n- MRI lumbar spine: Foraminosis at L4-5\n\nAssessment & Plan\n55-year-old female with history of low back pain and previous sacroiliac joint injection, presenting with left lower extremity pain and numbness.\n\nLow back pain with radiculopathy  \nAssessment: Patient presents with left lower extremity pain and numbness consistent with lumbar radiculopathy. MRI demonstrates foraminal stenosis at L4-5 level causing nerve root compression. Previous right sacroiliac joint injection provided 80% improvement in right-sided symptoms. Current left-sided symptoms represent a separate issue requiring targeted intervention.  \nPlan:  \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness  \n- If patient responds well to injection, no further intervention will be performed  \n- Follow up as needed based on response to treatment\n","review":108.64473684210526,"saved":38.85526315789474,"clean":false,"effort":28.57142857142857,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted and term garbled as foraminosis; side of foraminal stenosis guides the injection target."]],"mb":6.893361,"latency":32.39,"signable":129.34773684210526},{"label":"Run 5","wer":15.11627906976744,"text":"Diagnosis, low back pain with left lower extremity numbness-lumbar disc herniation-lumbar foraminosis, 55-year-old white female who underwent sacroiliac joint injection right with 80 percent improvement in right-sided low back pain.\nPatient now presents to pain clinic with left lower extremity pain and numbness.\nPatients MRI shows foraminosis L4-5.\nAs a result, we decide to proceed with a lumbar epidural injection.\nIn the end plan.\nIf patient is doing well, no further intervention will be done.\nEnd of discussion, thanks.","marks":[{"start":51,"end":101,"said":"numbness lumbar disk herniation lumbar foraminal stenosis.","significant":true},{"start":180,"end":190,"said":"80%","significant":false},{"start":314,"end":322,"said":"Patient's","significant":false},{"start":333,"end":344,"said":"foraminal stenosis","significant":true},{"start":367,"end":373,"said":"decided","significant":false},{"start":407,"end":407,"said":"steroid","significant":true},{"start":500,"end":517,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI foraminal stenosis at L4-5 recorded but the LEFT side is not stated for the MRI finding."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","partial","\"Proceed with lumbar epidural injection\" captures the decision but omits that it is a steroid injection."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"Subjective\nCliniTech Benchmark c9a864f9, a 55-year-old female with a history of low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis, presents to the pain clinic with left lower extremity pain and numbness. She previously underwent a right sacroiliac joint injection, which resulted in an 80 percent improvement in her right-sided low back pain. She now reports left-sided symptoms.\n\nMedical History  \n- Low back pain with left lower extremity numbness  \n- Lumbar disc herniation  \n- Lumbar foraminal stenosis\n\nSurgical History  \n- Right sacroiliac joint injection\n\nObjective\nLaboratory, Imaging, and Diagnostic Test Results  \n- MRI lumbar spine: Foraminal stenosis at L4-5.\n\nAssessment & Plan\n55-year-old female with history of low back pain, presenting with left lower extremity pain and numbness.\n\nLow back pain with radiculopathy  \nAssessment: Patient has low back pain with left lower extremity numbness secondary to lumbar disc herniation and lumbar foraminal stenosis at L4-5 as demonstrated on MRI. Previously underwent right sacroiliac joint injection with 80% improvement in right-sided low back pain. Now presents with left-sided symptoms requiring targeted intervention.  \nPlan:  \n- Proceed with lumbar epidural injection for left lower extremity pain and numbness  \n- If patient responds well to injection, no further intervention will be performed\n","review":93.80263157894737,"saved":53.69736842105263,"clean":false,"effort":14.285714285714285,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted; side of foraminal stenosis guides the injection target."]],"mb":6.895985,"latency":31.39,"signable":115.51463157894737}],"cliniscripts":[{"label":"Run 1","wer":8.13953488372093,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain.\nThe patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result.\nWe decided to proceed with lumbar epidural steroid injection. In the end, the plan if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Assessment lists low back pain with left LE numbness, lumbar disc herniation and lumbar foraminal stenosis; subjective has left LE pain and numbness."],["The note captures: 55-year-old female.","yes","\"55-year-old white female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"sacroiliac joint injection on the right side with 80% improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"now presents with left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI shows foraminal stenosis at L4-5\" omits the LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection.\" No invented drug, dose or completion."],["The note captures: No further intervention if doing well.","yes","\"If the patient is doing well, no further intervention will be done.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 55-year-old white female.\n- The patient previously underwent a sacroiliac joint injection on the right side with 80% improvement in right-sided low back pain.\n- The patient now presents with left lower extremity pain and numbness.\n\nO (Objective):\n- The patient's MRI shows foraminal stenosis at L4-5.\n\nA (Assessment):\n- Diagnosis: low back pain with left lower extremity numbness.\n- Diagnosis: lumbar disc herniation.\n- Diagnosis: lumbar foraminal stenosis.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient is doing well, no further intervention will be done.\n","review":39.93421052631579,"saved":107.56578947368422,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and it guides which side gets the planned epidural injection after a prior right-sided injection."]],"mb":4.321685,"latency":21.127,"signable":48.94621052631579},{"label":"Run 2","wer":8.13953488372093,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain.\nThe patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result.\nWe decided to proceed with lumbar epidural steroid injection. In the end, the plan if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI foraminal stenosis at L4-5 recorded but the LEFT side is not stated for the MRI finding."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"; no invented drug, dose or completed procedure."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"S (Subjective):\n- The patient is a 55-year-old female presenting to the pain clinic with left lower extremity pain and numbness.\n- They previously experienced right-sided low back pain, which improved by 80% following a right sacroiliac joint injection.\n\nO (Objective):\n- MRI findings indicate foraminal stenosis at L4-5.\n- The patient previously underwent a right sacroiliac joint injection.\n\nA (Assessment):\n- Diagnosis includes low back pain with left lower extremity numbness.\n- Diagnoses also include lumbar disc herniation and lumbar foraminal stenosis.\n- The patient experienced 80% improvement in right-sided low back pain after a right sacroiliac joint injection.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient shows good progress, no further intervention is planned.\n","review":47.19736842105263,"saved":100.30263157894737,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted; side of foraminal stenosis guides the injection target."]],"mb":4.405067,"latency":30.252,"signable":57.20736842105263},{"label":"Run 3","wer":6.976744186046512,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain.\nThe patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result.\nWe decided to proceed with a lumbar epidural steroid injection. In the end, the plan if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","no","No age or sex stated anywhere in the note."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI foraminal stenosis at L4-5 recorded but the LEFT side is not stated for the MRI finding."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"; no invented drug, dose or completed procedure."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"S (Subjective):\n- The patient presents with new onset left lower extremity pain and numbness.\n- They previously experienced right-sided low back pain.\n- A prior right sacroiliac joint injection resulted in 80% improvement in their right-sided low back pain.\n\nO (Objective):\n- MRI imaging reveals foraminal stenosis at L4-5.\n\nA (Assessment):\n- Diagnosis includes low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis.\n- The patient's MRI findings confirm foraminal stenosis at L4-5.\n- They previously showed significant improvement in right-sided low back pain following a right sacroiliac joint injection.\n\nP (Plan):\n- The current plan is to proceed with a lumbar epidural steroid injection.\n- If the patient's condition improves, no further intervention will be pursued.\n","review":59.776315789473685,"saved":87.72368421052632,"clean":false,"effort":21.428571428571427,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted; side of foraminal stenosis guides the injection target."]],"mb":4.448287,"latency":30.057,"signable":72.77531578947368},{"label":"Run 4","wer":8.13953488372093,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain.\nThe patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result.\nWe decided to proceed with lumbar epidural steroid injection. In the end, the plan if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Assessment lists \"low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis\"; subjective adds left LE pain."],["The note captures: 55-year-old female.","yes","\"The patient is a 55-year-old female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"right-sided low back pain, which improved by 80% following a right sacroiliac joint injection.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"now presents with left lower extremity pain and numbness\" - laterality correct."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI findings indicate foraminal stenosis at L4-5\" omits the LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\" with no invented drug, dose or completion."],["The note captures: No further intervention if doing well.","yes","\"If the patient responds well to the injection, no further intervention will be pursued.\""]],"claims":[],"note":"S (Subjective):\n- The patient is a 55-year-old female.\n- They previously experienced right-sided low back pain, which improved by 80% following a right sacroiliac joint injection.\n- The patient now presents with left lower extremity pain and numbness.\n\nO (Objective):\n- MRI findings indicate foraminal stenosis at L4-5.\n\nA (Assessment):\n- Diagnoses include low back pain with left lower extremity numbness, lumbar disc herniation, and lumbar foraminal stenosis.\n- The foraminal stenosis at L4-5 is identified as a contributing factor to their current symptoms.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient responds well to the injection, no further intervention will be pursued.\n","review":43.723684210526315,"saved":103.77631578947368,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and it guides which side gets the planned epidural injection after a prior right-sided injection."]],"mb":4.437424,"latency":25.021,"signable":54.711684210526315},{"label":"Run 5","wer":8.13953488372093,"text":"Diagnosis: low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foraminal stenosis. 55-year-old white female who underwent sacroiliac joint injection right with 80% improvement in right-sided low back pain.\nThe patient now presents to the pain clinic with left lower extremity pain and numbness. The patient's MRI shows foraminal stenosis at L4-5 as a result.\nWe decided to proceed with lumbar epidural steroid injection. In the end, the plan if the patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Lists low back pain with LLE numbness, lumbar disc herniation and lumbar foraminal stenosis, with LLE pain."],["The note captures: 55-year-old female.","yes","States \"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Prior right SI joint injection with 80% improvement in right-sided low back pain."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Current symptoms documented as left lower extremity pain and numbness."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI foraminal stenosis at L4-5 recorded but the LEFT side is not stated for the MRI finding."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"; no invented drug, dose or completed procedure."],["The note captures: No further intervention if doing well.","yes","States no further intervention if the patient does well."]],"claims":[],"note":"S (Subjective):\n- The patient is a 55-year-old female presenting with new onset left lower extremity pain and numbness.\n- They previously experienced right-sided low back pain.\n- This right-sided low back pain improved by 80% following a right sacroiliac joint injection.\n\nO (Objective):\n- MRI imaging reveals foraminal stenosis at L4-5.\n\nA (Assessment):\n- Low back pain with left lower extremity numbness.\n- Lumbar disc herniation.\n- Lumbar foraminal stenosis.\n\nP (Plan):\n- Proceed with lumbar epidural steroid injection.\n- If the patient's condition improves, no further intervention is planned.\n","review":38.03947368421053,"saved":109.46052631578948,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","MRI laterality (left L4-5) omitted; side of foraminal stenosis guides the injection target."]],"mb":4.405784,"latency":24.224,"signable":48.02347368421053}],"lyrebird":[{"label":"Run 1","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen stenosis. 55 year old white female who underwent sacroiliac joint injection right with 80 percent improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis l 4 5. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further\n\nIntervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":99,"said":"foraminal","significant":false},{"start":187,"end":197,"said":"80%","significant":false},{"start":361,"end":367,"said":"L4-5.","significant":false},{"start":384,"end":390,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Assessment: \"Low back pain with left lower extremity numbness\", \"Lumbar disc herniation\", \"Lumbar foraminal stenosis L4-5\"; LLE pain in S."],["The note captures: 55-year-old female.","yes","\"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Previous right-sided low back pain improved 80% following right sacroiliac joint injection\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"; laterality preserved."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI demonstrates foraminal stenosis at L4-5\" omits LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"; nothing invented."],["The note captures: No further intervention if doing well.","yes","\"If patient responds well to injection, no further intervention required\"."]],"claims":[],"note":"SOAP NOTES\n\n\n\n\nSubjective:\n\n55-year-old female presenting with left lower extremity pain and numbness\n\nPrevious right-sided low back pain improved 80% following right sacroiliac joint injection\n\nCurrently experiencing left lower extremity symptoms\n\n\n\n\nObjective:\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis L4-5\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required\n\nReview post-procedure","review":35.19736842105263,"saved":112.30263157894737,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis is dropped, and that side guides where the planned epidural injection goes."]],"mb":9.360705,"latency":13.87,"signable":49.06736842105263},{"label":"Run 2","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen stenosis. 55 year old white female who underwent sacroiliac joint injection right with 80 percent improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis l 4 5. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further\n\nIntervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":99,"said":"foraminal","significant":false},{"start":187,"end":197,"said":"80%","significant":false},{"start":361,"end":367,"said":"L4-5.","significant":false},{"start":384,"end":390,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Low back pain with LLE numbness, lumbar disc herniation, lumbar foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"right sacroiliac joint injection with 80% improvement in right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"foraminal stenosis at L4-5\" without the left side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"no further intervention required\" if responds well."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n55-year-old female presenting to pain clinic with left lower extremity pain and numbness\n\nPrevious right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nObjective:\n\nMRI findings: foraminal stenosis L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required","review":34.881578947368425,"saved":112.61842105263158,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis that the planned injection targets is lost."]],"mb":9.392714,"latency":15.711,"signable":50.59257894736842},{"label":"Run 3","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen stenosis. 55 year old white female who underwent sacroiliac joint injection right with 80 percent improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis l 4 5. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further\n\nIntervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":99,"said":"foraminal","significant":false},{"start":187,"end":197,"said":"80%","significant":false},{"start":361,"end":367,"said":"L4-5.","significant":false},{"start":384,"end":390,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left LE numbness, disc herniation, foraminal stenosis L4-5."],["The note captures: 55-year-old female.","yes","\"55-year-old female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Right SIJ injection with 80% improvement in right-sided LBP."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured, but laterality (LEFT) of the stenosis is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If patient responds well to injection, no further intervention required\"."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n55-year-old female presenting to pain clinic with left lower extremity pain and numbness\n\nPrevious right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nObjective:\n\nMRI findings: foraminal stenosis L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis L4-5\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required\n\nReview post-procedure","review":36.46052631578948,"saved":111.03947368421052,"clean":false,"effort":7.142857142857142,"sig":[],"mb":9.418579,"latency":15.616,"signable":52.07652631578948},{"label":"Run 4","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen stenosis. 55 year old white female who underwent sacroiliac joint injection right with 80 percent improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis l 4 5. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further\n\nIntervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":99,"said":"foraminal","significant":false},{"start":187,"end":197,"said":"80%","significant":false},{"start":361,"end":367,"said":"L4-5.","significant":false},{"start":384,"end":390,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left lower extremity pain/numbness, disc herniation and foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Previous right sacroiliac joint injection with 80% improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection.\""],["The note captures: No further intervention if doing well.","yes","\"If patient responds well to injection, no further intervention required.\""]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n55-year-old female presenting to pain clinic with left lower extremity pain and numbness\n\nPrevious right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nObjective:\n\nMRI findings: foraminal stenosis L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required","review":34.881578947368425,"saved":112.61842105263158,"clean":false,"effort":7.142857142857142,"sig":[],"mb":9.430175,"latency":15.174,"signable":50.055578947368424},{"label":"Run 5","wer":8.13953488372093,"text":"Diagnosis. Low back pain with left lower extremity numbness, lumbar disc herniation, lumbar foramen stenosis. 55 year old white female who underwent sacroiliac joint injection right with 80 percent improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness. Patient's MRI shows foraminal stenosis l 4 5. As a result, we decide to proceed with a lumbar epidural steroid injection. In the end plan, if patient is doing well, no further\n\nIntervention will be done. End of dictation. Thanks.","marks":[{"start":68,"end":72,"said":"disk","significant":false},{"start":92,"end":99,"said":"foraminal","significant":false},{"start":187,"end":197,"said":"80%","significant":false},{"start":361,"end":367,"said":"L4-5.","significant":false},{"start":384,"end":390,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left lower extremity pain/numbness, disc herniation and foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Previous right sacroiliac joint injection with 80% improvement in right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection.\""],["The note captures: No further intervention if doing well.","yes","\"If patient responds well to injection, no further intervention required.\""]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\n55-year-old female presenting to pain clinic with left lower extremity pain and numbness\n\nPrevious right sacroiliac joint injection with 80% improvement in right-sided low back pain\n\nMRI demonstrates foraminal stenosis at L4-5\n\n\n\n\nObjective:\n\nMRI findings: foraminal stenosis L4-5\n\n\n\n\nAssessment:\n\nLow back pain with left lower extremity numbness\n\nLumbar disc herniation\n\nLumbar foraminal stenosis\n\n\n\n\nPlan:\n\nProceed with lumbar epidural steroid injection\n\nIf patient responds well to injection, no further intervention required","review":34.881578947368425,"saved":112.61842105263158,"clean":false,"effort":7.142857142857142,"sig":[],"mb":9.412829,"latency":14.54,"signable":49.421578947368424}],"preve":[{"label":"Run 1","wer":13.953488372093023,"text":"Diagnosis, low back pain with left\n\nlurch empty. Numbness, lumbar disc herniation, lumbar foraminal stenosis. 55 years old white female underwent sacroiliac joint injection right with a\n\npercent improvement in right sided low back pain.\n\nPatient now presents the pain clinic with left lower\n\nextremity pain and numbness. Patient's MRI shows\n\nforaminal stenosis l four five. As a result, we decided to proceed within lumbar epidural steroid injection. In the end plan, if patient is doing\n\nwell, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":36,"end":48,"said":"lower extremity","significant":true},{"start":66,"end":70,"said":"disk","significant":false},{"start":110,"end":122,"said":"55-year-old","significant":false},{"start":135,"end":135,"said":"who","significant":false},{"start":184,"end":194,"said":"80%","significant":true},{"start":361,"end":373,"said":"L4-5.","significant":false},{"start":409,"end":415,"said":"with a","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","partial","Diagnosis section lists disc herniation, foraminal stenosis and LBP with LLE symptoms, but Dx line misstates \"left-sided lurch and numbness\"."],["The note captures: 55-year-old female.","no","Age 55 and female sex are not stated anywhere."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","partial","Right SIJ injection and right-sided LBP captured but says \"exact % not stated\" when transcript states 80%."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"Reports left lower extremity pain and numbness\"; laterality preserved."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI: Foraminal stenosis at L4-L5\" omits LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Planned procedure: Lumbar epidural steroid injection (LESI)\"; no drug, dose or completed procedure invented."],["The note captures: No further intervention if doing well.","yes","\"If patient is doing well post-procedure, no further intervention\"."]],"claims":[["\"Low back pain with left-sided lurch\" / \"Observation: Left lurch reported\"","Transcript mentions no lurch or gait finding; it says left lower extremity pain and numbness."],["\"(Consent obtained)\" under Objective and Treatment","Transcript contains no mention of consent being obtained."],["\"yielded % improvement ... (exact % not stated)\"","Transcript explicitly states \"80% improvement\"; the note asserts the figure was not given."]],"note":"Presenting Condition\n\nDx: Low back pain with left-sided lurch and numbness\n\nReports left lower extremity pain and numbness\n\nPrior right SIJ injection yielded % improvement in right-sided low back pain (exact % not stated)\n\nReason for visit: Pain clinic evaluation and management for LLE pain/numbness\n\nContributing factors: Lumbar disc herniation and lumbar foraminal stenosis\n\n\n\n\nRadiology\n\nMRI: Foraminal stenosis at L4–L5\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Left lurch reported\n\n\n\n\nDiagnosis\n\nLumbar foraminal stenosis at L4–L5\n\nLumbar disc herniation\n\nLow back pain with left lower extremity radicular symptoms\n\nPrognosis: If responds to LESI, no further intervention planned\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nPlanned procedure: Lumbar epidural steroid injection (LESI)\n\n\n\n\nPlan\n\nProceed with LESI\n\nIf patient is doing well post-procedure, no further intervention\n\nFollow-up: Assess response after injection\n","review":129.10526315789474,"saved":18.39473684210526,"clean":false,"effort":85.71428571428571,"sig":[["partial","Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","The Dx line invents a 'left-sided lurch' (a gait finding) in place of LLE pain."],["partial","Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","The 80% response to the prior SIJ injection, a key measurement for future treatment choices, is lost."],["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis is dropped, and that side guides where the planned epidural injection goes."],["fabrication","\"(Consent obtained)\" under Objective and Treatment","Invented consent documentation misstates the legal record of what happened."]],"mb":3.865955,"signable":148.70326315789475},{"label":"Run 2","wer":13.953488372093023,"text":"Diagnosis, low back pain with left\n\nlurch empty. Numbness, lumbar disc herniation, lumbar foraminal stenosis. 55 years old white female underwent sacroiliac joint injection right with a\n\npercent improvement in right sided low back pain.\n\nPatient now presents the pain clinic with left lower\n\nextremity pain and numbness. Patient's MRI shows\n\nforaminal stenosis l four five. As a result, we decided to proceed within lumbar epidural steroid injection. In the end plan, if patient is doing\n\nwell, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":36,"end":48,"said":"lower extremity","significant":true},{"start":66,"end":70,"said":"disk","significant":false},{"start":110,"end":122,"said":"55-year-old","significant":false},{"start":135,"end":135,"said":"who","significant":false},{"start":184,"end":194,"said":"80%","significant":true},{"start":361,"end":373,"said":"L4-5.","significant":false},{"start":409,"end":415,"said":"with a","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Low back pain with LLE pain and numbness, lumbar disc herniation, lumbar foraminal stenosis."],["The note captures: 55-year-old female.","no","Age and sex not recorded."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","partial","Right SIJ injection and right-sided improvement captured but says \"exact % not stated\" when 80% was stated."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain/numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI: foraminal stenosis at L4–L5\" without left side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Proceed with lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If patient is doing well post-injection, no further intervention planned\"."]],"claims":[],"note":"Presenting Condition\n\nDx: low back pain with left lower extremity pain and numbness\n\nImaging suggests lumbar disc herniation and lumbar foraminal stenosis\n\nRecent right sacroiliac joint injection with percent improvement in right-sided low back pain (exact % not stated)\n\nCurrent reason for visit: pain clinic presentation for left lower extremity pain/numbness\n\n\n\n\nRadiology\n\nMRI: foraminal stenosis at L4–L5\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nLow back pain with left lower extremity radicular symptoms\n\nLumbar foraminal stenosis at L4–L5\n\nLumbar disc herniation\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nPlan to proceed with lumbar epidural steroid injection\n\n\n\n\nPlan\n\nProceed with lumbar epidural steroid injection\n\nIf patient is doing well post-injection, no further intervention planned\n","review":70.73684210526315,"saved":76.76315789473685,"clean":false,"effort":28.57142857142857,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis that the planned injection targets is lost."]],"mb":4.236376,"signable":92.20084210526315},{"label":"Run 3","wer":13.953488372093023,"text":"Diagnosis, low back pain with left\n\nlurch empty. Numbness, lumbar disc herniation, lumbar foraminal stenosis. 55 years old white female underwent sacroiliac joint injection right with a\n\npercent improvement in right sided low back pain.\n\nPatient now presents the pain clinic with left lower\n\nextremity pain and numbness. Patient's MRI shows\n\nforaminal stenosis l four five. As a result, we decided to proceed within lumbar epidural steroid injection. In the end plan, if patient is doing\n\nwell, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":36,"end":48,"said":"lower extremity","significant":true},{"start":66,"end":70,"said":"disk","significant":false},{"start":110,"end":122,"said":"55-year-old","significant":false},{"start":135,"end":135,"said":"who","significant":false},{"start":184,"end":194,"said":"80%","significant":true},{"start":361,"end":373,"said":"L4-5.","significant":false},{"start":409,"end":415,"said":"with a","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left lower extremity pain and numbness; disc herniation; foraminal stenosis."],["The note captures: 55-year-old female.","no","Age and sex (55-year-old female) are not documented."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","partial","Right SIJ injection with improvement in right-sided LBP captured, but the 80% figure is missing (\"percent improvement\")."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured but the LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Procedure planned: lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If patient is doing well after LESI, no further intervention will be done\"."]],"claims":[],"note":"Presenting Condition\n\nDiagnosis: low back pain with left lower extremity pain and numbness\n\nMRI: foraminal stenosis at L4–L5\n\nPrior: right sacroiliac joint injection with percent improvement in right-sided low back pain\n\nReason for visit: presents to pain clinic for left leg pain/numbness\n\n\n\n\nRadiology\n\nMRI: lumbar foraminal stenosis at L4–L5\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nLumbar disc herniation (stated)\n\nLumbar foraminal stenosis (L4–L5)\n\nPrognosis: contingent on response to lumbar epidural steroid injection (LESI)\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nProcedure planned: lumbar epidural steroid injection (LESI)\n\n// Plan contingent on response; no immediate post-procedure response documented\n\n\n\n\nPlan\n\nIf patient is doing well after LESI, no further intervention will be done\n","review":70.73684210526315,"saved":76.76315789473685,"clean":false,"effort":28.57142857142857,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the L4-5 foraminal stenosis is omitted, and side guides the planned epidural injection."]],"mb":4.398107,"signable":90.36984210526315},{"label":"Run 4","wer":13.953488372093023,"text":"Diagnosis, low back pain with left\n\nlurch empty. Numbness, lumbar disc herniation, lumbar foraminal stenosis. 55 years old white female underwent sacroiliac joint injection right with a\n\npercent improvement in right sided low back pain.\n\nPatient now presents the pain clinic with left lower\n\nextremity pain and numbness. Patient's MRI shows\n\nforaminal stenosis l four five. As a result, we decided to proceed within lumbar epidural steroid injection. In the end plan, if patient is doing\n\nwell, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":36,"end":48,"said":"lower extremity","significant":true},{"start":66,"end":70,"said":"disk","significant":false},{"start":110,"end":122,"said":"55-year-old","significant":false},{"start":135,"end":135,"said":"who","significant":false},{"start":184,"end":194,"said":"80%","significant":true},{"start":361,"end":373,"said":"L4-5.","significant":false},{"start":409,"end":415,"said":"with a","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Left leg pain/numbness, lumbar disc herniation, foraminal stenosis listed."],["The note captures: 55-year-old female.","no","Age and sex (55-year-old female) not documented."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","partial","Prior right SIJ injection with improvement captured; 80% figure omitted."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"Left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","MRI L4-5 foraminal stenosis captured, but laterality (LEFT) of the stenosis is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Procedure: Lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If doing well after LESI, no further intervention\"."]],"claims":[],"note":"Presenting Condition\n\nDx: Low back pain with left leg pain and numbness\n\nMRI-confirmed lumbar foraminal stenosis at L4/5\n\nHx: Prior right sacroiliac joint injection with improvement in right-sided low back pain\n\nCurrent reason for visit: Left lower extremity pain and numbness\n\n\n\n\nRadiology\n\nMRI: Foraminal stenosis at L4/5\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nLumbar disc herniation (mentioned)\n\nLumbar foraminal stenosis (L4/5)\n\nPrognosis: If patient does well post-procedure, no further intervention planned\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nProcedure: Lumbar epidural steroid injection\n\n// Plan for no further intervention if patient responds well\n\n\n\n\nPlan\n\nIf doing well after LESI, no further intervention\n\nMonitor post-injection response\n","review":69.15789473684211,"saved":78.34210526315789,"clean":false,"effort":28.57142857142857,"sig":[],"mb":4.155167,"signable":86.90489473684211},{"label":"Run 5","wer":13.953488372093023,"text":"Diagnosis, low back pain with left\n\nlurch empty. Numbness, lumbar disc herniation, lumbar foraminal stenosis. 55 years old white female underwent sacroiliac joint injection right with a\n\npercent improvement in right sided low back pain.\n\nPatient now presents the pain clinic with left lower\n\nextremity pain and numbness. Patient's MRI shows\n\nforaminal stenosis l four five. As a result, we decided to proceed within lumbar epidural steroid injection. In the end plan, if patient is doing\n\nwell, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":36,"end":48,"said":"lower extremity","significant":true},{"start":66,"end":70,"said":"disk","significant":false},{"start":110,"end":122,"said":"55-year-old","significant":false},{"start":135,"end":135,"said":"who","significant":false},{"start":184,"end":194,"said":"80%","significant":true},{"start":361,"end":373,"said":"L4-5.","significant":false},{"start":409,"end":415,"said":"with a","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","partial","Herniation and foraminal stenosis captured, but the diagnosis reads \"left-sided lurch and numbness\" instead of left lower-extremity pain/numbness."],["The note captures: 55-year-old female.","yes","\"55-year-old female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","partial","Right SIJ injection with right-sided improvement captured, but the 80% figure is replaced by \"percentage not specified\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"new left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Lumbar epidural steroid injection planned.\""],["The note captures: No further intervention if doing well.","yes","\"If patient does well post-LESI, no further intervention planned.\""]],"claims":[["Low back pain with left-sided lurch and numbness","Source says left lower extremity numbness/pain; no gait lurch is mentioned anywhere."],["% improvement in right-sided low back pain (percentage not specified)","Source explicitly states 80% improvement; claiming the percentage was not specified is false."]],"note":"Presenting Condition\n\nDx: Low back pain with left-sided lurch and numbness; lumbar disc herniation; lumbar foraminal stenosis\n\n55‑year‑old female with new left lower extremity pain and numbness\n\nPrior right SIJ injection resulted in % improvement in right‑sided low back pain (percentage not specified)\n\nReason for visit: Presents to pain clinic for left leg pain/numbness management\n\n\n\n\nRadiology\n\nMRI: Foraminal stenosis at L4/5\n\n\n\n\nObjective\n\n(Consent obtained)\n\n\n\n\nDiagnosis\n\nLumbar foraminal stenosis (L4/5)\n\nLumbar disc herniation\n\nLow back pain with left lurch and numbness\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nProcedure: Lumbar epidural steroid injection planned to address left lower extremity pain/numbness\n\n\n\n\nPlan\n\nIf patient does well post‑LESI, no further intervention planned\n\nMonitor symptoms and response post‑procedure\n","review":103.57894736842104,"saved":43.92105263157896,"clean":false,"effort":50.0,"sig":[["partial","Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","Diagnosis twice records a 'left-sided lurch', an invented gait abnormality in place of left leg pain/numbness."]],"mb":4.028387,"signable":122.26694736842104}],"patientnotes":[{"label":"Run 1","wer":12.790697674418606,"text":"Diagnosis Low back pain with left lor empty numbness lumbar disc herniation lumber foraminosmosis 55 years old white female who underwent sacroiliac joint injection right with 80% improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness patients. MRI shows foraminal stenosis L4.5. As a result, we decide to proceed with a lumbar epidural steer injection in the end plan if patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":34,"end":43,"said":"lower extremity","significant":true},{"start":60,"end":64,"said":"disk","significant":false},{"start":76,"end":110,"said":"lumbar foraminal stenosis. 55-year-old","significant":true},{"start":303,"end":312,"said":"Patient's","significant":false},{"start":364,"end":370,"said":"decided","significant":false},{"start":405,"end":410,"said":"steroid","significant":true}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Assessment: \"low back pain with left leg numbness secondary to lumbar disc herniation and L4-L5 foraminal stenosis\"; CC gives left lower extremity pain."],["The note captures: 55-year-old female.","yes","\"55-year-old white female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection gave 80% improvement of right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","Chief complaint \"Left lower extremity pain and numbness\"; laterality preserved."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"MRI shows L4-L5 foraminal stenosis\" omits LEFT side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Perform lumbar epidural steroid injection\" with no invented drug, dose or completion."],["The note captures: No further intervention if doing well.","yes","\"If patient does well, no further intervention will be required.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nLeft lower extremity pain and numbness.\n\nHistory of Presenting Complaint::\n\n55-year-old white female with low back pain.\n\nPrior right sacroiliac joint injection gave 80% improvement of right-sided low back pain.\n\nMRI shows L4-L5 foraminal stenosis.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: low back pain with left leg numbness secondary to lumbar disc herniation and L4-L5 foraminal stenosis.\n\nPlan\n\nPerform lumbar epidural steroid injection.\n\nIf patient does well, no further intervention will be required.","review":36.14473684210526,"saved":111.35526315789474,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis is dropped, and that side guides where the planned epidural injection goes."]],"mb":7.244584,"latency":26.201,"signable":62.34573684210526},{"label":"Run 2","wer":13.953488372093023,"text":"Diagnosis Low back pain with left lower chimp numbness lumbar disc herniation lumbar foraminal 55 old white female wonderment sacroiliac joint injection right with 80% improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness patients. MRI shows foraminal stenosis L4-5. As a result, we decide to proceed with a lumbar epidural steroid injection in the end plan if patient is doing well, no further intervention will be done. End of vacation. Thanks.","marks":[{"start":40,"end":45,"said":"extremity","significant":true},{"start":62,"end":66,"said":"disk","significant":false},{"start":95,"end":101,"said":"stenosis. 55-year-old","significant":true},{"start":115,"end":125,"said":"who underwent","significant":false},{"start":291,"end":300,"said":"Patient's","significant":false},{"start":352,"end":358,"said":"decided","significant":false},{"start":491,"end":507,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LLE pain and numbness, low back pain, lumbar disc herniation and L4-5 foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old white female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"right sacroiliac joint injection with 80% relief of right-sided low back pain\"."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"LLE pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","\"L4-5 foraminal stenosis\" without the left side."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"Perform lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If patient improves, no further intervention required\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nLLE pain and numbness\n\nHistory of Presenting Complaint::\n\n55‑year‑old white female with prior low back pain and lumbar disc herniation\n\nPreviously received right sacroiliac joint injection with 80% relief of right‑sided low back pain\n\nCurrent MRI shows L4‑5 foraminal stenosis\n\nObjective\n\nMRI demonstrates foraminal stenosis at L4‑5\n\nAge: 55 years\n\nRight sacroiliac joint injection resulted in 80% improvement in right‑sided low back pain\n\nAssessment\n\nLow back pain with left lower extremity numbness secondary to lumbar disc herniation and L4‑5 foraminal stenosis\n\nPlan\n\nPerform lumbar epidural steroid injection\n\nIf patient improves, no further intervention required","review":43.0921052631579,"saved":104.40789473684211,"clean":false,"effort":7.142857142857142,"sig":[["partial","MRI shows LEFT L4–5 foraminal stenosis.","Laterality of the stenosis that the planned injection targets is lost."]],"mb":7.224426,"latency":23.058,"signable":66.1501052631579},{"label":"Run 3","wer":11.627906976744185,"text":"Diagnosis Low back pain with left lor empty numbness lumbar disc herniation lumber foraminosmosis 55 years old white female who underwent sacroiliac joint injection right with 80% improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness patients. MRI shows foraminal stenosis L4-5. As a result, we decide to proceed with a lumbar epidural steroid injection in the end plan if patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":34,"end":43,"said":"lower extremity","significant":true},{"start":60,"end":64,"said":"disk","significant":false},{"start":76,"end":110,"said":"lumbar foraminal stenosis. 55-year-old","significant":true},{"start":303,"end":312,"said":"Patient's","significant":false},{"start":364,"end":370,"said":"decided","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","LBP with left leg numbness secondary to disc herniation and foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old white female\"."],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","Right SIJ injection with 80% improvement in right-sided LBP."],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"Left lower extremity pain and numbness\"."],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis in assessment, but MRI source and LEFT laterality of stenosis not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"perform lumbar epidural steroid injection\"."],["The note captures: No further intervention if doing well.","yes","\"If patient does well, no further intervention required\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nLeft lower extremity pain and numbness.\n\nHistory of Presenting Complaint::\n\n55‑year‑old white female with low back pain.\n\nPrior right sacroiliac joint injection with 80% improvement in right‑sided low back pain.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: low back pain with left leg numbness secondary to lumbar disc herniation and foraminal stenosis at L4‑5.\n\nPlan\n\nPlan: perform lumbar epidural steroid injection.\n\nIf patient does well, no further intervention required.","review":34.25,"saved":113.25,"clean":false,"effort":7.142857142857142,"sig":[],"mb":6.59187,"latency":24.164,"signable":58.414},{"label":"Run 4","wer":12.790697674418606,"text":"Diagnosis Low back pain with left lor empty numbness lumbar disc herniation lumber foraminosmosis 55 years old white female who underwent sacroiliac joint injection right with 80% improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness patients. MRI shows foraminal stenosis L4.5. As a result, we decide to proceed with a lumbar epidural steer injection in the end plan if patient is doing well, no further intervention will be done. End of dictation. Thanks.","marks":[{"start":34,"end":43,"said":"lower extremity","significant":true},{"start":60,"end":64,"said":"disk","significant":false},{"start":76,"end":110,"said":"lumbar foraminal stenosis. 55-year-old","significant":true},{"start":303,"end":312,"said":"Patient's","significant":false},{"start":364,"end":370,"said":"decided","significant":false},{"start":405,"end":410,"said":"steroid","significant":true}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Low back pain, left leg pain/numbness, disc herniation and L4-5 foraminal stenosis."],["The note captures: 55-year-old female.","yes","\"55-year-old white female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"prior right sacroiliac joint injection (80% improvement in right-sided low back pain).\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"perform lumbar epidural steroid injection\"; no drug or dose invented."],["The note captures: No further intervention if doing well.","yes","\"if patient does well, no further intervention will be required.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with left lower extremity pain and numbness.\n\nHistory of Presenting Complaint::\n\n55‑year‑old white female with prior right sacroiliac joint injection (80% improvement in right‑sided low back pain).\n\nNow reports left lower extremity pain and numbness.\n\nMRI demonstrates foraminal stenosis at L4‑5.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nDiagnosis: low back pain with left leg numbness secondary to lumbar disc herniation and L4‑5 foraminal stenosis.\n\nPlan\n\nPlan: perform lumbar epidural steroid injection; if patient does well, no further intervention will be required.","review":38.98684210526316,"saved":108.51315789473685,"clean":false,"effort":7.142857142857142,"sig":[],"mb":7.223829,"latency":26.15,"signable":65.13684210526316},{"label":"Run 5","wer":16.27906976744186,"text":"Diagnosis Low back pain with left lower empty numbness lumbar disc herniation lumbar foraminosis 55 years old white female who underwent sacroiliac joint injection right with 80% improvement in right sided low back pain. Patient now presents the pain clinic with left lower extremity pain and numbness patients MRI shows foraminal stenosis L4-5. As a result, we decide to proceed within lumbar epidural steer injection in the end plan if patient is doing well, no further intervention will be done. End of decation Thanks.","marks":[{"start":40,"end":45,"said":"extremity","significant":false},{"start":62,"end":66,"said":"disk","significant":false},{"start":85,"end":109,"said":"foraminal stenosis. 55-year-old","significant":true},{"start":302,"end":310,"said":"Patient's","significant":false},{"start":362,"end":368,"said":"decided","significant":false},{"start":380,"end":386,"said":"with a","significant":false},{"start":403,"end":408,"said":"steroid","significant":true},{"start":499,"end":514,"said":"","significant":false}],"facts":[["The note captures: Low back pain with left lower-extremity pain/numbness, lumbar disc herniation and lumbar foraminal stenosis.","yes","Low back pain, left lower extremity pain/numbness, disc herniation and foraminal stenosis (though garbled once as \"foraminosis\")."],["The note captures: 55-year-old female.","yes","\"55-year-old white female.\""],["The note captures: Previous RIGHT sacroiliac joint injection improved RIGHT-sided low back pain by 80%.","yes","\"Prior right sacroiliac joint injection gave 80% relief of right-sided low back pain.\""],["The note captures: Current symptoms involve the LEFT lower extremity; do not reverse laterality.","yes","\"Left lower extremity pain and numbness.\""],["The note captures: MRI shows LEFT L4–5 foraminal stenosis.","partial","L4-5 foraminal stenosis captured, but the MRI's LEFT side is not stated."],["The note captures: Decision to proceed with lumbar epidural steroid injection; do not invent a drug, dose or confirmed completed procedure.","yes","\"perform lumbar epidural steroid injection\"; no drug, dose or completion invented."],["The note captures: No further intervention if doing well.","yes","\"if patient does well, no further intervention.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nLeft lower extremity pain and numbness.\n\nHistory of Presenting Complaint::\n\n55‑year‑old white female with low back pain, left lower extremity numbness, lumbar disc herniation and lumbar foraminosis.\n\nPrior right sacroiliac joint injection gave 80% relief of right‑sided low back pain.\n\nMRI shows L4‑5 foraminal stenosis.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nAssessment: low back pain with left lower extremity pain and numbness secondary to L4‑5 foraminal stenosis.\n\nPlan\n\nPlan: perform lumbar epidural steroid injection; if patient does well, no further intervention.","review":38.35526315789474,"saved":109.14473684210526,"clean":false,"effort":7.142857142857142,"sig":[],"mb":5.984968,"latency":26.124,"signable":64.47926315789474}]}},{"id":"indic-hindi","name":"Hindi consultation","dictation":false,"language":true,"stress":false,"reference":"नमस्ते। आइए, बैठिए। मैं डॉक्टर मेहता हूँ। किस परेशानी के लिए आए हैं?\n\nनमस्ते डॉक्टर। पिछले दो हफ्तों से बहुत थकान लग रही है। बार-बार सिरदर्द भी हो रहा है।\n\nठीक है। सिरदर्द हमेशा रहता है या कभी-कभी?\n\nकभी-कभी होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है।\n\nसमझ 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टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":591,"end":594,"said":"जर","significant":false},{"start":607,"end":609,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue x2 weeks.\""],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Intermittent HA, worse in evenings\" matches."],["Captures occasional dizziness.","yes","\"occasional dizziness\" matches."],["Captures work stress, poor sleep, and skipped meals.","yes","\"↑ work stress; poor sleep. Sometimes skips meals.\" captures all three."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Assessment frames symptoms \"in context of poor sleep, work stress, and skipped meals\" without a confirmed diagnosis."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Anaemia or vitamin deficiency considered; blood test ... to assess\" — investigation planned, not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","\"Advise regular meals, ↑ fluid intake, adequate sleep\" captures the three advice items."],["Plans review after blood results, with treatment determined after results.","partial","\"Review after results available\" captures review but not that treatment will be decided after results."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","\"Concerned about possible serious cause; reassured.\" without claiming serious disease excluded."]],"claims":[["Advise ... relaxation","Doctor advised only meals, water and sleep; 'relax' appears only as the patient saying he now feels relieved ('ab thoda relax lag raha hai'), not as advice."]],"note":"Subjective\nFatigue x2 weeks.\nIntermittent HA, worse in evenings; occasional dizziness.\n↑ work stress; poor sleep.\nSometimes skips meals.\nConcerned about possible serious cause; reassured.\nObjective\nNo examination findings or measurements documented.\nAssessment\nFatigue with intermittent evening HA/dizziness, in context of poor sleep, work stress, and skipped meals.\nAnaemia or vitamin deficiency considered; blood test discussed to assess.\nPlan\nSimple blood test to assess for anaemia/vitamin deficiency.\nAdvise regular meals, ↑ fluid intake, adequate sleep, and relaxation.\nReview after results available.","review":50.078947368421055,"saved":113.42105263157895,"clean":false,"effort":22.22222222222222,"sig":[]},{"label":"Run 2","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद।","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":591,"end":594,"said":"जर","significant":false},{"start":607,"end":609,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","Fatigue for 2 weeks."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Intermittent headaches worse in the evening."],["Captures occasional dizziness.","yes","Occasional dizziness."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Stress/sleep/meals presented as possible contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests for anaemia/vitamin deficiency, not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, hydration and adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","Review after results to determine treatment."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Patient concern about serious problem recorded but clinician reassurance not documented."]],"claims":[],"note":"Subjective\nReports fatigue x2 weeks.\nIntermittent HA, worse in evenings.\nOccasional dizziness.\nReports increased work stress, poor sleep, and occasionally skipping meals.\nConcerned about possible serious underlying problem.\nObjective\nNo objective examination findings or measurements documented.\nAssessment\nFatigue with intermittent evening HA and occasional dizziness.\nPoor sleep, work stress, and missed meals may be contributory.\nAnaemia and vitamin deficiency to be assessed with blood tests.\nPlan\nBlood tests planned to assess for anaemia or vitamin deficiency.\nAdvise regular meals, increased water intake, and adequate sleep.\nReview after results available for further treatment guidance.","review":44.118421052631575,"saved":119.38157894736842,"clean":false,"effort":5.555555555555555,"sig":[],"mb":3.283335,"latency":7.435,"signable":51.55342105263158},{"label":"Run 3","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद।","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":591,"end":594,"said":"जर","significant":false},{"start":607,"end":609,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"fatigue x2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Intermittent HA, worse in evenings\"."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","Poor sleep related to work stress; sometimes skips meals."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"Poor sleep, work stress, and skipped meals may be contributing\"."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Anaemia or vitamin deficiency considered; blood testing planned\"."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meals, increased water intake, and adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Review after results available; discuss appropriate treatment based on findings\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","Patient concern is recorded but the clinician's reassurance is not."]],"claims":[],"note":"Subjective\nReports fatigue x2 weeks.\nIntermittent HA, worse in evenings.\nOccasional dizziness.\nPoor sleep related to work stress.\nSometimes skips meals.\nConcerned about serious underlying condition.\nObjective\nNo objective findings or measurements documented.\nAssessment\nFatigue with intermittent evening HA and occasional dizziness.\nPoor sleep, work stress, and skipped meals may be contributing.\nAnaemia or vitamin deficiency considered; blood testing planned to evaluate.\nPlan\nArrange blood tests to assess for anaemia and vitamin deficiency.\nAdvise regular meals, increased water intake, and adequate sleep.\nReview after results available; discuss appropriate treatment based on findings.","review":53.55263157894737,"saved":109.94736842105263,"clean":false,"effort":11.11111111111111,"sig":[],"mb":3.251567,"latency":7.49,"signable":61.04263157894737},{"label":"Run 4","wer":1.7045454545454544,"text":"नमस्ते, आइए बैठिए। मैं डॉक्टर मेहता हूँ; किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है, सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद।","marks":[{"start":89,"end":90,"said":"द","significant":false},{"start":594,"end":597,"said":"जर","significant":false},{"start":610,"end":612,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","Fatigue x2 weeks."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Intermittent HA, worse in evenings."],["Captures occasional dizziness.","yes","Occasional dizziness."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Framed as \"may be contributing\", not diagnosis."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests to assess anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, increased water, adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","Review after results with treatment guided by results."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Patient's concern about serious illness recorded, but the doctor's reassurance (common problem, no need to worry now) is omitted."]],"claims":[],"note":"Subjective\nReports fatigue x2 weeks.\nIntermittent HA, worse in evenings.\nOccasional dizziness.\nReports increased work-related stress.\nSleep poor.\nSometimes skips meals.\nConcerned about serious underlying illness.\nObjective\nNo examination findings or measurements documented.\nAssessment\nFatigue with intermittent evening HA and occasional dizziness.\nPoor sleep, skipped meals, and work stress may be contributing.\nConsider anaemia or vitamin deficiency; blood testing discussed to evaluate.\nPlan\nSimple blood test planned to assess for anaemia/vitamin deficiency.\nAdvised regular meals, increased water intake, and adequate sleep.\nReview after results available for further treatment planning.","review":43.48684210526316,"saved":120.01315789473685,"clean":false,"effort":5.555555555555555,"sig":[],"mb":3.277749,"latency":8.181,"signable":51.667842105263155},{"label":"Run 5","wer":1.7045454545454544,"text":"नमस्ते, आइए बैठिए। मैं डॉक्टर मेहता हूँ; किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है, सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद।","marks":[{"start":89,"end":90,"said":"द","significant":false},{"start":594,"end":597,"said":"जर","significant":false},{"start":610,"end":612,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","Fatigue x2 weeks."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Intermittent HA, worse in evenings."],["Captures occasional dizziness.","yes","Occasional dizziness."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Framed as \"may be contributing\", not diagnosis."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests to assess anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, increased water, adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","Review after results with treatment guided by results."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Patient's concern about serious illness recorded, but the doctor's reassurance (common problem, no need to worry now) is omitted."]],"claims":[],"note":"Subjective\nReports fatigue x2 weeks.\nIntermittent HA, worse in evenings.\nOccasional dizziness.\nReports increased work stress, poor sleep, and sometimes skipping meals.\nConcerned about possible serious illness.\nObjective\nNo objective exam findings or measurements documented.\nAssessment\nFatigue with intermittent evening HA and occasional dizziness.\nPoor sleep, increased stress, and missed meals may be contributing.\nAnaemia or vitamin deficiency to be evaluated with blood tests.\nPlan\nBlood tests planned to assess for anaemia and vitamin deficiency.\nAdvise regular meals, increased water intake, and adequate sleep.\nReview after results available; treatment to be guided by results.","review":44.43421052631579,"saved":119.06578947368422,"clean":false,"effort":5.555555555555555,"sig":[],"mb":3.267282,"latency":8.483,"signable":52.917210526315785}],"heidi":[{"label":"Run 1","wer":3.4090909090909087,"text":"नमस्ते, आइए बैठिए। मैं Doctor Mehta हूँ। किस परेशानी के लिए आए हैं? नमस्ते Doctor, पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी होता है। खासकर शाम को ज्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं पता चल जाएगा। ठीक है doctor, कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":23,"end":35,"said":"ड क टर म हत","significant":false},{"start":75,"end":81,"said":"ड क टर","significant":false},{"start":311,"end":315,"said":"ट इम","significant":false},{"start":337,"end":343,"said":"स ट र स","significant":false},{"start":354,"end":366,"said":"ड क टर इसल","significant":false},{"start":406,"end":410,"said":"स क प","significant":false},{"start":447,"end":464,"said":"स पल ब लड ट स ट","significant":false},{"start":478,"end":484,"said":"एन म","significant":false},{"start":488,"end":495,"said":"य व ट म न","significant":false},{"start":535,"end":541,"said":"ड क टर","significant":false},{"start":607,"end":609,"said":"य","significant":false},{"start":624,"end":630,"said":"र प र ट","significant":false},{"start":646,"end":655,"said":"ट र टम ट","significant":false},{"start":675,"end":681,"said":"ड क टर","significant":false},{"start":692,"end":697,"said":"र ल क स","significant":false},{"start":724,"end":728,"said":"ट इम","significant":false},{"start":780,"end":786,"said":"र प र ट","significant":false},{"start":816,"end":822,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue for the past 2 weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Recurrent headaches, intermittent, worse in the evenings\" captured."],["Captures occasional dizziness.","yes","\"Occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","\"Poor sleep attributed to work stress\" and \"Occasionally skips meals\" captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Assessment attributes symptoms only to possible anaemia/vitamin deficiency; stress/lifestyle not presented as contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"possible anaemia or vitamin deficiency\" with blood tests to check; not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","\"eat meals on time, increase fluid intake, and ensure adequate sleep\" captured."],["Plans review after blood results, with treatment determined after results.","yes","\"Review results upon availability to determine appropriate management\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance to the patient is documented."]],"claims":[],"note":"Subjective\n\n- Fatigue for the past 2 weeks\n\n- Recurrent headaches, intermittent, worse in the evenings\n\n- Occasional dizziness\n\n- Poor sleep attributed to work stress\n\n- Occasionally skips meals\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- Symptoms suggestive of possible anaemia or vitamin deficiency\n\n\n\n\nPlan\n\n- Order blood tests to check for anaemia and vitamin deficiencies\n\n- Advised to eat meals on time, increase fluid intake, and ensure adequate sleep\n\n- Review results upon availability to determine appropriate management","review":67.15789473684211,"saved":96.34210526315789,"clean":false,"effort":22.22222222222222,"sig":[],"mb":24.956826,"latency":23.336,"signable":90.49389473684211},{"label":"Run 2","wer":5.681818181818182,"text":"नमस्ते, आइए बैठिए। मैं डॉक्टर मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर, पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार-बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है या कभी-कभी? कभी-कभी होता है। खासकर शाम को ज्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं, पता चल जाएगा। ठीक है doctor। कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":134,"end":138,"said":"रदर","significant":false},{"start":165,"end":169,"said":"रदर","significant":false},{"start":313,"end":317,"said":"ट इम","significant":false},{"start":339,"end":345,"said":"स ट र स","significant":false},{"start":356,"end":368,"said":"ड क टर इसल","significant":false},{"start":408,"end":412,"said":"स क प","significant":false},{"start":449,"end":466,"said":"स पल ब लड ट स ट","significant":false},{"start":480,"end":486,"said":"एन म","significant":false},{"start":490,"end":497,"said":"य व ट म न","significant":false},{"start":538,"end":544,"said":"ड क टर","significant":false},{"start":610,"end":612,"said":"य","significant":false},{"start":627,"end":633,"said":"र प र ट","significant":false},{"start":649,"end":658,"said":"ट र टम ट","significant":false},{"start":678,"end":684,"said":"ड क टर","significant":false},{"start":695,"end":700,"said":"र ल क स","significant":false},{"start":727,"end":731,"said":"ट इम","significant":false},{"start":783,"end":789,"said":"र प र ट","significant":false},{"start":819,"end":825,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue x2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Recurrent headaches, intermittent, more pronounced in evenings\"."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","\"Significant work stress\", \"Irregular sleep\", \"Occasional skipped meals\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Assessment names only possible deficiency; stress/sleep/meals are cited as supporting a deficiency rather than as possible contributors themselves."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","partial","Blood test for anaemia and vitamin deficiency planned and framed as possible, but narrowed to \"iron deficiency anaemia\", which was never raised."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meals, increase water intake, ensure adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Review after blood test results available for further management\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance recorded."]],"claims":[["Possible iron deficiency anaemia","Doctor mentioned only एनीमिया generically; iron deficiency is a specific type not raised anywhere in the transcript."]],"note":"Subjective\n\n- Fatigue x2 weeks\n\n- Recurrent headaches, intermittent, more pronounced in evenings\n\n- Occasional dizziness\n\n- Significant work stress\n\n- Irregular sleep\n\n- Occasional skipped meals\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- Possible iron deficiency anaemia or vitamin deficiency given reported symptoms and lifestyle factors\n\n\n\n\nPlan\n\n- Order FBC to check for anaemia and vitamin deficiencies\n\n- Lifestyle advice: regular meals, increase water intake, ensure adequate sleep\n\n- Review after blood test results available for further management","review":85.77631578947368,"saved":77.72368421052632,"clean":false,"effort":33.33333333333333,"sig":[],"mb":20.217945,"latency":24.517,"signable":110.29331578947368},{"label":"Run 3","wer":3.4090909090909087,"text":"नमस्ते, आइए बैठिए। मैं डॉक्टर मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर, पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी होता है। खासकर शाम को ज्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं पता चल जाएगा। ठीक है doctor। कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":311,"end":315,"said":"ट इम","significant":false},{"start":337,"end":343,"said":"स ट र स","significant":false},{"start":354,"end":366,"said":"ड क टर इसल","significant":false},{"start":406,"end":410,"said":"स क प","significant":false},{"start":447,"end":464,"said":"स पल ब लड ट स ट","significant":false},{"start":478,"end":484,"said":"एन म","significant":false},{"start":488,"end":495,"said":"य व ट म न","significant":false},{"start":535,"end":541,"said":"ड क टर","significant":false},{"start":607,"end":609,"said":"य","significant":false},{"start":624,"end":630,"said":"र प र ट","significant":false},{"start":646,"end":655,"said":"ट र टम ट","significant":false},{"start":675,"end":681,"said":"ड क टर","significant":false},{"start":692,"end":697,"said":"र ल क स","significant":false},{"start":724,"end":728,"said":"ट इम","significant":false},{"start":780,"end":786,"said":"र प र ट","significant":false},{"start":816,"end":822,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","Fatigue for 2 weeks."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Intermittent headaches worse in the evening."],["Captures occasional dizziness.","yes","Occasional dizziness."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Stress/sleep/meals presented as possible contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests for anaemia/vitamin deficiency, not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, hydration and adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","Review after results to determine treatment."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","Clinician reassurance that there is no need to worry now and it is common is not recorded."]],"claims":[],"note":"Subjective\n\n- Fatigue x2 weeks\n\n- Recurrent headaches, intermittent, worse in evenings\n\n- Occasional dizziness\n\n- Poor sleep\n\n- Frequently missing meals\n\n- Work-related stress\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- Symptoms consistent with possible anaemia or vitamin deficiency\n\n- Potentially exacerbated by stress and inconsistent lifestyle habits\n\n\n\n\nPlan\n\n- Order simple blood test to check for anaemia and vitamin deficiencies\n\n- Counselled on importance of regular meals, adequate hydration and sufficient sleep\n\n- Review results once available to determine appropriate treatment","review":46.28947368421053,"saved":117.21052631578948,"clean":false,"effort":11.11111111111111,"sig":[],"mb":28.753375,"latency":26.972,"signable":73.26147368421053},{"label":"Run 4","wer":3.4090909090909087,"text":"नमस्ते। आइए, बैठिए। मैं Doctor Mehta हूँ। किस परेशानी के लिए आए हैं? नमस्ते Doctor। पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी होता है। खासकर शाम को ज्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं पता चल जाएगा। ठीक है doctor, कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":24,"end":36,"said":"ड क टर म हत","significant":false},{"start":76,"end":82,"said":"ड क टर","significant":false},{"start":312,"end":316,"said":"ट इम","significant":false},{"start":338,"end":344,"said":"स ट र स","significant":false},{"start":355,"end":367,"said":"ड क टर इसल","significant":false},{"start":407,"end":411,"said":"स क प","significant":false},{"start":448,"end":465,"said":"स पल ब लड ट स ट","significant":false},{"start":479,"end":485,"said":"एन म","significant":false},{"start":489,"end":496,"said":"य व ट म न","significant":false},{"start":536,"end":542,"said":"ड क टर","significant":false},{"start":608,"end":610,"said":"य","significant":false},{"start":625,"end":631,"said":"र प र ट","significant":false},{"start":647,"end":656,"said":"ट र टम ट","significant":false},{"start":676,"end":682,"said":"ड क टर","significant":false},{"start":693,"end":698,"said":"र ल क स","significant":false},{"start":725,"end":729,"said":"ट इम","significant":false},{"start":781,"end":787,"said":"र प र ट","significant":false},{"start":817,"end":823,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue x2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","'Intermittent headaches, predominantly in the evening'."],["Captures occasional dizziness.","yes","'Occasional dizziness'."],["Captures work stress, poor sleep, and skipped meals.","yes","'Increased work stress → inadequate sleep and occasional skipped meals'."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Assessment is empty; stress/lifestyle not presented as a possible contributor to the symptoms."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","'Blood test to check for anaemia or vitamin deficiencies'."],["Advises regular meals, hydration, and adequate sleep.","yes","'eat meals on time, increase water intake, ensure adequate sleep'."],["Plans review after blood results, with treatment determined after results.","yes","'Follow-up after blood test results for treatment plan'."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","The doctor's reassurance ('अभी चिंता करने की जरूरत नहीं है। ये आम समस्या है') is not recorded."]],"claims":[],"note":"Subjective\n\n- Fatigue x2 weeks\n\n- Intermittent headaches, predominantly in the evening\n\n- Occasional dizziness\n\n- Increased work stress → inadequate sleep and occasional skipped meals\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- \n\n\n\n\nPlan\n\n- Blood test to check for anaemia or vitamin deficiencies\n\n- Advised to eat meals on time, increase water intake, ensure adequate sleep\n\n- Follow-up after blood test results for treatment plan","review":63.05263157894737,"saved":100.44736842105263,"clean":false,"effort":22.22222222222222,"sig":[],"mb":21.278129,"latency":25.642,"signable":88.69463157894737},{"label":"Run 5","wer":5.681818181818182,"text":"नमस्ते। आइए बैठिए। मैं Doctor Mehta हूँ। किस परेशानी के लिए आए हैं? नमस्ते Doctor, पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है या कभी कभी? कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं पता चल जाएगा। ठीक है doctor, कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":23,"end":35,"said":"ड क टर म हत","significant":false},{"start":75,"end":81,"said":"ड क टर","significant":false},{"start":134,"end":138,"said":"रदर","significant":false},{"start":165,"end":169,"said":"रदर","significant":false},{"start":191,"end":191,"said":"-कभ","significant":false},{"start":198,"end":204,"said":"-कभ","significant":false},{"start":313,"end":317,"said":"ट इम","significant":false},{"start":339,"end":345,"said":"स ट र स","significant":false},{"start":356,"end":368,"said":"ड क टर इसल","significant":false},{"start":408,"end":412,"said":"स क प","significant":false},{"start":449,"end":466,"said":"स पल ब लड ट स ट","significant":false},{"start":480,"end":486,"said":"एन म","significant":false},{"start":490,"end":497,"said":"य व ट म न","significant":false},{"start":537,"end":543,"said":"ड क टर","significant":false},{"start":609,"end":611,"said":"य","significant":false},{"start":626,"end":632,"said":"र प र ट","significant":false},{"start":648,"end":657,"said":"ट र टम ट","significant":false},{"start":677,"end":683,"said":"ड क टर","significant":false},{"start":694,"end":699,"said":"र ल क स","significant":false},{"start":726,"end":730,"said":"ट इम","significant":false},{"start":782,"end":788,"said":"र प र ट","significant":false},{"start":818,"end":824,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue x2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","'Intermittent headaches, worse in evenings'."],["Captures occasional dizziness.","yes","'Occasional dizziness'."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals recorded."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","'possibly related to stress and irregular lifestyle'."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test to check anaemia/vitamin deficiency, framed as to exclude."],["Advises regular meals, hydration, and adequate sleep.","yes","'regular meals, adequate hydration, sufficient sleep'."],["Plans review after blood results, with treatment determined after results.","yes","'Review after blood test results for definitive treatment'."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","The doctor's reassurance ('अभी चिंता करने की जरूरत नहीं है। ये आम समस्या है') is not recorded."]],"claims":[],"note":"Subjective\n\n- Fatigue x2 weeks\n\n- Intermittent headaches, worse in evenings\n\n- Occasional dizziness\n\n- Increased work-related stress\n\n- Poor sleep\n\n- Skipped meals\n\n\n\n\nObjective\n\n- \n\n\n\n\nAssessment\n\n- General fatigue, possibly related to stress and irregular lifestyle\n\n- Further investigation required to exclude anaemia or vitamin deficiency\n\n\n\n\nPlan\n\n- Blood test: check for anaemia and vitamin deficiencies\n\n- Counselled on regular meals, adequate hydration, sufficient sleep\n\n- Review after blood test results for definitive treatment","review":44.71052631578947,"saved":118.78947368421052,"clean":false,"effort":11.11111111111111,"sig":[],"mb":21.037776,"latency":29.341,"signable":74.05152631578947},{"label":"Run 6","wer":3.4090909090909087,"text":"नमस्ते, आइए बैठिए। मैं Doctor Mehta हूँ। किस परेशानी के लिए आए हैं? नमस्ते Doctor, पिछले दो हफ्तों से बहुत थकान लग रही है।\n\nबार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी होता है। खासकर शाम को ज्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना time पर हो रहा है? काम का stress ज्यादा है doctor, इसीलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी skip हो जाता है। यही वजह हो सकती है।\n\nएक simple blood test कर लेते हैं। Anemia या vitamin की कमी है या नहीं पता चल जाएगा। ठीक है doctor, कोई बड़ी समस्या तो नहीं है ना? अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। Report आने के बाद सही treatment बता दूंगा। धन्यवाद doctor। अब थोड़ा relax लग रहा है। इसीलिए हम हैं। Time पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए। Report आने पर फिर मिलते हैं। ठीक है doctor। बहुत धन्यवाद।","marks":[{"start":23,"end":35,"said":"ड क टर म हत","significant":false},{"start":75,"end":81,"said":"ड क टर","significant":false},{"start":311,"end":315,"said":"ट इम","significant":false},{"start":337,"end":343,"said":"स ट र स","significant":false},{"start":354,"end":366,"said":"ड क टर इसल","significant":false},{"start":406,"end":410,"said":"स क प","significant":false},{"start":447,"end":464,"said":"स पल ब लड ट स ट","significant":false},{"start":478,"end":484,"said":"एन म","significant":false},{"start":488,"end":495,"said":"य व ट म न","significant":false},{"start":535,"end":541,"said":"ड क टर","significant":false},{"start":607,"end":609,"said":"य","significant":false},{"start":624,"end":630,"said":"र प र ट","significant":false},{"start":646,"end":655,"said":"ट र टम ट","significant":false},{"start":675,"end":681,"said":"ड क टर","significant":false},{"start":692,"end":697,"said":"र ल क स","significant":false},{"start":724,"end":728,"said":"ट इम","significant":false},{"start":780,"end":786,"said":"र प र ट","significant":false},{"start":816,"end":822,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"fatigue for 2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Intermittent headaches, worse in the evenings\"."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","\"Work-related stress affecting sleep\", \"Missed meals\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Assessment lists only possible anaemia/vitamin deficiency; lifestyle factors not framed as contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Blood tests ordered to investigate for anaemia and vitamin deficiency\"; only \"possible\"."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meal times, increasing fluid intake, and ensuring adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","partial","\"Review once blood test results available\" but treatment decision after results not stated."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance recorded."]],"claims":[],"note":"Subjective:\n\n- Persistent fatigue for 2 weeks\n\n- Intermittent headaches, worse in the evenings\n\n- Occasional dizziness\n\n- Work-related stress affecting sleep\n\n- Missed meals\n\n\n\n\nObjective:\n\n- \n\n\n\n\nAssessment:\n\n- Symptoms suggestive of possible anaemia or vitamin deficiency\n\n\n\n\nPlan:\n\n- Blood tests ordered to investigate for anaemia and vitamin deficiency\n\n- Counselled on maintaining regular meal times, increasing fluid intake, and ensuring adequate sleep\n\n- Review once blood test results available","review":77.76315789473685,"saved":85.73684210526315,"clean":false,"effort":27.77777777777778,"sig":[],"mb":20.125102,"latency":23.235,"signable":100.99815789473685}],"freed":[{"label":"Run 1","wer":95.45454545454545,"text":"Namaste.\nAaye baithiye.\nMain doctor mehta hu.\nKis pareshani ke liye aaye hain?\nNamaste doctor.\nPichle do hafton se bahut thakaan lag rahi hain.\nBar bar sirr darad bhi ho raha hain.\nTheek hai.\nSirr darad hamesha rahe hain ya kabhi kabhi.\nKabhi kabhi hota hain.\nKhas kar shyaam ko zyada hota hain.\nKabhi kabhi chakkar jaisa bhi lagta hain.\nSamajh gaya.\nNeend theek se mil rahi hain.\nKhaana time par ho raha hain.\nKam ka stress zyada hain doctor.\nIsiliye neend bhi theek nahi hain.\nSometimes, cannabis is skipped.\nThis could be the reason.\nLet's do a simple blood test.\nAnemia or vitamin deficiency, whether there is or not, will be found out.\nOkay, doctor, is there any major problem?\nThere is no need to worry now.\nThis is a common problem.\nAfter the report comes, I will tell you the right treatment.\nThank you, doctor.\nNow I am feeling a little relaxed.\nThat's why we are here.\nEat on time, drink more water and sleep well.\nReport anay par phir milte hain.\nTheek hai doctor.\nBahut dhanyavad.","marks":[{"start":0,"end":992,"said":"नमस त आइए ब ठ ए म ड क टर म हत ह क स पर श न क ल ए आए ह नमस त ड क टर प छल द हफ त स बह त थक न लग रह ह ब र-ब र स रदर द भ ह रह ह ठ क ह स रदर द हम श रहत ह य कभ -कभ कभ -कभ ह त ह ख सकर श म क ज य द ह त ह कभ -कभ चक कर ज स भ लगत ह समझ गय न द ठ क स म ल रह ह ख न ट इम पर ह रह ह क म क स ट र स ज य द ह ड क टर इसल ए न द भ ठ क नह ह कभ -कभ ख न भ स क प ह ज त ह यह वजह ह सकत ह एक स पल ब लड ट स ट कर ल त ह एन म य य व ट म न क कम ह य नह पत चल ज एग ठ क ह ड क टर क ई बड समस य त नह ह न अभ च त करन क जर रत नह ह य आम समस य ह र प र ट आन क ब द सह ट र टम ट बत द ग धन यव द ड क टर अब थ ड र ल क स लग रह ह इस ल ए हम ह ट इम पर ख न ख इए प न ज य द प ज ए और न द प र रख ए र प र ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional episodes of lightheadedness\" and \"associated dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and \"irregular eating habits\" captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"Symptoms appear to be related to work stress\" framed as possible."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance to the patient is documented."]],"claims":[["Cannabis use, sometimes skipped","Transcript never mentions cannabis or any substance use; patient said meals were sometimes skipped (khana skip)."]],"note":"Subjective\nCliniTech Benchmark 8e3f6db5 presents with complaints of fatigue and intermittent headaches over the past two weeks. The patient reports significant fatigue and describes intermittent headaches that occur more frequently in the evening. The patient also reports occasional episodes of lightheadedness. The patient attributes the symptoms to increased work-related stress, which has been affecting sleep quality. The patient notes that cannabis is sometimes skipped, which could be a contributing factor. The patient also reports irregular eating habits.\n\nSocial History  \n- Stress: Reports significant work-related stress  \n- Diet: Irregular eating habits  \n- Substance Use: Cannabis use, sometimes skipped\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 2-week history of fatigue and intermittent headaches, worse in the evenings, associated with dizziness and poor sleep due to work stress.\n\nFatigue and headaches  \nAssessment: Patient reports 2 weeks of fatigue and intermittent headaches, particularly in the evenings, with associated dizziness. Symptoms appear to be related to work stress affecting sleep patterns. Clinician suspects possible anemia or vitamin deficiency as underlying causes.  \nPlan:  \n- Order blood tests to evaluate for anemia and vitamin deficiency  \n- Lifestyle recommendations: eat on time, drink more water, and improve sleep habits  \n- Follow up after lab results are available to determine appropriate treatment\n","review":100.28947368421052,"saved":63.21052631578948,"clean":false,"effort":27.77777777777778,"sig":[["fabrication","Cannabis use, sometimes skipped","Cannabis use never discussed (patient skipped meals); invented substance history could alter differential and the legal record."]],"mb":7.297442,"latency":33.697,"signable":124.40547368421052},{"label":"Run 2","wer":95.45454545454545,"text":"Namaste.\nAaye baithiye.\nMain doctor mehta hu.\nKis pareshani ke liye aaye hain?\nNamaste doctor.\nPichle do hafton se bahut thakaan lag rahi hain.\nBar bar sirr darad bhi ho raha hain.\nTheek hai.\nSirr darad hamesha rahe hain ya kabhi kabhi.\nKabhi kabhi hota hain.\nKhas kar shyaam ko zyada hota hain.\nKabhi kabhi chakkar jaisa bhi lagta hain.\nSamajh gaya.\nNeend theek se mil rahi hain.\nKhaana time par ho raha hain.\nKam ka stress zyada hain doctor.\nIsiliye neend bhi theek nahi hain.\nSometimes, cannabis is skipped.\nThis could be the reason.\nLet's do a simple blood test.\nAnemia or vitamin deficiency, whether there is or not, will be found out.\nOkay, doctor, is there any major problem?\nThere is no need to worry now.\nThis is a common problem.\nAfter the report comes, I will tell you the right treatment.\nThank you, doctor.\nNow I am feeling a little relaxed.\nThat's why we are here.\nEat on time, drink more water and sleep well.\nReport anay par phir milte hain.\nTheek hai doctor.\nBahut dhanyavad.","marks":[{"start":0,"end":992,"said":"नमस त आइए ब ठ ए म ड क टर म हत ह क स पर श न क ल ए आए ह नमस त ड क टर प छल द हफ त स बह त थक न लग रह ह ब र-ब र स रदर द भ ह रह ह ठ क ह स रदर द हम श रहत ह य कभ -कभ कभ -कभ ह त ह ख सकर श म क ज य द ह त ह कभ -कभ चक कर ज स भ लगत ह समझ गय न द ठ क स म ल रह ह ख न ट इम पर ह रह ह क म क स ट र स ज य द ह ड क टर इसल ए न द भ ठ क नह ह कभ -कभ ख न भ स क प ह ज त ह यह वजह ह सकत ह एक स पल ब लड ट स ट कर ल त ह एन म य य व ट म न क कम ह य नह पत चल ज एग ठ क ह ड क टर क ई बड समस य त नह ह न अभ च त करन क जर रत नह ह य आम समस य ह र प र ट आन क ब द सह ट र टम ट बत द ग धन यव द ड क टर अब थ ड र ल क स लग रह ह इस ल ए हम ह ट इम पर ख न ख इए प न ज य द प ज ए और न द प र रख ए र प र ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","partial","Work stress and poor sleep captured, but skipped meals garbled as \"cannabis is sometimes skipped\"; only \"meal timing affected\" remains."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"Symptoms appear to be related to work stress affecting sleep\" presented as possible, not confirmed."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance to the patient is documented."]],"claims":[["Cannabis use, sometimes skipped","Transcript never mentions cannabis or any substance use; patient said meals were sometimes skipped (khana skip)."]],"note":"Subjective\nCliniTech Benchmark 12f5e4cb presents with complaints of fatigue and intermittent headaches over the past two weeks. The patient reports significant fatigue and intermittent headaches that tend to worsen in the evening. The patient also reports occasional episodes of dizziness. The patient attributes the symptoms to increased work-related stress, which has also affected sleep quality. The patient notes that cannabis is sometimes skipped, which could be a contributing factor. The patient's diet and meal timing have also been affected.\n\nSocial History  \n- Substance Use: Cannabis use reported, sometimes skipped  \n- Stress: Reports significant work-related stress  \n- Sleep: Sleep quality is poor due to stress  \n- Diet: Meal timing has been affected due to stress\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 2-week history of fatigue and intermittent headaches, worse in the evenings, associated with dizziness and poor sleep due to work stress.\n\nFatigue and headaches  \nAssessment: Patient reports 2 weeks of fatigue and intermittent headaches that occur more frequently in the evenings, sometimes accompanied by dizziness. Symptoms appear to be related to work stress affecting sleep patterns and overall well-being. The clinician suspects possible anemia or vitamin deficiency as contributing factors to these nonspecific symptoms.  \nPlan:  \n- Order blood tests to evaluate for anemia and vitamin deficiency  \n- Lifestyle recommendations: eat meals on time, increase water intake, and improve sleep hygiene  \n- Follow up after laboratory results are available to determine appropriate treatment\n","review":121.07894736842105,"saved":42.421052631578945,"clean":false,"effort":27.77777777777778,"sig":[["partial","Captures work stress, poor sleep, and skipped meals.","Skipped meals mistranscribed as cannabis being skipped, putting invented substance use into the history."]],"mb":5.360363,"latency":35.671,"signable":145.13394736842105},{"label":"Run 3","wer":95.45454545454545,"text":"Namaste.\nAaye baithiye.\nMain doctor mehta hu.\nKis pareshani ke liye aaye hain?\nNamaste doctor.\nPichle do hafton se bahut thakaan lag rahi hain.\nBar bar sirr darad bhi ho raha hain.\nTheek hai.\nSirr darad hamshe rehta hain ya kabhi kabhi.\nKabhi kabhi hota hain.\nKhas kar shyam ko zyada hota hain.\nKabhi kabhi chakkar jaisa bhi lagta hain.\nSamajh gaya.\nNeend theek se mil rahi hain.\nKhana time par ho raha hain.\nKam ka stress zyada hain doctor.\nIsiliye neend bhi theek nahi hain.\nSometimes, cannabis is skipped.\nThis could be the reason.\nLet's do a simple blood test.\nAnemia or vitamin deficiency, whether there is or not, will be found out.\nOkay, doctor, is there any major problem?\nThere is no need to worry now.\nThis is a common problem.\nAfter the report comes, I will tell you the right treatment.\nThank you, doctor.\nNow I am feeling a little relaxed.\nThat's why we are here.\nEat on time, drink more water and sleep well.\nReport anay par phir milte hain.\nTheek hai doctor.\nBahut dhanyavad.","marks":[{"start":0,"end":990,"said":"नमस त आइए ब ठ ए म ड क टर म हत ह क स पर श न क ल ए आए ह नमस त ड क टर प छल द हफ त स बह त थक न लग रह ह ब र-ब र स रदर द भ ह रह ह ठ क ह स रदर द हम श रहत ह य कभ -कभ कभ -कभ ह त ह ख सकर श म क ज य द ह त ह कभ -कभ चक कर ज स भ लगत ह समझ गय न द ठ क स म ल रह ह ख न ट इम पर ह रह ह क म क स ट र स ज य द ह ड क टर इसल ए न द भ ठ क नह ह कभ -कभ ख न भ स क प ह ज त ह यह वजह ह सकत ह एक स पल ब लड ट स ट कर ल त ह एन म य य व ट म न क कम ह य नह पत चल ज एग ठ क ह ड क टर क ई बड समस य त नह ह न अभ च त करन क जर रत नह ह य आम समस य ह र प र ट आन क ब द सह ट र टम ट बत द ग धन यव द ड क टर अब थ ड र ल क स लग रह ह इस ल ए हम ह ट इम पर ख न ख इए प न ज य द प ज ए और न द प र रख ए र प र ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","States fatigue \"over the past two weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"intermittent headaches that tend to worsen in the evening\"."],["Captures occasional dizziness.","yes","\"occasional episodes of dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","partial","Work stress and poor sleep captured, but skipped meals is mistranslated as \"cannabis is sometimes skipped\" and Diet says \"Eating on time\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Hedged: \"Symptoms appear to be related to work stress and poor sleep patterns\"; no confirmed diagnosis."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Order blood tests to evaluate for anemia and vitamin deficiency\"; framed as suspected, not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","\"eating regular meals, increasing water intake, and improving sleep hygiene\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Follow-up after laboratory results are available to determine appropriate treatment\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Only notes \"a common presentation\"; the doctor reassurance that there is no need to worry now is not captured."]],"claims":[["Cannabis use noted, with occasional skipped use","Transcript mentions skipping meals (खाना भी स्किप); no cannabis or any substance use is mentioned."],["Diet: Eating on time","Contradicts transcript: patient said meals are sometimes skipped; doctor advised eating on time."],["Review of Systems negatives (denies fever, weight changes, chest pain, palpitations, orthopnea, PND, syncope, edema, cough, wheezing, abdominal pain, nausea, vomiting, focal weakness)","None of these symptoms were asked about or denied anywhere in the transcript."]],"note":"Subjective\nCliniTech Benchmark 8da74727 presents with complaints of fatigue and intermittent headaches over the past two weeks. The patient reports persistent fatigue and intermittent headaches that tend to worsen in the evening. The patient also reports occasional episodes of dizziness. The patient attributes the symptoms to increased work-related stress, which has been affecting sleep quality. The patient notes that cannabis is sometimes skipped, which could be a contributing factor.\n\nSocial History  \n- Substance Use: Cannabis use noted, with occasional skipped use  \n- Stress: Reports significant work-related stress  \n- Sleep: Sleep is not adequate due to work stress  \n- Diet: Eating on time\n\nReview of Systems  \n- General: Denies fever, weight changes  \n- Cardiovascular: Denies chest pain, palpitations, orthopnea, PND, syncope, edema  \n- Respiratory: Denies cough, wheezing  \n- Gastrointestinal: Denies abdominal pain, nausea, vomiting  \n- Neurological: Dizziness, headaches, denies focal weakness\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with fatigue and intermittent headaches over the past two weeks, worse in the evenings, associated with occasional dizziness and poor sleep due to work stress.\n\nFatigue and headaches  \nAssessment: Patient reports fatigue and intermittent headaches over the past two weeks, with headaches occurring more frequently in the evenings and associated with occasional dizziness. Symptoms appear to be related to work stress and poor sleep patterns. The clinician suspects possible anemia or vitamin deficiency as contributing factors to the fatigue and headaches, noting this is a common presentation that requires laboratory evaluation for proper diagnosis.  \nPlan:  \n- Order blood tests to evaluate for anemia and vitamin deficiency  \n- Recommend eating regular meals, increasing water intake, and improving sleep hygiene  \n- Follow-up after laboratory results are available to determine appropriate treatment\n","review":146.06578947368422,"saved":17.43421052631578,"clean":false,"effort":50.0,"sig":[["partial","Captures work stress, poor sleep, and skipped meals.","Skipped meals becomes invented cannabis use and 'eating on time', reversing a key contributing history item."],["fabrication","Review of Systems negatives (denies fever, weight changes, chest pain, palpitations, orthopnea, PND, syncope, edema, cough, wheezing, abdominal pain, nausea, vomiting, focal weakness)","Full ROS of denied symptoms (syncope, chest pain, focal weakness etc.) never asked in a dizziness/headache presentation."]],"mb":7.356379,"latency":38.251,"signable":174.77978947368422},{"label":"Run 4","wer":95.45454545454545,"text":"Namaste.\nAaye baithiye.\nMain doctor mehta hu.\nKis pareshani ke liye aaye hain?\nNamaste doctor.\nPichle do hafton se bahut thakaan lag rahi hain.\nBar bar sirr darad bhi ho raha hain.\nTheek hai.\nSirr darad hamesha rahe hain ya kabhi kabhi.\nKabhi kabhi hota hain.\nKhas kar shyaam ko zyada hota hain.\nKabhi kabhi chakkar jaisa bhi lagta hain.\nSamajh gaya.\nNeend theek se mil rahi hain.\nKhaana time par ho raha hain.\nKam ka stress zyada hain doctor.\nIsiliye neend bhi theek nahi hain.\nSometimes, cannabis is skipped.\nThis could be the reason.\nLet's do a simple blood test.\nAnemia or vitamin deficiency, whether there is or not, will be found out.\nOkay, doctor, is there any major problem?\nThere is no need to worry now.\nThis is a common problem.\nAfter the report comes, I will tell you the right treatment.\nThank you, doctor.\nNow I am feeling a little relaxed.\nThat's why we are here.\nEat on time, drink more water and sleep well.\nReport anay par phir milte hain.\nTheek hai doctor.\nBahut dhanyavad.","marks":[{"start":0,"end":992,"said":"नमस त आइए ब ठ ए म ड क टर म हत ह क स पर श न क ल ए आए ह नमस त ड क टर प छल द हफ त स बह त थक न लग रह ह ब र-ब र स रदर द भ ह रह ह ठ क ह स रदर द हम श रहत ह य कभ -कभ कभ -कभ ह त ह ख सकर श म क ज य द ह त ह कभ -कभ चक कर ज स भ लगत ह समझ गय न द ठ क स म ल रह ह ख न ट इम पर ह रह ह क म क स ट र स ज य द ह ड क टर इसल ए न द भ ठ क नह ह कभ -कभ ख न भ स क प ह ज त ह यह वजह ह सकत ह एक स पल ब लड ट स ट कर ल त ह एन म य य व ट म न क कम ह य नह पत चल ज एग ठ क ह ड क टर क ई बड समस य त नह ह न अभ च त करन क जर रत नह ह य आम समस य ह र प र ट आन क ब द सह ट र टम ट बत द ग धन यव द ड क टर अब थ ड र ल क स लग रह ह इस ल ए हम ह ट इम पर ख न ख इए प न ज य द प ज ए और न द प र रख ए र प र ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","\"fatigue ... over the past two weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"intermittent, occurring more frequently in the evening\"."],["Captures occasional dizziness.","yes","\"reports occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","partial","Stress and poor sleep captured; skipped meals rendered as \"cannabis is sometimes skipped\" and \"Reports eating on time\", only vaguely noted as \"meal timing\" in assessment."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","Stress listed within a differential (\"stress-related symptoms\"), not confirmed."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Anaemia and vitamin deficiency in differential; \"Order blood tests to evaluate\"."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meal timing, increased water intake, and improved sleep hygiene\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Follow-up after lab results are available to determine appropriate treatment\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Says \"common presentation requiring further evaluation\" but omits the reassurance that there is no need to worry now."]],"claims":[["Cannabis use reported; sometimes skipped","Transcript refers to skipped meals; no cannabis or substance use is mentioned."],["Diet/Nutrition: Reports eating on time","Contradicts transcript: patient said meals are sometimes skipped."]],"note":"Subjective\nCliniTech Benchmark 3830f130 presents with complaints of fatigue and intermittent headache over the past two weeks. The headache is intermittent, occurring more frequently in the evening. The patient also reports occasional dizziness and attributes the symptoms in part to significant work-related stress, which has been affecting sleep quality. The patient notes that cannabis is sometimes skipped, which could be a contributing factor.\n\nSocial History  \n- Substance Use: Cannabis use reported; sometimes skipped  \n- Stress: Reports significant work-related stress  \n- Sleep: Sleep is not adequate due to stress  \n- Diet/Nutrition: Reports eating on time\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with a 2-week history of fatigue and intermittent headaches, worse in the evenings, associated with dizziness and poor sleep due to work stress.\n\nFatigue and headaches  \nAssessment: Patient reports 2 weeks of fatigue and intermittent headaches, particularly worse in the evenings, associated with dizziness. Symptoms appear to be related to work stress affecting sleep patterns and meal timing. Differential diagnosis includes anemia, vitamin deficiency, or stress-related symptoms. This is a common presentation requiring further evaluation to determine underlying cause.  \nPlan:  \n- Order blood tests to evaluate for anemia and vitamin deficiency  \n- Recommend regular meal timing, increased water intake, and improved sleep hygiene  \n- Follow-up after lab results are available to determine appropriate treatment\n","review":117.32894736842105,"saved":46.171052631578945,"clean":false,"effort":33.33333333333333,"sig":[["partial","Captures work stress, poor sleep, and skipped meals.","Skipped meals becomes invented cannabis use and 'eating on time', reversing a key contributing history item."]],"mb":7.338011,"latency":34.41,"signable":142.05994736842106},{"label":"Run 5","wer":95.45454545454545,"text":"Namaste.\nAaye baithiye.\nMain doctor mehta hu.\nKis pareshani ke liye aaye hain?\nNamaste doctor.\nPichle do hafton se bahut thakaan lag rahi hain.\nBar bar sirr darad bhi ho raha hain.\nTheek hai.\nSirr darad hamesha rahe hain ya kabhi kabhi.\nKabhi kabhi hota hain.\nKhas kar shyaam ko zyada hota hain.\nKabhi kabhi chakkar jaisa bhi lagta hain.\nSamajh gaya.\nNeend theek se mil rahi hain.\nKhaana time par ho raha hain.\nKam ka stress zyada hain doctor.\nIsiliye neend bhi theek nahi hain.\nSometimes, cannabis is skipped.\nThis could be the reason.\nLet's do a simple blood test.\nAnemia or vitamin deficiency, whether there is or not, will be found out.\nOkay, doctor, is there any major problem?\nThere is no need to worry now.\nThis is a common problem.\nAfter the report comes, I will tell you the right treatment.\nThank you, doctor.\nNow I am feeling a little relaxed.\nThat's why we are here.\nEat on time, drink more water and sleep well.\nReport anay par phir milte hain.\nTheek hai doctor.\nBahut dhanyavad.","marks":[{"start":0,"end":992,"said":"नमस त आइए ब ठ ए म ड क टर म हत ह क स पर श न क ल ए आए ह नमस त ड क टर प छल द हफ त स बह त थक न लग रह ह ब र-ब र स रदर द भ ह रह ह ठ क ह स रदर द हम श रहत ह य कभ -कभ कभ -कभ ह त ह ख सकर श म क ज य द ह त ह कभ -कभ चक कर ज स भ लगत ह समझ गय न द ठ क स म ल रह ह ख न ट इम पर ह रह ह क म क स ट र स ज य द ह ड क टर इसल ए न द भ ठ क नह ह कभ -कभ ख न भ स क प ह ज त ह यह वजह ह सकत ह एक स पल ब लड ट स ट कर ल त ह एन म य य व ट म न क कम ह य नह पत चल ज एग ठ क ह ड क टर क ई बड समस य त नह ह न अभ च त करन क जर रत नह ह य आम समस य ह र प र ट आन क ब द सह ट र टम ट बत द ग धन यव द ड क टर अब थ ड र ल क स लग रह ह इस ल ए हम ह ट इम पर ख न ख इए प न ज य द प ज ए और न द प र रख ए र प र ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","partial","Work stress and poor sleep captured; skipped meals replaced by \"sometimes cannabis is skipped\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"Symptoms appear to be related to work stress and poor sleep patterns\" framed as possible."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance to the patient is documented."]],"claims":[["Cannabis use, sometimes skipped","Transcript never mentions cannabis or any substance use; patient said meals were sometimes skipped (khana skip)."]],"note":"Subjective\nCliniTech Benchmark dd844657 presents with complaints of fatigue and intermittent headaches over the past two weeks. The headaches are intermittent, occurring more frequently in the evenings. The patient also reports occasional episodes of dizziness. The patient attributes the symptoms to increased work-related stress, which has been affecting sleep quality. It is noted that sometimes cannabis is skipped, which could be a contributing factor.\n\nSocial History  \n- Substance Use: Cannabis use noted, sometimes skipped  \n- Stress: Reports increased work-related stress\n\nReview of Systems  \n- Neurological: Positive for dizziness  \n- Psychiatric: Positive for poor sleep\n\nObjective\nN/A\n\nAssessment & Plan\nPatient presents with fatigue and intermittent headaches over the past two weeks, with symptoms worse in the evenings and associated dizziness.\n\nFatigue and headaches  \nAssessment: Patient reports two weeks of fatigue and intermittent headaches, worse in the evenings, with associated dizziness. Symptoms appear to be related to work stress and poor sleep patterns. Clinician suspects possible anemia or vitamin deficiency as underlying cause and recommends laboratory evaluation to rule out these conditions.  \nPlan:  \n- Order blood tests to evaluate for anemia and vitamin deficiency  \n- Lifestyle recommendations: eat on time, drink more water, and ensure adequate sleep  \n- Follow up after lab results are available to determine appropriate treatment\n","review":111.60526315789474,"saved":51.89473684210526,"clean":false,"effort":27.77777777777778,"sig":[["partial","Captures work stress, poor sleep, and skipped meals.","Skipped meals replaced by cannabis being skipped; meal-skipping lost and substance use invented."]],"mb":7.304791,"latency":35.715,"signable":137.65726315789473}],"cliniscripts":[{"label":"Run 1","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर, इसलिए नींद भी ठीक नहीं है। कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं\n, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":592,"end":595,"said":"जर","significant":false},{"start":608,"end":610,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, insufficient sleep and skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"likely related to stress, inadequate sleep, and irregular dietary habits\" framed as assessment, with differentials still open."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","\"common issue and not a major problem at this stage\" reflects reassurance without claiming serious disease excluded."]],"claims":[],"note":"S (Subjective):\n- The patient reports experiencing significant fatigue for the past two weeks.\n- They describe frequent headaches, which occur occasionally and worsen in the evening.\n- The patient also reports experiencing occasional dizziness.\n- They attribute their symptoms to high work-related stress, leading to insufficient sleep and sometimes skipping meals.\n- The patient expressed concern about the potential severity of their condition.\n\nO (Objective):\n- The patient presented in a cooperative manner during the interaction.\n- They appeared initially concerned but became more relaxed after reassurance from the doctor.\n- No specific objective measurements, such as vital signs or physical examination findings, were documented in the transcript.\n- No laboratory results or imaging studies are available at this time.\n\nA (Assessment):\n- The patient's symptoms are currently assessed as likely related to stress, inadequate sleep, and irregular dietary habits.\n- Differential diagnoses include anemia or vitamin deficiency, requiring further investigation.\n- The doctor reassured the patient that their symptoms appear to be a common issue and not a major problem at this stage.\n\nP (Plan):\n- A simple blood test will be conducted to screen for anemia and vitamin deficiencies.\n- The patient was advised to ensure timely meals, increase water intake, and prioritize adequate sleep.\n- The treatment plan will be finalized after the blood test results are available.\n- A follow-up appointment is scheduled to discuss the test results and implement appropriate management.\n","review":70.73684210526315,"saved":92.76315789473685,"clean":true,"effort":0.0,"sig":[],"mb":5.884388,"latency":29.212,"signable":84.74084210526316},{"label":"Run 2","wer":9.090909090909092,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसीलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं\n, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":362,"end":366,"said":"इसल","significant":false},{"start":593,"end":596,"said":"जर","significant":false},{"start":609,"end":611,"said":"य","significant":false},{"start":792,"end":792,"said":"ट आन पर फ र म लत ह ठ क ह ड क टर बह त धन यव द","significant":true}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and occasional skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Stress/lifestyle appear only as patient attribution in S; assessment does not frame them as possible contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","partial","\"Treatment will be determined ... once the blood test reports are available\" but no explicit review visit."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Notes doctor considers it \"a common problem\" but the reassurance to the patient is not clearly captured."]],"claims":[],"note":"S (Subjective):\n- The patient reports experiencing significant fatigue for the past two weeks.\n- They also report frequent headaches, which occur occasionally and are exacerbated in the evenings.\n- The patient sometimes experiences dizziness.\n- They attribute their symptoms to high work stress, leading to poor sleep and occasional skipped meals.\n- The patient expressed concern about the potential seriousness of their condition.\n\nO (Objective):\n- The patient presented with stated concerns regarding their health.\n- Not enough information for objective findings such as vital signs, physical examination, or initial test results.\n\nA (Assessment):\n- The doctor considers the patient's presented symptoms to be a common problem.\n- Differential diagnoses include anemia or vitamin deficiency, prompting further investigation.\n\nP (Plan):\n- A simple blood test has been ordered to check for anemia or vitamin deficiency.\n- The patient was advised to eat meals on time, increase water intake, and ensure adequate sleep.\n- Treatment will be determined and communicated once the blood test reports are available.\n","review":89.76315789473685,"saved":73.73684210526315,"clean":false,"effort":16.666666666666664,"sig":[],"mb":5.873237,"latency":71.59,"signable":147.93815789473683},{"label":"Run 3","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं\n, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":592,"end":595,"said":"जर","significant":false},{"start":608,"end":610,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, insufficient sleep and skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","S says symptoms \"partly\" attributed to stress, but assessment frames anaemia/vitamin deficiency as the suspected cause, omitting lifestyle factors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","Patient \"appeared to relax following the doctor's reassurance regarding the commonality\" without claiming serious disease excluded."]],"claims":[],"note":"S (Subjective):\n- The patient reports experiencing significant fatigue for the past two weeks.\n- They report recurrent headaches, which are occasional and tend to worsen in the evenings.\n- The patient also reports experiencing occasional dizziness.\n- They attribute their symptoms partly to high work-related stress, leading to insufficient sleep and sometimes skipping meals.\n\nO (Objective):\n- The patient presented with concerns regarding their symptoms.\n- They expressed worry about the potential severity of their condition, asking if it was a major problem.\n- The patient appeared to relax following the doctor's reassurance regarding the commonality of their symptoms.\n\nA (Assessment):\n- The doctor suspects potential anemia or vitamin deficiency as a cause for the patient's symptoms.\n- The doctor noted that the reported issues are common.\n\nP (Plan):\n- A simple blood test has been ordered to investigate for anemia or vitamin deficiency.\n- The patient was advised to eat meals on time, increase water intake, and ensure adequate sleep.\n- A follow-up appointment is scheduled after the blood test reports are available to discuss appropriate treatment.\n","review":67.25,"saved":96.25,"clean":false,"effort":5.555555555555555,"sig":[],"mb":5.931467,"latency":27.34,"signable":82.245},{"label":"Run 4","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं\n, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":592,"end":595,"said":"जर","significant":false},{"start":608,"end":610,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past 2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"recurrent headaches, primarily in the evenings\"."],["Captures occasional dizziness.","yes","\"occasionally experiences dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","\"poor sleep and sometimes skips meals due to work-related stress\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Lifestyle factors are recorded but not framed as a possible contributor to the symptoms; assessment names only anaemia/vitamin deficiency."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"suspects ... anemia or vitamin deficiency as potential causes\"; blood test planned to check."],["Advises regular meals, hydration, and adequate sleep.","yes","\"eat on time, drink more water, and ensure adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","partial","Treatment after results captured, but the planned review visit after results is not explicitly stated."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","\"no need for immediate concern, describing it as a common problem\"; does not claim serious disease excluded."]],"claims":[["The patient presented in a cooperative manner.","No observation of demeanour or cooperation appears in the transcript."]],"note":"S (Subjective):\n- The patient reports experiencing significant fatigue for the past 2 weeks.\n- The patient complains of recurrent headaches, primarily in the evenings, for the past 2 weeks.\n- The patient occasionally experiences dizziness.\n- The patient reports poor sleep and sometimes skips meals due to work-related stress.\n\nO (Objective):\n- The patient presented in a cooperative manner.\n- No other objective findings were explicitly mentioned in the transcript.\n\nA (Assessment):\n- The doctor suspects common issues such as anemia or vitamin deficiency as potential causes for the patient's symptoms.\n- The doctor indicates that there is no need for immediate concern, describing it as a common problem.\n\nP (Plan):\n- A simple blood test will be conducted to check for anemia or vitamin deficiency.\n- The doctor will provide the appropriate treatment plan after the blood test results are available.\n- The patient was advised to eat on time, drink more water, and ensure adequate sleep.\n","review":85.11842105263159,"saved":78.38157894736841,"clean":false,"effort":27.77777777777778,"sig":[],"mb":5.929328,"latency":20.94,"signable":94.13842105263159},{"label":"Run 5","wer":2.272727272727273,"text":"नमस्ते, आइए बैठिए। मैं डॉ. मेहता हूँ। किस परेशानी के लिए आए हैं? नमस्ते डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है, बार-बार सिरदर्द भी हो रहा है। ठीक है। सिरदर्द हमेशा रहता है या कभी-कभी? कभी-कभी, होता है। खासकर शाम को ज़्यादा होता है। कभी-कभी चक्कर जैसा भी लगता है। समझ गया। नींद ठीक से मिल रही है? खाना टाइम पर हो रहा है? काम का स्ट्रेस ज़्यादा है, डॉक्टर? इसलिए नींद भी ठीक नहीं है? कभी-कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। एक सिंपल ब्लड टेस्ट कर लेते हैं। एनीमिया या विटामिन की कमी है या नहीं\n, पता चल जाएगा। ठीक है डॉक्टर। कोई बड़ी समस्या तो नहीं है न? अभी चिंता करने की ज़रूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूँगा। धन्यवाद डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं। टाइम पर खाना खाइए, पानी ज़्यादा पीजिए, और नींद पूरी रखिए। रिपोर्ट आने पर फिर मिलते हैं। ठीक है डॉक्टर। बहुत धन्यवाद","marks":[{"start":25,"end":26,"said":"क टर","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":592,"end":595,"said":"जर","significant":false},{"start":608,"end":610,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"significant fatigue for the past two weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Headaches documented as occasional/intermittent and worse in the evening."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Sleep difficulty due to work stress and occasional skipped meals captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Stress, sleep and meals listed in S but never presented as possible contributors to the symptoms."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood test planned for anaemia/vitamin deficiency; neither stated as diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Advice on timely meals, more water and adequate sleep captured."],["Plans review after blood results, with treatment determined after results.","yes","Follow-up after blood results with treatment determined then is captured."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","\"no need to worry about a major problem currently\" captures reassurance without ruling out disease."]],"claims":[],"note":"S (Subjective):\n- The patient reports experiencing significant fatigue for the past 2 weeks.\n- They report recurrent headaches, occurring intermittently, particularly worsening in the evenings.\n- The patient also reports occasional dizziness.\n- They state difficulty with sleep due to work-related stress.\n- The patient mentions occasionally skipping meals.\n\nO (Objective):\n- The patient presented in a cooperative manner.\n- The patient reported feeling relaxed after the doctor's reassurance.\n\nA (Assessment):\n- The doctor suspects common issues such as anemia or vitamin deficiency.\n- The doctor reassured the patient that there is no need to worry about a major problem currently.\n\nP (Plan):\n- A simple blood test is planned to check for anemia or vitamin deficiency.\n- The patient was advised to eat on time, drink more water, and ensure adequate sleep.\n- Follow-up is scheduled after the blood test reports are available to determine the correct treatment.\n","review":57.776315789473685,"saved":105.72368421052632,"clean":false,"effort":5.555555555555555,"sig":[],"mb":5.961908,"latency":21.246,"signable":66.73831578947369}],"lyrebird":[{"label":"Run 1","wer":3.4090909090909087,"text":"नमस्ते आइए बैठिए मैं doctor मेहता हूं किस परेशानी के लिए आए हैं नमस्ते doctor पिछले दो हफ्तों से बहुत थकान लग रही है बार बार सिरदर्द भी हो रहा है ठीक है सिरदर्द हमेशा रहता है या कभी कभी कभी कभी होता है खासकर शाम को ज़्यादा होता है कभी कभी चक्कर जैसा भी लगता है समझ गया नींद ठीक से मिल रही है खाना time पर हो रहा है काम का stress ज़्यादा है doctor इसीलिए\n\nभी ठीक नहीं है कभी कभी खाना भी skip हो जाता है यही वजह हो सकती है एक simple blood test कर लेते हैं एनीमिया या विटामिन की कमी है या नहीं पता चल जाएगा ठीक है doctor कोई बड़ी समस्या तो नहीं है ना अभी चिंता करने की ज़रूरत नहीं है यह आम समस्या है report आने के बाद सही treatment बता दूंगा धन्यवाद doctor अब थोड़ा relax लग रहा है इसीलिए हम हैं time पर खाना खाइए पानी ज़्यादा पीजिए और नींद\n\nपूरी रखिए report आने पर फिर मिलते हैं ठीक है doctor बहुत धन्यवाद","marks":[{"start":21,"end":27,"said":"ड क टर","significant":false},{"start":71,"end":77,"said":"ड क टर","significant":false},{"start":180,"end":180,"said":"-कभ","significant":false},{"start":186,"end":192,"said":"-कभ","significant":false},{"start":297,"end":301,"said":"ट इम","significant":false},{"start":322,"end":328,"said":"स ट र स","significant":false},{"start":340,"end":351,"said":"ड क टर इसल","significant":false},{"start":353,"end":353,"said":"न द","significant":true},{"start":386,"end":390,"said":"स क प","significant":false},{"start":424,"end":441,"said":"स पल ब लड ट स ट","significant":false},{"start":511,"end":517,"said":"ड क टर","significant":false},{"start":566,"end":569,"said":"जर","significant":false},{"start":581,"end":583,"said":"य","significant":false},{"start":597,"end":603,"said":"र प र ट","significant":false},{"start":619,"end":628,"said":"ट र टम ट","significant":false},{"start":647,"end":653,"said":"ड क टर","significant":false},{"start":663,"end":668,"said":"र ल क स","significant":false},{"start":693,"end":697,"said":"ट इम","significant":false},{"start":749,"end":755,"said":"र प र ट","significant":false},{"start":784,"end":790,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue for 2 weeks\" captured."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Intermittent headache, particularly worse in the evenings\" captured."],["Captures occasional dizziness.","yes","\"Occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","Poor sleep, meal skipping and \"Increased work-related stress\" all captured."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"likely multifactorial\" with listed contributing factors, not a confirmed diagnosis."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Differential diagnosis includes anaemia and vitamin deficiency\" with blood tests to assess."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, increased fluid intake and adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","\"Review appointment ... following blood test results to discuss treatment plan\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","yes","\"Reassurance provided regarding likely benign nature of symptoms\" without claiming serious disease excluded."]],"claims":[["Inadequate fluid intake / dehydration as a contributing factor","Patient never reported low fluid intake and no dehydration was assessed; doctor only advised drinking more water."]],"note":"Subjective:\n\nFatigue for 2 weeks\n\nIntermittent headache, particularly worse in the evenings\n\nOccasional dizziness\n\nPoor sleep quality\n\nIrregular meal patterns with frequent meal skipping\n\nIncreased work-related stress\n\nInadequate fluid intake\n\n\n\n\nObjective:\n\nNo objective findings documented\n\n\n\n\nAssessment:\n\nFatigue and headache, likely multifactorial\n\nDifferential diagnosis includes anaemia and vitamin deficiency\n\nContributing factors: poor sleep hygiene, irregular nutrition, work stress, dehydration\n\n\n\n\nPlan:\n\nBlood tests ordered to assess for anaemia and vitamin deficiency\n\nLifestyle modifications advised:\n\nRegular meal times without skipping meals\n\nIncreased fluid intake\n\nAdequate sleep\n\nReview appointment scheduled following blood test results to discuss treatment plan\n\nReassurance provided regarding likely benign nature of symptoms","review":44.526315789473685,"saved":118.97368421052632,"clean":false,"effort":16.666666666666664,"sig":[["fabrication","Inadequate fluid intake / dehydration as a contributing factor","Invents patient-reported low fluid intake and lists dehydration as a diagnostic contributor, although the doctor only advised drinking more water."]],"mb":9.753511,"latency":17.35,"signable":61.876315789473686},{"label":"Run 2","wer":3.977272727272727,"text":"नमस्ते आइए बैठिए मैं doctor मेहता हूं किस परेशानी के लिए आए हैं नमस्ते doctor पिछले दो हफ्तों से बहुत थकान लग रही है बार बार सिरदर्द भी हो रहा है ठीक है सिरदर्द हमेशा रहता है या कभी कभी कभी कभी कभी होता है खासकर शाम को ज़्यादा होता है कभी कभी चक्कर जैसा भी लगता है समझ गया नींद ठीक से मिल रही है खाना time पर हो रहा है काम का stress ज़्यादा है doctor इसलिए\n\nठीक नहीं है कभी कभी खाना भी skip हो जाता है यही वजह हो सकती है एक simple blood test कर लेते हैं anemia या विटामिन की कमी है या नहीं पता चल जाएगा ठीक है doctor कोई बड़ी समस्या तो नहीं है ना अभी चिंता करने की ज़रूरत नहीं है यह आम समस्या है report आने के बाद सही treatment बता दूंगा धन्यवाद doctor अब थोड़ा relax लग रहा है इसीलिए हम हैं time पर खाना खाइए पानी ज़्यादा पीजिए और नींद\n\nपूरी रखिए report आने पर फिर मिलते हैं ठीक है doctor बहुत धन्यवाद","marks":[{"start":21,"end":27,"said":"ड क टर","significant":false},{"start":71,"end":77,"said":"ड क टर","significant":false},{"start":180,"end":180,"said":"-कभ","significant":false},{"start":186,"end":196,"said":"-कभ","significant":false},{"start":301,"end":305,"said":"ट इम","significant":false},{"start":326,"end":332,"said":"स ट र स","significant":false},{"start":344,"end":350,"said":"ड क टर","significant":false},{"start":356,"end":356,"said":"न द भ","significant":true},{"start":386,"end":390,"said":"स क प","significant":false},{"start":424,"end":441,"said":"स पल ब लड ट स ट","significant":false},{"start":454,"end":460,"said":"एन म य","significant":false},{"start":510,"end":516,"said":"ड क टर","significant":false},{"start":565,"end":568,"said":"जर","significant":false},{"start":580,"end":582,"said":"य","significant":false},{"start":596,"end":602,"said":"र प र ट","significant":false},{"start":618,"end":627,"said":"ट र टम ट","significant":false},{"start":646,"end":652,"said":"ड क टर","significant":false},{"start":662,"end":667,"said":"र ल क स","significant":false},{"start":692,"end":696,"said":"ट इम","significant":false},{"start":748,"end":754,"said":"र प र ट","significant":false},{"start":783,"end":789,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue for 2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Intermittent headache, particularly worse in the evenings\"."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","partial","Stress and poor sleep captured, but \"frequently skipping meals\" overstates कभी-कभी (sometimes)."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Assessment lists only \"Query anaemia / Query vitamin deficiency\"; stress/lifestyle not presented as possible contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Blood test ordered to assess for anaemia and vitamin deficiency\" with both only queried."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, increased fluid intake and adequate sleep all advised."],["Plans review after blood results, with treatment determined after results.","partial","\"Review appointment ... following receipt of blood test results\" captured, but treatment being decided after results is not stated."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance recorded."]],"claims":[],"note":"Subjective:\n\nFatigue for 2 weeks\n\nIntermittent headache, particularly worse in the evenings\n\nOccasional dizziness\n\nPoor sleep quality\n\nIrregular meals, frequently skipping meals\n\nIncreased work-related stress\n\n\n\n\nObjective:\n\nNot documented\n\n\n\n\nAssessment:\n\nQuery anaemia\n\nQuery vitamin deficiency\n\n\n\n\nPlan:\n\nBlood test ordered to assess for anaemia and vitamin deficiency\n\nAdvised to maintain regular meals\n\nAdvised to increase fluid intake\n\nAdvised to ensure adequate sleep\n\nReview appointment scheduled following receipt of blood test results","review":91.60526315789474,"saved":71.89473684210526,"clean":false,"effort":33.33333333333333,"sig":[],"mb":6.294096,"latency":15.656,"signable":107.26126315789475},{"label":"Run 3","wer":3.4090909090909087,"text":"नमस्ते आइए बैठिए मैं doctor मेहता हूं किस परेशानी के लिए आए हैं नमस्ते doctor पिछले दो हफ्तों से बहुत थकान लग रही है बार बार सिरदर्द भी हो रहा है ठीक है सिरदर्द हमेशा रहता है या कभी कभी कभी कभी होता है खासकर शाम को ज़्यादा होता है कभी कभी चक्कर जैसा भी लगता है समझ गया नींद ठीक से मिल रही है खाना time पर हो रहा है काम का stress ज़्यादा है doctor इसीलिए\n\nभी ठीक नहीं है कभी कभी खाना भी skip हो जाता है यही वजह हो सकती है एक simple blood test कर लेते हैं एनीमिया या विटामिन की कमी है या नहीं पता चल जाएगा ठीक है doctor कोई बड़ी समस्या तो नहीं है ना अभी चिंता करने की ज़रूरत नहीं है यह आम समस्या है report आने के बाद सही treatment बता दूंगा धन्यवाद doctor अब थोड़ा relax लग रहा है इसीलिए हम हैं time पर खाना खाइए पानी ज़्यादा पीजिए और नींद\n\nपूरी रखिए report आने पर फिर मिलते हैं ठीक है doctor बहुत धन्यवाद","marks":[{"start":21,"end":27,"said":"ड क टर","significant":false},{"start":71,"end":77,"said":"ड क टर","significant":false},{"start":180,"end":180,"said":"-कभ","significant":false},{"start":186,"end":192,"said":"-कभ","significant":false},{"start":297,"end":301,"said":"ट इम","significant":false},{"start":322,"end":328,"said":"स ट र स","significant":false},{"start":340,"end":351,"said":"ड क टर इसल","significant":false},{"start":353,"end":353,"said":"न द","significant":true},{"start":386,"end":390,"said":"स क प","significant":false},{"start":424,"end":441,"said":"स पल ब लड ट स ट","significant":false},{"start":511,"end":517,"said":"ड क टर","significant":false},{"start":566,"end":569,"said":"जर","significant":false},{"start":581,"end":583,"said":"य","significant":false},{"start":597,"end":603,"said":"र प र ट","significant":false},{"start":619,"end":628,"said":"ट र टम ट","significant":false},{"start":647,"end":653,"said":"ड क टर","significant":false},{"start":663,"end":668,"said":"र ल क स","significant":false},{"start":693,"end":697,"said":"ट इम","significant":false},{"start":749,"end":755,"said":"र प र ट","significant":false},{"start":784,"end":790,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","Fatigue for 2 weeks."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","Intermittent headaches worse in the evening."],["Captures occasional dizziness.","yes","Occasional dizziness."],["Captures work stress, poor sleep, and skipped meals.","yes","Work stress, poor sleep and skipped meals."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Stress and lifestyle factors listed only in Subjective, not presented as possible contributors; assessment is only anaemia/vitamin queries."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests for anaemia/vitamin deficiency, not diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, hydration and adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","yes","Review after results to determine treatment."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","Clinician reassurance that there is no need to worry now and it is common is not recorded."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nFatigue for 2 weeks\n\nIntermittent headache, particularly worse in the evenings\n\nOccasional dizziness\n\nIrregular eating pattern with meals frequently skipped\n\nIncreased work-related stress\n\nPoor sleep quality\n\n\n\n\nObjective:\n\nNo objective findings documented\n\n\n\n\nAssessment:\n\nQuery anaemia\n\nQuery vitamin deficiency\n\n\n\n\nPlan:\n\nBlood tests ordered to assess for anaemia and vitamin deficiency\n\nAdvised to maintain regular meal times\n\nAdvised to increase fluid intake\n\nAdvised to ensure adequate sleep\n\nReview appointment scheduled following receipt of blood test results","review":70.3157894736842,"saved":93.1842105263158,"clean":false,"effort":22.22222222222222,"sig":[],"mb":10.003307,"latency":15.991,"signable":86.3067894736842},{"label":"Run 4","wer":3.4090909090909087,"text":"नमस्ते आइए बैठिए मैं doctor मेहता हूं किस परेशानी के लिए आए हैं नमस्ते doctor पिछले दो हफ्तों से बहुत थकान लग रही है बार बार सिरदर्द भी हो रहा है ठीक है सिरदर्द हमेशा रहता है या कभी कभी कभी कभी होता है खासकर शाम को ज़्यादा होता है कभी कभी चक्कर जैसा भी लगता है समझ गया नींद ठीक से मिल रही है खाना time पर हो रहा है काम का stress ज़्यादा है doctor इसीलिए\n\nभी ठीक नहीं है कभी कभी खाना भी skip हो जाता है यही वजह हो सकती है एक simple blood test कर लेते हैं एनीमिया या विटामिन की कमी है या नहीं पता चल जाएगा ठीक है doctor कोई बड़ी समस्या तो नहीं है ना अभी चिंता करने की ज़रूरत नहीं है यह आम समस्या है report आने के बाद सही treatment बता दूंगा धन्यवाद doctor अब थोड़ा relax लग रहा है इसीलिए हम हैं time पर खाना खाइए पानी ज़्यादा पीजिए और नींद\n\nपूरी रखिए report आने पर फिर मिलते हैं ठीक है doctor बहुत धन्यवाद","marks":[{"start":21,"end":27,"said":"ड क टर","significant":false},{"start":71,"end":77,"said":"ड क टर","significant":false},{"start":180,"end":180,"said":"-कभ","significant":false},{"start":186,"end":192,"said":"-कभ","significant":false},{"start":297,"end":301,"said":"ट इम","significant":false},{"start":322,"end":328,"said":"स ट र स","significant":false},{"start":340,"end":351,"said":"ड क टर इसल","significant":false},{"start":353,"end":353,"said":"न द","significant":true},{"start":386,"end":390,"said":"स क प","significant":false},{"start":424,"end":441,"said":"स पल ब लड ट स ट","significant":false},{"start":511,"end":517,"said":"ड क टर","significant":false},{"start":566,"end":569,"said":"जर","significant":false},{"start":581,"end":583,"said":"य","significant":false},{"start":597,"end":603,"said":"र प र ट","significant":false},{"start":619,"end":628,"said":"ट र टम ट","significant":false},{"start":647,"end":653,"said":"ड क टर","significant":false},{"start":663,"end":668,"said":"र ल क स","significant":false},{"start":693,"end":697,"said":"ट इम","significant":false},{"start":749,"end":755,"said":"र प र ट","significant":false},{"start":784,"end":790,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue for 2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","'Intermittent headache, worse in the evenings'."],["Captures occasional dizziness.","yes","'Occasional dizziness'."],["Captures work stress, poor sleep, and skipped meals.","yes","Poor sleep, skipped meals, work stress recorded."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","Assessment lists only query anaemia/vitamin deficiency; stress/lifestyle not presented as a possible contributor."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","Blood tests for anaemia and vitamin deficiency, framed as 'Query'."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meals, fluids, adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","partial","Review after blood results recorded, but treatment being decided after results not stated."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","The doctor's reassurance ('अभी चिंता करने की जरूरत नहीं है। ये आम समस्या है') is not recorded."]],"claims":[],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nFatigue for 2 weeks\n\nIntermittent headache, worse in the evenings\n\nOccasional dizziness\n\nPoor sleep quality\n\nIrregular meals, frequently skipping meals\n\nHigh work-related stress\n\n\n\n\nObjective:\n\nNo objective findings documented\n\n\n\n\nAssessment:\n\nQuery anaemia\n\nQuery vitamin deficiency\n\n\n\n\nPlan:\n\nBlood tests ordered to assess for anaemia and vitamin deficiency\n\nAdvised to maintain regular meals\n\nAdvised to increase fluid intake\n\nAdvised to ensure adequate sleep\n\nReview appointment scheduled following blood test results","review":80.92105263157895,"saved":82.57894736842105,"clean":false,"effort":27.77777777777778,"sig":[],"mb":9.810787,"latency":17.395,"signable":98.31605263157894},{"label":"Run 5","wer":3.4090909090909087,"text":"नमस्ते आइए बैठिए मैं doctor मेहता हूं किस परेशानी के लिए आए हैं नमस्ते doctor पिछले दो हफ्तों से बहुत थकान लग रही है बार बार सिरदर्द भी हो रहा है ठीक है सिरदर्द हमेशा रहता है या कभी कभी कभी कभी होता है खासकर शाम को ज़्यादा होता है कभी कभी चक्कर जैसा भी लगता है समझ गया नींद ठीक से मिल रही है खाना time पर हो रहा है काम का stress ज़्यादा है doctor इसीलिए\n\nभी ठीक नहीं है कभी कभी खाना भी skip हो जाता है यही वजह हो सकती है एक simple blood test कर लेते हैं एनीमिया या विटामिन की कमी है या नहीं पता चल जाएगा ठीक है doctor कोई बड़ी समस्या तो नहीं है ना अभी चिंता करने की ज़रूरत नहीं है यह आम समस्या है report आने के बाद सही treatment बता दूंगा धन्यवाद doctor अब थोड़ा relax लग रहा है इसीलिए हम हैं time पर खाना खाइए पानी ज़्यादा पीजिए और नींद\n\nपूरी रखिए report आने पर फिर मिलते हैं ठीक है doctor बहुत धन्यवाद","marks":[{"start":21,"end":27,"said":"ड क टर","significant":false},{"start":71,"end":77,"said":"ड क टर","significant":false},{"start":180,"end":180,"said":"-कभ","significant":false},{"start":186,"end":192,"said":"-कभ","significant":false},{"start":297,"end":301,"said":"ट इम","significant":false},{"start":322,"end":328,"said":"स ट र स","significant":false},{"start":340,"end":351,"said":"ड क टर इसल","significant":false},{"start":353,"end":353,"said":"न द","significant":true},{"start":386,"end":390,"said":"स क प","significant":false},{"start":424,"end":441,"said":"स पल ब लड ट स ट","significant":false},{"start":511,"end":517,"said":"ड क टर","significant":false},{"start":566,"end":569,"said":"जर","significant":false},{"start":581,"end":583,"said":"य","significant":false},{"start":597,"end":603,"said":"र प र ट","significant":false},{"start":619,"end":628,"said":"ट र टम ट","significant":false},{"start":647,"end":653,"said":"ड क टर","significant":false},{"start":663,"end":668,"said":"र ल क स","significant":false},{"start":693,"end":697,"said":"ट इम","significant":false},{"start":749,"end":755,"said":"र प र ट","significant":false},{"start":784,"end":790,"said":"ड क टर","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue for 2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","'Intermittent headache, particularly worse in the evenings'."],["Captures occasional dizziness.","yes","'Occasional dizziness'."],["Captures work stress, poor sleep, and skipped meals.","yes","Poor sleep, skipped meals, work stress recorded."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","'likely related to lifestyle factors'."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","'Possible anaemia or vitamin deficiency to be excluded'."],["Advises regular meals, hydration, and adequate sleep.","yes","Regular meal times, fluids, adequate sleep advised."],["Plans review after blood results, with treatment determined after results.","partial","Review after blood results recorded, but treatment decided after results not stated."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","The doctor's reassurance ('अभी चिंता करने की जरूरत नहीं है। ये आम समस्या है') is not recorded."]],"claims":[],"note":"Subjective:\n\nFatigue for 2 weeks\n\nIntermittent headache, particularly worse in the evenings\n\nOccasional dizziness\n\nPoor sleep quality\n\nIrregular meals, frequently skipping meals\n\nIncreased work-related stress\n\n\n\n\nObjective:\n\nNo objective findings documented\n\n\n\n\nAssessment:\n\nFatigue and headache, likely related to lifestyle factors\n\nPossible anaemia or vitamin deficiency to be excluded\n\n\n\n\nPlan:\n\nBlood tests ordered to assess for anaemia and vitamin deficiency\n\nAdvised to maintain regular meal times\n\nAdvised to increase fluid intake\n\nAdvised to ensure adequate sleep\n\nReview appointment scheduled following receipt of blood test results","review":63.526315789473685,"saved":99.97368421052632,"clean":false,"effort":16.666666666666664,"sig":[],"mb":9.795398,"latency":17.338,"signable":80.8643157894737}],"patientnotes":[{"label":"Run 1","wer":6.8181818181818175,"text":"नमस्ते आइए। बैठिए मैं डॉक्टर महता हूँ किस परेशानी के लिए आए हैं नमस्ते। डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है। बार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है। या कभी कभी, कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी। चक्कर जैसा भी लगता है। समझ गया नींद। ठीक से मिल रही है। खाना, टाइम पर हो रहा है। काम का स्ट्रेस। ज्यादा है डॉक्टर। इसलिए नींद भी ठीक नहीं है। कभी कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। 1 सिंपल ब्लड टेस्ट कर लेते हैं। एनिमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है। डॉक्टर। कोई बड़ी समस्या तो नहीं है ना। अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूंगा। धन्यवाद। डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं टाइम पर खाना खाइए, पानी ज्यादा पीजिए।\nऔर नींद पूरी रखिये रिपोर्ट आने पर फिर मिलते हैं। ठीक है, डॉक्टर बहुत धन्यवाद।","marks":[{"start":29,"end":32,"said":"म हत","significant":false},{"start":86,"end":87,"said":"द","significant":false},{"start":129,"end":133,"said":"रदर","significant":false},{"start":160,"end":164,"said":"रदर","significant":false},{"start":187,"end":187,"said":"-कभ","significant":false},{"start":194,"end":200,"said":"-कभ","significant":false},{"start":445,"end":446,"said":"एक","significant":false},{"start":609,"end":611,"said":"य","significant":false},{"start":782,"end":783,"said":"ए","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue for 2 weeks\" matches the two-week tiredness."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"headaches variable, worse evenings\" captures intermittent evening-predominant headaches."],["Captures occasional dizziness.","yes","\"occasional dizziness\" captured."],["Captures work stress, poor sleep, and skipped meals.","yes","\"sleep disturbed due to work stress; occasional meal skipping\" captures all three."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Stress is linked to sleep in HPI, but the Assessment only says \"symptoms considered common\" without framing lifestyle factors as likely contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","partial","Blood test for anaemia/vitamin deficiency planned and not diagnosed, but it adds an unsupported specific panel \"(CBC, vitamin levels)\"."],["Advises regular meals, hydration, and adequate sleep.","yes","\"Advise regular meals, adequate hydration, maintain full sleep\" captured."],["Plans review after blood results, with treatment determined after results.","yes","\"Review results and provide treatment at follow-up\" matches."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","Reassurance present but \"No major pathology identified\" overstates it as if serious disease was excluded."]],"claims":[["Order simple blood test (CBC, vitamin levels)","Transcript only says a simple blood test for anaemia or vitamin deficiency; no specific panel such as CBC was named."],["relaxation techniques advised","Doctor advised meals on time, more water and full sleep only; no relaxation techniques were advised."]],"note":"Subjective\n\nChief Complaint::\n\nFatigue for 2 weeks; frequent headaches.\n\nHistory of Presenting Complaint::\n\nOnset 2 weeks ago, persistent fatigue; headaches variable, worse evenings; occasional dizziness; sleep disturbed due to work stress; occasional meal skipping.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nNo major pathology identified; symptoms considered common; await blood test for anaemia/vitamin deficiency before definitive treatment.\n\nPlan\n\nOrder simple blood test (CBC, vitamin levels).\n\nAdvise regular meals, adequate hydration, maintain full sleep, relaxation techniques.\n\nReview results and provide treatment at follow‑up.","review":93.71052631578948,"saved":69.78947368421052,"clean":false,"effort":44.44444444444444,"sig":[],"mb":7.292578,"latency":24.263,"signable":117.97352631578948},{"label":"Run 2","wer":8.522727272727272,"text":"नमस्ते आइए। बैठिए मैं डॉक्टर महता हूँ किस परेशानी के लिए आये हैं नमस्ते। डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है। बार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है। या कभी कभी, कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी। चक्कर जैसा भी लगता है। समझ गया नींद। ठीक से मिल रही है। खाना, टाइम पर हो रहा है। काम का स्ट्रेस। ज्यादा है डॉक्टर। इसलिए नींद भी ठीक नहीं है। कभी कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। 1 सिंपल ब्लड टेस्ट कर लेते हैं। एनिमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है। डॉक्टर। कोई बड़ी समस्या तो नहीं है न। अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूंगा। धन्यवाद। डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसी लिए हम हैं टाइम पर खाना खाइए, पानी ज्यादा पीजिए और नींद पूरी रखिए।\nरिपोर्ट आने पर फिर मिलते हैं। ठीक है, डॉक्टर बहुत धन्यवाद।","marks":[{"start":29,"end":32,"said":"म हत","significant":false},{"start":57,"end":59,"said":"आए","significant":false},{"start":87,"end":88,"said":"द","significant":false},{"start":130,"end":134,"said":"रदर","significant":false},{"start":161,"end":165,"said":"रदर","significant":false},{"start":188,"end":188,"said":"-कभ","significant":false},{"start":195,"end":201,"said":"-कभ","significant":false},{"start":446,"end":447,"said":"एक","significant":false},{"start":609,"end":611,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue started ~2 weeks ago\"."],["Captures recurrent/intermittent headaches, worse in the evening.","partial","Evening worsening captured, but \"sometimes constant\" contradicts the patient's answer that headaches are only कभी-कभी (occasional)."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","\"Work-related stress, disrupted sleep, occasional skipped meals\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","\"likely related to stress, sleep disturbance or possible nutritional deficiency; awaiting blood test results\"."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Order simple blood test (CBC, vitamin levels) to assess anaemia or deficiency\"; nothing diagnosed."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meals on time, increase fluid intake, maintain adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Review test results and adjust treatment at next appointment\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","\"Common problem\" reflects ये आम समस्या है, but the explicit reassurance that there is no need to worry now is not recorded."]],"claims":[["Headaches ... sometimes constant","Patient said headaches occur कभी-कभी (sometimes), directly answering 'always or sometimes'; 'constant' is unsupported."]],"note":"Subjective\n\nChief Complaint::\n\n2 weeks of fatigue and frequent headaches\n\nHistory of Presenting Complaint::\n\nFatigue started ~2 weeks ago, persistent\n\nHeadaches occur repeatedly, sometimes constant, worsen in evenings\n\nOccasional dizziness\n\nWork‑related stress, disrupted sleep, occasional skipped meals\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nCommon problem likely related to stress, sleep disturbance or possible nutritional deficiency; awaiting blood test results\n\nPlan\n\nOrder simple blood test (CBC, vitamin levels) to assess anaemia or deficiency\n\nAdvise regular meals on time, increase fluid intake, maintain adequate sleep\n\nReview test results and adjust treatment at next appointment","review":67.11842105263158,"saved":96.38157894736842,"clean":false,"effort":22.22222222222222,"sig":[],"mb":7.14021,"latency":24.217,"signable":91.33542105263157},{"label":"Run 3","wer":8.522727272727272,"text":"नमस्ते आइए। बैठिए मैं डॉक्टर महता हूँ किस परेशानी के लिए आये हैं नमस्ते। डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है। बार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है। या कभी कभी, कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी। चक्कर जैसा भी लगता है। समझ गया नींद। ठीक से मिल रही है। खाना, टाइम पर हो रहा है। काम का स्ट्रेस। ज्यादा है डॉक्टर। इसलिए नींद भी ठीक नहीं है। कभी कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। 1 सिंपल ब्लड टेस्ट कर लेते हैं। एनिमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है। डॉक्टर। कोई बड़ी समस्या तो नहीं है ना। अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूंगा। धन्यवाद। डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसी लिए हम हैं टाइम पर खाना खाइए, पानी ज्यादा पीजिए।\nऔर नींद पूरी रखिये रिपोर्ट आने पर फिर मिलते हैं। ठीक है, डॉक्टर बहुत धन्यवाद।","marks":[{"start":29,"end":32,"said":"म हत","significant":false},{"start":57,"end":59,"said":"आए","significant":false},{"start":87,"end":88,"said":"द","significant":false},{"start":130,"end":134,"said":"रदर","significant":false},{"start":161,"end":165,"said":"रदर","significant":false},{"start":188,"end":188,"said":"-कभ","significant":false},{"start":195,"end":201,"said":"-कभ","significant":false},{"start":446,"end":447,"said":"एक","significant":false},{"start":610,"end":612,"said":"य","significant":false},{"start":785,"end":786,"said":"ए","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","\"Fatigue ... for past 2 weeks\"."],["Captures recurrent/intermittent headaches, worse in the evening.","yes","\"Headache worse in evenings, intermittent\"."],["Captures occasional dizziness.","yes","\"Occasional dizziness\"."],["Captures work stress, poor sleep, and skipped meals.","yes","\"Work stress, irregular meals, disrupted sleep, occasional meal skipping\"."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","partial","Links symptoms to stress but adds a \"tension headache\" diagnosis not made in the dialogue."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","\"Rule out anemia or vitamin deficiency; basic blood test ordered\"."],["Advises regular meals, hydration, and adequate sleep.","yes","\"regular meals, increase water intake, maintain adequate sleep\"."],["Plans review after blood results, with treatment determined after results.","yes","\"Review labs and schedule follow-up after results\"."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","No reassurance recorded; instead asserts \"No red-flag features identified\"."]],"claims":[["tension headache","Doctor only said stress/sleep/meals could be the cause; no headache diagnosis was made."],["No red-flag features identified.","No red-flag screening was done; doctor only said there was no need to worry now."],["Order simple blood test (CBC, iron, vitamin levels).","Doctor only said 'एक सिंपल ब्लड टेस्ट'; no specific panel was named."]],"note":"Subjective\n\nChief Complaint::\n\nFatigue and frequent headaches for past 2 weeks.\n\nHistory of Presenting Complaint::\n\nOnset ~2 weeks ago, fatigue and headache.\n\nHeadache worse in evenings, intermittent.\n\nOccasional dizziness.\n\nWork stress, irregular meals, disrupted sleep, occasional meal skipping.\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely stress‑related fatigue/tension headache.\n\nRule out anemia or vitamin deficiency; basic blood test ordered.\n\nNo red‑flag features identified.\n\nPlan\n\nOrder simple blood test (CBC, iron, vitamin levels).\n\nCounsel: regular meals, increase water intake, maintain adequate sleep.\n\nReview labs and schedule follow‑up after results.","review":102.48684210526315,"saved":61.01315789473685,"clean":false,"effort":55.55555555555556,"sig":[["partial","Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","Adds a tension-headache diagnosis the clinician never made."]],"mb":8.580317,"latency":32.205,"signable":134.69184210526316},{"label":"Run 4","wer":7.386363636363637,"text":"नमस्ते आइए। बैठिए मैं डॉक्टर मेहता हूँ किस परेशानी के लिए आये हैं नमस्ते। डॉक्टर पिछले 2 हफ्तों से बहुत थकान लग रही है। बार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है। या कभी कभी, कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी। चक्कर जैसा भी लगता है। समझ गया नींद। ठीक से मिल रही है। खाना, टाइम पर हो रहा है। काम का स्ट्रेस ज्यादा है डॉक्टर। इसलिए नींद भी ठीक नहीं है। कभी कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। 1 सिंपल ब्लड टेस्ट कर लेते हैं। एनिमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है। डॉक्टर। कोई बड़ी समस्या तो नहीं है ना। अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूंगा। धन्यवाद। डॉक्टर अब थोड़ा रिलैक्स लग रहा है। इसी लिए हम हैं टाइम पर खाना खाइए, पानी ज्यादा पीजिए।\nऔर नींद पूरी रखिए रिपोर्ट आने पर फिर मिलते हैं। ठीक है, डॉक्टर बहुत धन्यवाद।","marks":[{"start":58,"end":60,"said":"आए","significant":false},{"start":87,"end":88,"said":"द","significant":false},{"start":130,"end":134,"said":"रदर","significant":false},{"start":161,"end":165,"said":"रदर","significant":false},{"start":188,"end":188,"said":"-कभ","significant":false},{"start":195,"end":201,"said":"-कभ","significant":false},{"start":445,"end":446,"said":"एक","significant":false},{"start":609,"end":611,"said":"य","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue 2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","partial","Worse in evenings recorded but 'constant or intermittent' blurs the stated intermittency."],["Captures occasional dizziness.","yes","'Dizziness sensation reported'."],["Captures work stress, poor sleep, and skipped meals.","yes","Inadequate sleep, high work stress, meals occasionally skipped."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","no","States a diagnosis ('tension-type headache') rather than stress/lifestyle as possible contributors."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","partial","Blood test planned, but anaemia/vitamin deficiency not named as the target."],["Advises regular meals, hydration, and adequate sleep.","yes","'regular meals, adequate hydration, sleep hygiene'."],["Plans review after blood results, with treatment determined after results.","yes","'Review results and determine treatment'."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","partial","'Common functional fatigue' echoes reassurance, but 'No red-flag identified' asserts serious disease excluded."]],"claims":[["tension-type headache","No headache diagnosis was made; the doctor only said stress/sleep/meals could be the cause."],["No red-flag identified","No red-flag screening took place; the doctor only said there is no need to worry for now."],["Blood test specified as 'CBC, iron, vitamin levels'","Doctor only said 'एक सिंपल ब्लड टेस्ट' to check anaemia or vitamin deficiency; no test panel or iron studies were named."]],"note":"Subjective\n\nChief Complaint::\n\nFatigue 2 weeks\n\nFrequent headaches\n\nHistory of Presenting Complaint::\n\nHeadaches constant or intermittent, worse in evenings\n\nDizziness sensation reported\n\nInadequate sleep, high work stress\n\nMeals occasionally skipped\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nCommon functional fatigue and tension‑type headache\n\nNo red‑flag identified\n\nPlan\n\nOrder simple blood test (CBC, iron, vitamin levels)\n\nReview results and determine treatment\n\nAdvise regular meals, adequate hydration, sleep hygiene\n\nFollow‑up after lab results","review":121.80263157894737,"saved":41.69736842105263,"clean":false,"effort":61.111111111111114,"sig":[["missing","Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","Asserts tension-type headache diagnosis the doctor never made."],["partial","Captures reassurance about current concern without asserting serious disease has been ruled out.","\"No red-flag identified\" asserts a screen that never happened."]],"mb":7.106337,"latency":32.188,"signable":153.9906315789474},{"label":"Run 5","wer":7.386363636363637,"text":"नमस्ते आइए। बैठिए मैं डॉक्टर महता हूँ किस परेशानी के लिए आये हैं नमस्ते। डॉक्टर। पिछले 2 हफ्तों से बहुत थकान लग रही है। बार बार सिर दर्द भी हो रहा है। ठीक है। सिर दर्द हमेशा रहता है। या कभी कभी, कभी कभी होता है। खासकर शाम को ज्यादा होता है। कभी कभी। चक्कर जैसा भी लगता है। समझ गया नींद। ठीक से मिल रही है। खाना, टाइम पर हो रहा है। काम का स्ट्रेस ज्यादा है डॉक्टर। इसलिए नींद भी ठीक नहीं है। कभी कभी खाना भी स्किप हो जाता है। यही वजह हो सकती है। 1 सिंपल ब्लड टेस्ट कर लेते हैं। एनिमिया या विटामिन की कमी है या नहीं, पता चल जाएगा। ठीक है। डॉक्टर। कोई बड़ी समस्या तो नहीं है ना। अभी चिंता करने की जरूरत नहीं है। यह आम समस्या है। रिपोर्ट आने के बाद सही ट्रीटमेंट बता दूंगा। धन्यवाद। डॉक्टर। अब थोड़ा रिलैक्स लग रहा है। इसीलिए हम हैं टाइम पर खाना खाइए, पानी ज्यादा पीजिए।\nऔर नींद पूरी रखिये रिपोर्ट आने पर फिर मिलते हैं। ठीक है, डॉक्टर बहुत धन्यवाद।","marks":[{"start":29,"end":32,"said":"म हत","significant":false},{"start":57,"end":59,"said":"आए","significant":false},{"start":87,"end":88,"said":"द","significant":false},{"start":130,"end":134,"said":"रदर","significant":false},{"start":161,"end":165,"said":"रदर","significant":false},{"start":188,"end":188,"said":"-कभ","significant":false},{"start":195,"end":201,"said":"-कभ","significant":false},{"start":445,"end":446,"said":"एक","significant":false},{"start":609,"end":611,"said":"य","significant":false},{"start":783,"end":784,"said":"ए","significant":false}],"facts":[["Captures fatigue for two weeks.","yes","'Fatigue... for past 2 weeks'."],["Captures recurrent/intermittent headaches, worse in the evening.","partial","Worse in evenings recorded, but 'constant or intermittent' blurs that the patient said only sometimes."],["Captures occasional dizziness.","yes","'occasional dizziness'."],["Captures work stress, poor sleep, and skipped meals.","yes","'high work stress, poor sleep, occasional missed meals'."],["Presents stress/lifestyle factors as possible contributors, not a confirmed diagnosis.","yes","'Likely stress-related fatigue/headache' as a probable cause."],["Plans blood testing to investigate anaemia and vitamin deficiency; neither is established as diagnosed.","yes","'Possible anemia or vitamin deficiency pending labs'."],["Advises regular meals, hydration, and adequate sleep.","yes","'regular meals, increased fluid intake, adequate sleep'."],["Plans review after blood results, with treatment determined after results.","yes","'Review results and adjust treatment at follow-up'."],["Captures reassurance about current concern without asserting serious disease has been ruled out.","no","The doctor's reassurance ('अभी चिंता करने की जरूरत नहीं है। ये आम समस्या है') is not recorded."]],"claims":[["Blood test specified as 'CBC, iron, vitamin levels'","Doctor only said 'एक सिंपल ब्लड टेस्ट' to check anaemia or vitamin deficiency; no test panel or iron studies were named."]],"note":"Subjective\n\nChief Complaint::\n\nFatigue and frequent headaches for past 2 weeks\n\nHistory of Presenting Complaint::\n\nOnset 2 weeks ago; headaches constant or intermittent, worse evenings; occasional dizziness\n\nAssociated with high work stress, poor sleep, occasional missed meals\n\nObjective\n\nNot discussed\n\nNot discussed\n\nAssessment\n\nLikely stress‑related fatigue/headache\n\nPossible anemia or vitamin deficiency pending labs\n\nPlan\n\nOrder simple blood test (CBC, iron, vitamin levels)\n\nAdvise regular meals, increased fluid intake, adequate sleep\n\nReview results and adjust treatment at follow‑up","review":72.76315789473685,"saved":90.73684210526315,"clean":false,"effort":33.33333333333333,"sig":[],"mb":7.629447,"latency":22.248,"signable":95.01115789473685}]}},{"id":"myotherapy-50min","name":"50-minute stress test","dictation":false,"language":false,"stress":true,"reference":"Morning, come on through. Take a seat wherever's comfortable.\n\n Thanks.\n\n So what's brought you in today?\n\n It's my lower back mostly. And the right shoulder's been playing up as well.\n\n Okay. Let's start with the back. Whereabouts is it?\n\n Right across the bottom. Both sides, but the right's worse.\n\n And how long's that been going on?\n\n Years, on and off. It flares up every few months and settles down again.\n\n Is this a flare at the moment?\n\n Yeah. Started about ten days ago.\n\n Anything set it off that you can think of?\n\n We poured a big slab on the Thursday. I was bent over most of the day.\n\n That'll do it. And you're concreting full time?\n\n Yeah, fifteen years now.\n\n On a scale of one to ten, where's it sitting today?\n\n Probably a six. It was an eight on the weekend.\n\n What makes it worse?\n\n Sitting's the worst. Driving to site in the morning I'm stiff as anything.\n\n And what helps?\n\n A hot shower. Helps for about an hour, then it comes back.\n\n Anything shooting down the leg? Pins and needles, numbness, anything like that?\n\n No, nothing like that. It's just an ache.\n\n Any pain at night that wakes you, or any trouble with the bladder or bowels?\n\n No, none of that.\n\n Good. Have you had any imaging done, or seen anyone else about it?\n\n I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n Right. And are you on any medications, or any other health conditions I should know about?\n\n Just blood pressure tablets. Nothing else.\n\n Okay. Now the shoulder — how long's that been there?\n\n Maybe six weeks. It's worse when I'm reaching overhead.\n\n Does it wake you if you roll onto it?\n\n Sometimes, yeah.\n\n And what would you like to get out of today?\n\n Honestly just to get through a work week without it seizing up.\n\n That's fair. Here's what I'd suggest — I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound alright?\n\n Yeah, sounds good.\n\n It can be a bit tender in spots. Sing out if anything's too much and I'll back off.\n\n Will do.\n\n Righto. I'll step out while you get comfortable — face down for me, head in the cradle, and pull the towel up over you.\n\n How's that pressure?\n\n Yeah, that's good.\n\n Ooh, that's the spot.\n\n Too much?\n\n Nah, it's alright.\n\n I'm going to use the massage gun on this one, it's a bit loud.\n\n No worries.\n\n Is the pain okay?\n\n Yeah, that's fine. Bit intense but it's alright.\n\n Sing out if you want me to back off.\n\n Right, roll onto your back for me.\n\n Okay, sit yourself up slowly when you're ready.\n\n That feels a lot looser.\n\n Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulder's mostly the upper trap.\n\n So what should I be doing at home?\n\n Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n Yeah, righto.\n\n I'd book you back in two weeks. Does a Thursday suit?\n\n Thursday's fine. Do I get something for the health fund?\n\n I'll email the receipt through with the provider number on it, you can claim it straight from that.\n\n Perfect, thanks very much.\n\n No worries. Take it easy for the rest of 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1","wer":2.0408163265306123,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\n  Thanks.\n\n  So, what's brought you in today?\n\n  It's my lower back, mostly. And the right shoulder's been playing up as well.\n\n  Okay. Let's start with the back. Where about is it?\n\n  Right across the bottom.\n\n  Both sides, but the right's worse. And how long's that been going on?\n\n  Years. On and off. It flares up every few months and settles down again.\n\n  Is this a flare at the moment?\n\n  Yeah. Started about 10 days ago.\n\n  Anything set it off that you can think of?\n\n  We poured a big slab on the Thursday. I was bent over most of the day.\n\n  That'll do it. And you're concreting full-time?\n\n  Yeah, 15 years now.\n\n  On a scale of 1 to 10, where's it sitting today?\n\n  Probably a 6. It was an 8 on the weekend.\n\n  What makes it worse?\n\n  Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\n  And what helps?\n\n  A hot shower. Helps for about an hour, then it comes back.\n\n  Anything shooting down the leg? Pins, a needles, numbness, anything like that?\n\n  No, nothing like that. It's just an ache.\n\n  Any pain at night that wakes you? Or any trouble with the bladder or bowels?\n\n  No, none of that.\n\n  Good. Have you had any imaging done, or seen anyone else about it?\n\n  I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n  Right. And are you on any medications, or any other health conditions I should know about?\n\n  Just blood pressure tablets. Nothing else.\n\n  Okay. Now, the shoulder. How long's that been there?\n\n  Maybe 6 weeks. It's worse when I'm reaching overhead.\n\n  Does it wake you if you roll onto it?\n\n  Sometimes, yeah.\n\n  And what would you like to get out of today?\n\n  Honestly, just to get through a work week without it seizing up.\n\n  That's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound all right?\n\n  Yeah, sounds good.\n\n  It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\n  Will do.\n\n  Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you. How's that pressure?\n\n  Yeah, that's good. Ooh, that's the spot.\n\n  Too much?\n\n  Nah, it's all right.\n\n आपण\n\n  I'm going to use the massage gun on this one. It's a bit loud.\n\n  No worries.\n\n  Is the pain okay?\n\n  Yeah, that's fine. Bit intense, but it's all right.\n\n  Sing out if you want me to back off. Right, roll onto your back for me. Okay, sit yourself up slowly when you're ready.\n\n  That feels a lot looser.\n\n  Good. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\n\n  So what should I be doing at home?\n\n  Two things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n  Yeah, rightho.\n\n  I'd book you back in 2 weeks. Does a Thursday suit?\n\n  Thursday's fine.\n\n  Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that.\n\n  Perfect. Thanks very much.\n\n  No worries. Take it easy for the rest of today.","marks":[{"start":226,"end":237,"said":"Whereabouts","significant":false},{"start":1988,"end":1997,"said":"alright","significant":false},{"start":2334,"end":2350,"said":"alright.","significant":false},{"start":2497,"end":2507,"said":"alright.","significant":false},{"start":2787,"end":2796,"said":"shoulder's","significant":false},{"start":3007,"end":3015,"said":"righto.","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Documents recurrent LBP and \"R shoulder pain x ~6 wks\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"Recurrent LBP x years\" and \"R shoulder pain x ~6 wks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 today, 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Concreting full-time x 15 yrs\" and flare after \"prolonged bending while pouring large concrete slab\"; lifting noted in assessment."],["The output records that radicular symptoms and red flags were denied","yes","\"Denies leg radiation, paraesthesia or numbness. No nocturnal waking pain or bladder/bowel changes.\""],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Treatment provided to low back/gluteal region and R shoulder region\"."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip-flexor stretch: 90 sec each side, BID.\""],["The output notes a review in two weeks","yes","\"F/u in 2 wks; Thursday agreed.\""]],"claims":[],"note":"Subjective\nRecurrent LBP x years; flares q few months. Current flare x 10 days after prolonged bending while pouring large concrete slab.\nBilat low back ache, R > L; 6/10 today, 8/10 on weekend.\nWorse with sitting/driving; marked morning stiffness. Hot shower relieves for ~1 hr.\nDenies leg radiation, paraesthesia or numbness. No nocturnal waking pain or bladder/bowel changes.\nConcreting full-time x 15 yrs.\nPrevious X-ray a few yrs ago reportedly showed “wear and tear”; no concerning findings per pt.\nR shoulder pain x ~6 wks; worse overhead and sometimes wakes when lying on R side.\nTakes BP medication only.\nGoal: complete work week without back “seizing up.”\nObjective\nClinician noted tightness through gluteals > lumbar spine.\nR shoulder symptoms/localisation noted predominantly at upper trapezius.\nTreatment provided to low back/gluteal region and R shoulder region; massage gun used. Tolerated despite intensity.\nPost-treatment, pt reported feeling looser.\nAssessment\nRecurrent bilat LBP flare, R > L, following prolonged bending/lifting at work; gluteal tightness supports load-related muscular contribution.\nNo reported radicular sx, sensory disturbance, nocturnal pain or bladder/bowel changes.\nR shoulder pain x 6 wks, aggravated by overhead reach and lying on affected side; upper trapezius involvement noted.\nPlan\nHip-flexor stretch: 90 sec each side, BID.\nAdvise keeping loads close to body before standing when lifting.\nTake it easy for remainder of today.\nF/u in 2 wks; Thursday agreed.\nEmail receipt with provider number for health-fund claim.","review":77.6842105263158,"saved":94.3157894736842,"clean":true,"effort":0.0,"sig":[]},{"label":"Run 2","wer":1.870748299319728,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\n  Thanks.\n\n  So, what's brought you in today?\n\n  It's my lower back, mostly. And the right shoulder's been playing up as well.\n\n  Okay. Let's start with the back. Where about is it?\n\n  Right across the bottom.\n\n  Both sides, but the right's worse. And how long's that been going on?\n\n  Years. On and off. It flares up every few months and settles down again.\n\n  Is this a flare at the moment?\n\n  Yeah. Started about 10 days ago.\n\n  Anything set it off that you can think of?\n\n  We poured a big slab on the Thursday. I was bent over most of the day.\n\n  That'll do it. And you're concreting full-time?\n\n  Yeah, 15 years now.\n\n  On a scale of 1 to 10, where's it sitting today?\n\n  Probably a 6. It was an 8 on the weekend.\n\n  What makes it worse?\n\n  Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\n  And what helps?\n\n  A hot shower. Helps for about an hour, then it comes back.\n\n  Anything shooting down the leg? Pins, a needles, numbness, anything like that?\n\n  No, nothing like that. It's just an ache.\n\n  Any pain at night that wakes you?\n\n  No.\n\n  Or any trouble with the bladder or bowels?\n\n  No, none of that.\n\n  Good. Have you had any imaging done, or seen anyone else about it?\n\n  I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n  Right. And are you on any medications, or any other health conditions I should know about?\n\n  Just blood pressure tablets. Nothing else.\n\n  Okay. Now, the shoulder: how long's that been there?\n\n  Maybe 6 weeks. It's worse when I'm reaching overhead.\n\n  Does it wake you if you roll onto it?\n\n  Sometimes, yeah.\n\n  And what would you like to get out of today?\n\n  Honestly, just to get through a work week without it seizing up.\n\n  That's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound all right?\n\n  Yeah, sounds good.\n\n  It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\n  Will do.\n\n  Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you. How's that pressure?\n\n  Yeah, that's good. Ooh, that's the spot.\n\n  Too much?\n\n  Nah, it's all right.\n\n  I'm going to use the massage gun on this one. It's a bit loud.\n\n  No worries.\n\n  Is the pain okay?\n\n  Yeah, that's fine.\n\n  Bit intense, but it's all right. Sing out if you want me to back off. Right, roll onto your back for me. Okay, sit yourself up slowly when you're ready.\n\n  That feels a lot looser.\n\n  Good. The lower back was tight through the glutes, more than the spine itself.\n\n  Which is what I'd expect with the lifting.\n\n  The shoulders mostly the upper trap.\n\n  So what should I be doing at home?\n\n  Two things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n  Yeah, righto.\n\n  I'd book you back in 2 weeks. Does a Thursday suit?\n\n  Thursday's fine.\n\n  Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that.\n\n  Perfect. Thanks very much.\n\n  No worries. Take it easy for the rest of today.","marks":[{"start":226,"end":237,"said":"Whereabouts","significant":false},{"start":1134,"end":1137,"said":"","significant":false},{"start":1998,"end":2007,"said":"alright","significant":false},{"start":2344,"end":2354,"said":"alright.","significant":false},{"start":2504,"end":2514,"said":"alright.","significant":false},{"start":2798,"end":2807,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","LBP and R shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Recurrent LBP for years; R shoulder x6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today; up to 8/10 over weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Full-time concreting, 15 years; flare after prolonged bending during slab pour."],["The output records that radicular symptoms and red flags were denied","yes","Denies LE radiation, paraesthesia, numbness, nocturnal waking, bowel/bladder dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Treatment to lower back/gluteal region and R shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 sec each side, BID\"."],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks\"."]],"claims":[],"note":"Subjective\nLBP, bilateral with R > L; recurrent intermittent episodes for years. Current flare x10 days after prolonged bending during concrete slab pour.\nWorks full-time in concreting; 15-year history.\nPain 6/10 today; up to 8/10 over weekend.\nWorse with sitting/driving; reports marked morning stiffness.\nTemporarily relieved by hot shower (~1 hr).\nDenies LE radiation, paraesthesia, numbness, nocturnal waking due to back pain, or bowel/bladder dysfunction.\nReports prior lumbar XR several years ago; advised “wear and tear,” no concerning findings reported.\nR shoulder pain x6 weeks; aggravated by overhead reach and sometimes when lying/rolling onto R side.\nPMHx: hypertension, on antihypertensive medication.\nGoal: tolerate work week without back “seizing up.”\nObjective\nTreatment provided to lower back/gluteal region and R shoulder/upper trapezius region.\nPatient reported focal tenderness during treatment, tolerated pressure and massage gun application.\nPost-treatment, patient reported feeling “a lot looser.”\nClinician noted tightness through gluteal region, greater than spinal area.\nClinician noted shoulder symptoms/tightness predominantly at upper trapezius.\nAssessment\nRecurrent mechanical LBP flare, temporally associated with prolonged bending/concreting duties.\nNo reported radicular symptoms, sensory disturbance, nocturnal back pain, or bowel/bladder symptoms.\nGluteal tightness considered contributory to current LBP presentation.\nR shoulder pain, aggravated by overhead activity and side-lying; upper trapezius involvement noted.\nPlan\nHip flexor stretch: 90 sec each side, BID.\nLifting advice: keep load closer to body before standing.\nFollow-up in 2 weeks; Thursday suitable.\nReceipt with provider number to be emailed for health fund claim.\nAdvised to take it easy for remainder of day.","review":82.10526315789474,"saved":89.89473684210526,"clean":true,"effort":0.0,"sig":[],"mb":15.321409,"latency":21.976,"signable":104.08126315789474},{"label":"Run 3","wer":1.0204081632653061,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\n  Thanks.\n\n  So, what's brought you in today?\n\n  It's my lower back, mostly. And the right shoulder's been playing up as well.\n\n  Okay. Let's start with the back. Where about is it?\n\n  Right across the bottom.\n\n  Both sides, but the right's worse. And how long's that been going on?\n\n  Years. On and off. It flares up every few months and settles down again.\n\n  Is this a flare at the moment?\n\n  Yeah. Started about 10 days ago.\n\n  Anything set it off that you can think of?\n\n  We poured a big slab on the Thursday. I was bent over most of the day.\n\n  That'll do it. And your concreting full-time?\n\n  Yeah, 15 years now.\n\n  On a scale of 1 to 10, where's it sitting today?\n\n  Probably a 6. It was an 8 on the weekend.\n\n  What makes it worse?\n\n  Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\n  And what helps?\n\n  A hot shower. Helps for about an hour, then it comes back.\n\n  Anything shooting down the leg? Pins, a needles, numbness, anything like that?\n\n  No. Nothing like that. It's just an ache.\n\n  Any pain at night that wakes you? Or any trouble with the bladder or bowels?\n\n  No. None of that.\n\n  Good. Have you had any imaging done, or seen anyone else about it?\n\n  I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n  Right. And are you on any medications, or any other health conditions I should know about?\n\n  Just blood pressure tablets. Nothing else.\n\n  Okay. Now, the shoulder. How long's that been there?\n\n  Maybe 6 weeks. It's worse when I'm reaching overhead.\n\n  Does it wake you if you roll onto it?\n\n  Sometimes, yeah.\n\n  And what would you like to get out of today?\n\n  Honestly, just to get through a work week without it seizing up.\n\n  That's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound alright?\n\n  Yeah. Sounds good.\n\n  It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\n  Will do.\n\n  Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you. How's that pressure?\n\n  Yeah, that's good. Ooh, that's the spot.\n\n  Too much?\n\n  Nah, it's alright.\n\n  I'm going to use the massage gun on this one. It's a bit loud.\n\n  No worries.\n\n  Is the pain okay?\n\n  Yeah, that's fine. Bit intense, but it's alright.\n\n  Sing out if you want me to back off. Right, roll onto your back for me. Okay, sit yourself up slowly when you're ready.\n\n  That feels a lot looser.\n\n  Good. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\n\n  So what should I be doing at home?\n\n  Two things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n  Yeah, rightho.\n\n  I'd book you back in 2 weeks. Does a Thursday suit?\n\n  Thursday's fine.\n\n  Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that.\n\n  Perfect. Thanks very much.\n\n  No worries. Take it easy for the rest of today.","marks":[{"start":226,"end":237,"said":"Whereabouts","significant":false},{"start":634,"end":638,"said":"you're","significant":false},{"start":2773,"end":2782,"said":"shoulder's","significant":false},{"start":2993,"end":3001,"said":"righto.","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","LBP and R shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Chronic intermittent LBP for years; R shoulder x6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today; 8/10 over weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Full-time concreting, 15 years; flare after prolonged bending during slab work."],["The output records that radicular symptoms and red flags were denied","yes","Denies LE radiation, paraesthesia, numbness, nocturnal waking, bladder/bowel concerns."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Treatment to lower back/gluteal region and R shoulder region."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 sec each side, BID\"."],["The output notes a review in two weeks","yes","\"Review in 2 weeks\"."]],"claims":[],"note":"Subjective\nChronic intermittent LBP for years; flares every few months.\nCurrent flare commenced 10 days ago after prolonged bending during concrete slab work.\nBilateral low lumbar ache, R>L. Pain 6/10 today; 8/10 over weekend.\nWorse with sitting/driving; hot shower provides relief for ~1 hr.\nDenies LE radiation, paraesthesia, numbness, nocturnal waking, or bladder/bowel concerns.\nReports prior lumbar XR several years ago described as “wear and tear.”\nR shoulder pain x6 weeks; aggravated by OH reaching and occasionally waking when lying on it.\nWorks full-time in concreting; 15-year history.\nPMH: hypertension. Medications: BP tablets.\nGoal: tolerate work week without back “seizing.”\nObjective\nClinician noted marked tightness through gluteal region > lumbar spine.\nClinician noted shoulder tightness predominantly through upper trapezius.\nManual soft-tissue treatment provided to lower back/gluteal region and R shoulder region.\nPercussive therapy/massage gun applied; pt tolerated, reporting treatment was intense but acceptable.\nPt reported feeling looser post-treatment.\nAssessment\nMechanical LBP flare, likely associated with prolonged flexed posture/manual concreting work; no reported radicular, neurological, nocturnal, or bladder/bowel symptoms.\nR shoulder pain with OH activity, with upper trapezius tightness noted clinically.\nGluteal tightness likely contributing to reported lumbar symptoms.\nPlan\nHip flexor stretch: 90 sec each side, BID.\nLifting advice: position load closer to body before standing.\nReview in 2 weeks; Thursday suitable.\nEmail receipt with provider number for health-fund claim.","review":73.57894736842105,"saved":98.42105263157895,"clean":true,"effort":0.0,"sig":[],"mb":12.743808,"latency":19.468,"signable":93.04694736842106},{"label":"Run 4","wer":0.6802721088435374,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\n  Thanks.\n\n  So, what's brought you in today?\n\n  It's my lower back, mostly. And the right shoulder's been playing up as well.\n\n  Okay. Let's start with the back. Where about is it?\n\n  Right across the bottom.\n\n  Both sides, but the right's worse. And how long's that been going on?\n\n  Years. On and off. It flares up every few months and settles down again.\n\n  Is this a flare at the moment?\n\n  Yeah. Started about 10 days ago.\n\n  Anything set it off that you can think of?\n\n  We poured a big slab on the Thursday. I was bent over most of the day.\n\n  That'll do it. And your concreting full-time?\n\n  Yeah, 15 years now.\n\n  On a scale of 1 to 10, where's it sitting today?\n\n  Probably a 6. It was an 8 on the weekend.\n\n  What makes it worse?\n\n  Sitting's the worst. Driving to site in the morning I'm stiff as anything.\n\n  And what helps?\n\n  A hot shower. Helps for about an hour, then it comes back.\n\n  Anything shooting down the leg? Pins and needles, numbness, anything like that?\n\n  No, nothing like that. It's just an ache.\n\n  Any pain at night that wakes you?\n\n  Or any trouble with the bladder or bowels? No. None of that.\n\n  Good. Have you had any imaging done, or seen anyone else about it?\n\n  I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n  Right. And are you on any medications, or any other health conditions I should know about?\n\n  Just blood pressure tablets. Nothing else.\n\n  Okay. Now, the shoulder. How long's that been there?\n\n  Maybe 6 weeks. It's worse when I'm reaching overhead.\n\n  Does it wake you if you roll onto it?\n\n  Sometimes yeah.\n\n  And what would you like to get out of today?\n\n  Honestly, just to get through a work week without it seizing up.\n\n  That's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound alright?\n\n  Yeah, sounds good.\n\n  It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\n  Will do.\n\n  Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you. How's that pressure?\n\n  Yeah, that's good. Ooh, that's the spot.\n\n  Too much?\n\n  Nah, it's alright.\n\n  I'm going to use the massage gun on this one. It's a bit loud.\n\n  No worries.\n\n  Is the pain okay?\n\n  Yeah, that's fine. Bit intense, but it's alright.\n\n  Sing out if you want me to back off. Right, roll onto your back for me. Okay, sit yourself up slowly when you're ready.\n\n  That feels a lot looser.\n\n  Good. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\n\n  So what should I be doing at home?\n\n  Two things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n  Yeah, righto.\n\n  I'd book you back in 2 weeks. Does a Thursday suit?\n\n  Thursday's fine.\n\n  Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that.\n\n  Perfect. Thanks very much.\n\n  No worries. Take it easy for the rest of today.","marks":[{"start":226,"end":237,"said":"Whereabouts","significant":false},{"start":634,"end":638,"said":"you're","significant":false},{"start":2772,"end":2781,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","LBP and R shoulder pain both captured."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","LBP recurrent for years; R shoulder ~6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","6/10 today, up to 8/10 over weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Full-time concreting ~15 yrs with prolonged bending/slab pour."],["The output records that radicular symptoms and red flags were denied","yes","Denies LE radiation, paraesthesia, numbness, night pain, bladder/bowel changes."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Treatment to lower back/gluteal region and R shoulder."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 sec each side BID."],["The output notes a review in two weeks","yes","Follow-up in 2 weeks."]],"claims":[],"note":"Subjective\nRecurrent LBP x years; intermittent flares every few months.\nCurrent flare onset ~10 days after prolonged bending during concrete slab pour.\nPain 6/10 today; up to 8/10 over weekend.\nWorse with sitting/driving; morning stiffness reported.\nTemporary relief with hot shower (~1 hr).\nDenies LE radiation, paraesthesia, numbness, nocturnal pain, or bladder/bowel changes.\nPrior lumbar X-ray reportedly showed “wear and tear.”\nR shoulder pain x ~6 weeks.\nR shoulder worse with OH reaching; intermittently painful when lying/rolling onto R side at night.\nWorks full-time in concreting; ~15 yrs.\nPMH/meds: antihypertensive medication only.\nGoal: complete work week without back “seizing.”\nObjective\nClinician noted tightness through gluteal region > lumbar spine.\nClinician noted R upper trapezius tightness.\nSoft-tissue treatment provided to LB/gluteal region and R shoulder region; massage gun used.\nPt tolerated treatment; reported feeling looser post-treatment.\nAssessment\nRecurrent mechanical LBP flare, likely associated with prolonged bent posture/manual concreting work; no reported radicular sx or bladder/bowel concerns.\nGluteal tightness greater than spinal tightness on treatment assessment.\nR shoulder pain aggravated by OH activity and R side-lying, with upper trapezius tightness noted.\nPlan\nHip flexor stretch: 90 sec each side, BID.\nLifting advice: keep load closer to body before standing.\nFU in 2 weeks; Thursday suitable.\nEmail receipt with provider number for health fund claim.","review":71.05263157894737,"saved":100.94736842105263,"clean":true,"effort":0.0,"sig":[],"mb":13.079575,"latency":24.536,"signable":95.58863157894737},{"label":"Run 5","wer":0.6802721088435374,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\n  Thanks.\n\n  So, what's brought you in today?\n\n  It's my lower back, mostly. And the right shoulder's been playing up as well.\n\n  Okay. Let's start with the back. Whereabouts is it?\n\n  Right across the bottom.\n\n  Both sides, but the right's worse. And how long's that been going on?\n\n  Years. On and off. It flares up every few months and settles down again.\n\n  Is this a flare at the moment?\n\n  Yeah. Started about 10 days ago.\n\n  Anything set it off that you can think of?\n\n  We poured a big slab on the Thursday. I was bent over most of the day.\n\n  That'll do it. And your concreting full-time?\n\n  Yeah, 15 years now.\n\n  On a scale of 1 to 10, where's it sitting today?\n\n  Probably a 6. It was an 8 on the weekend.\n\n  What makes it worse?\n\n  Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\n  And what helps?\n\n  A hot shower. Helps for about an hour, then it comes back.\n\n  Anything shooting down the leg? Pins, a needles, numbness, anything like that?\n\n  No. Nothing like that. It's just an ache.\n\n  Any pain at night that wakes you? Or any trouble with the bladder or bowels?\n\n  No. None of that.\n\n  Good. Have you had any imaging done, or seen anyone else about it?\n\n  I had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\n  Right. And are you on any medications, or any other health conditions I should know about?\n\n  Just blood pressure tablets. Nothing else.\n\n  Okay. Now, the shoulder. How long's that been there?\n\n  Maybe 6 weeks. It's worse when I'm reaching overhead.\n\n  Does it wake you if you roll onto it?\n\n  Sometimes, yeah.\n\n  And what would you like to get out of today?\n\n  Honestly, just to get through a work week without it seizing up.\n\n  That's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound alright?\n\n  Yeah. Sounds good.\n\n  It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\n  Will do.\n\n  Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you. How's that pressure?\n\n  Yeah, that's good. Ooh, that's the spot.\n\n  Too much?\n\n  Nah. It's alright.\n\n  I'm going to use the massage gun on this one. It's a bit loud.\n\n  No worries.\n\n  Is the pain okay?\n\n  Yeah, that's fine. Bit intense, but it's alright.\n\n  Sing out if you want me to back off. Right, roll onto your back for me. Okay, sit yourself up slowly when you're ready.\n\n  That feels a lot looser.\n\n  Good. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\n\n  So what should I be doing at home?\n\n  Two things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\n\n  Yeah, rightho.\n\n  I'd book you back in 2 weeks. Does a Thursday suit?\n\n  Thursday's fine.\n\n  Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that.\n\n  Perfect. Thanks very much.\n\n  No worries. Take it easy for the rest of today.","marks":[{"start":634,"end":638,"said":"you're","significant":false},{"start":2773,"end":2782,"said":"shoulder's","significant":false},{"start":2993,"end":3001,"said":"righto.","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","LBP and R shoulder pain both captured."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","LBP recurrent for years; R shoulder ~6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","6/10 today, up to 8/10 over weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Full-time concreting ~15 yrs with prolonged bending/slab pour."],["The output records that radicular symptoms and red flags were denied","yes","Denies LE radiation, paraesthesia, numbness, night pain, bladder/bowel changes."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Treatment to lower back/gluteal region and R shoulder."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 sec each side BID."],["The output notes a review in two weeks","yes","Follow-up in 2 weeks."]],"claims":[],"note":"Subjective\nRecurrent LBP, bilateral with R > L. Intermittent for years; flares every few months.\nCurrent flare commenced ~10 days ago after prolonged bending while pouring a concrete slab.\nConcreter x15 yrs.\nPain 6/10 today; up to 8/10 over weekend.\nAggravated by sitting/driving to work; reports marked morning stiffness.\nTemporary relief with hot shower (~1 hr).\nDenies LE radiation, paraesthesia or numbness.\nDenies nocturnal pain, bladder or bowel changes.\nPrevious lumbar XR several years ago reportedly showed “wear and tear.”\nR shoulder pain x~6 weeks; worse with OH reaching and occasionally when rolling onto shoulder at night.\nTakes BP medication; no other reported health conditions.\nGoal: tolerate work week without back “seizing up.”\nObjective\nClinician noted tightness through gluteal region > lumbar spine.\nClinician noted upper trapezius tightness associated with R shoulder symptoms.\nSoft-tissue treatment performed to lower back/gluteal region and R shoulder region; massage gun used.\nPt tolerated treatment; reported reduced tightness post-treatment.\nAssessment\nRecurrent LBP flare, likely mechanically related to sustained bending/lifting during concreting, with gluteal tightness noted on treatment.\nNo reported radicular symptoms or bowel/bladder changes.\nR shoulder pain with OH activity and intermittent positional night pain; upper trapezius tightness noted.\nPlan\nHip-flexor stretch: 90 sec each side, BID.\nLifting advice: bring load closer to body before standing.\nTake it easy for remainder of day.\nReview in 2 weeks; Thursday agreed.\nEmail receipt with provider number for health-fund claim.","review":76.10526315789474,"saved":95.89473684210526,"clean":true,"effort":0.0,"sig":[],"mb":12.790846,"latency":24.225,"signable":100.33026315789473}],"heidi":[{"label":"Run 1","wer":2.891156462585034,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay. Let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where's it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles, numbness, anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound all right? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto, I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah, that's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOoh, that's the spot. Too much? Nah, it's all right.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo worries.\n\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI can hear it.\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay, sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":1466,"end":1474,"said":"long's","significant":false},{"start":1913,"end":1922,"said":"alright","significant":false},{"start":2273,"end":2283,"said":"alright.","significant":false},{"start":2457,"end":2467,"said":"alright.","significant":false},{"start":2522,"end":2536,"said":"","significant":false},{"start":2794,"end":2803,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and 'Right shoulder pain ~6 weeks' recorded."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","'on and off for years, flares every few months'; shoulder '~6 weeks'."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","'Pain 6/10 today, peaked 8/10 on weekend'."],["The output notes the patient works in concreting with repeated bending and lifting","partial","Mentions pouring a concrete slab bent over and 'occupational lifting' but never states the patient works as a concreter."],["The output records that radicular symptoms and red flags were denied","yes","Denies radiating pain, pins and needles, numbness, night pain, bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","'Soft tissue release to lower back, glutes, right upper trapezius'."],["The output mentions a hip flexor stretch as home advice","yes","'hip flexor stretch, 90 sec each side, BD'."],["The output notes a review in two weeks","yes","'Follow-up in 2 weeks (Thursday)'."]],"claims":[],"note":"Subjective\n\n- Lower back pain, bilateral, worse on right, across the bottom\n\n- Ache, on and off for years, flares every few months\n\n- Current flare ~10 days ago, attributed to pouring large concrete slab (bent over most of the day)\n\n- Pain 6/10 today, peaked 8/10 on weekend\n\n- Worse with sitting, esp. driving in morning\n\n- Hot shower gives ~1 hr relief\n\n- Denies radiating pain, pins and needles, numbness in leg\n\n- Denies night pain waking from sleep, bladder/bowel issues\n\n- Right shoulder pain ~6 weeks, worse with overhead reaching, sometimes wakes when rolling onto it\n\n- PMHx: HTN (on antihypertensive)\n\n- Imaging: Lumbar spine X-ray a few years ago - reported wear and tear, nothing to worry about\n\n- Goals: get through a work week without exacerbation\n\n\n\n\nObjective\n\n- Lower back: tightness through glutes, less so in spine\n\n- Right shoulder: tightness in upper trapezius\n\n\n\n\nAssessment\n\n- Lower back pain with gluteal tightness, likely related to occupational lifting\n\n- Right shoulder pain with upper trapezius tightness\n\n\n\n\nPlan\n\n- Soft tissue release to lower back, glutes, right upper trapezius; massage gun used\n\n- Home exercises: hip flexor stretch, 90 sec each side, BD\n\n- Ergonomic advice: keep load close to body when lifting\n\n- Follow-up in 2 weeks (Thursday)\n\n- Receipt with provider number to be emailed for health fund claim\n\n- Advised to take it easy for remainder of day","review":82.96052631578948,"saved":89.03947368421052,"clean":false,"effort":6.25,"sig":[],"mb":119.35525,"latency":27.1,"signable":110.06052631578947},{"label":"Run 2","wer":2.5510204081632653,"text":"Morning, come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay. Let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where is it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah, that's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOh, that's the spot. Too much? No. It's all right.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one. It's a bit loud. No worries.\n\n\n\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay. Sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":684,"end":692,"said":"where's","significant":false},{"start":1467,"end":1475,"said":"long's","significant":false},{"start":2230,"end":2232,"said":"Ooh","significant":false},{"start":2261,"end":2264,"said":"Nah","significant":false},{"start":2270,"end":2280,"said":"alright.","significant":false},{"start":2455,"end":2465,"said":"alright.","significant":false},{"start":2778,"end":2787,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"Lower back pain and right shoulder pain.\""],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"Years, on and off\" and shoulder \"~6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today, 8/10 on weekend.\""],["The output notes the patient works in concreting with repeated bending and lifting","partial","Mentions \"pouring large concrete slab, bent over\" and \"occupational lifting\" but does not state he works as a concreter."],["The output records that radicular symptoms and red flags were denied","yes","\"Denies radiating pain, pins and needles, numbness, night pain..., bladder/bowel issues.\""],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Treatment to lower back, glutes and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretch, 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks (Thursday).\""]],"claims":[],"note":"Subjective\n\n- Lower back pain and right shoulder pain.\n\n- Back pain:\n\n  - Across lower back, bilateral, right worse.\n\n  - Years, on and off, flares every few months.\n\n  - Current flare ~10 days ago, precipitated by pouring large concrete slab, bent over most of the day.\n\n  - Pain 6/10 today, 8/10 on weekend.\n\n  - Aggravated by sitting, driving in morning (stiffness).\n\n  - Relieved by hot shower (~1 hour temporary relief).\n\n  - Denies radiating pain, pins and needles, numbness, night pain waking from sleep, bladder/bowel issues.\n\n  - Previous X-ray a few years ago: \"wear and tear\", reassured.\n\n- Right shoulder pain:\n\n  - ~6 weeks.\n\n  - Worse with overhead reaching.\n\n  - Wakes from sleep if rolling onto it.\n\n- Goal: get through a work week without seizing up.\n\n\n\n\nObjective\n\n- Lower back: tight through glutes rather than spine.\n\n- Shoulder: mostly upper trapezius tightness.\n\n\n\n\nAssessment\n\n- Lower back pain, gluteal tightness, associated with occupational lifting.\n\n- Right shoulder pain, upper trapezius tightness.\n\n\n\n\nPlan\n\n- Treatment to lower back, glutes and right shoulder (upper trapezius); massage gun used.\n\n- Post-treatment: reported feeling \"a lot looser\".\n\n- Home exercises: hip flexor stretch, 90 seconds each side, twice daily.\n\n- Lifting technique advice: get load closer before standing.\n\n- Follow-up in 2 weeks (Thursday).\n\n- Receipt with provider number to be emailed for health fund claim.\n\n- Advised to take it easy for the rest of today.","review":81.69736842105263,"saved":90.30263157894737,"clean":false,"effort":6.25,"sig":[],"mb":182.186702,"latency":27.138,"signable":108.83536842105264},{"label":"Run 3","wer":2.5510204081632653,"text":"Morning, come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay. Let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where is it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles, numbness, anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Rita, I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah, that's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOoh, that's the spot. Too much? Nah, it's all right.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo worries.\n\nIs the pain okay? Yeah, that's fine. Good intense, but it's all right. Sing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay. Sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":684,"end":692,"said":"where's","significant":false},{"start":1467,"end":1475,"said":"long's","significant":false},{"start":2037,"end":2041,"said":"Righto.","significant":false},{"start":2270,"end":2280,"said":"alright.","significant":false},{"start":2432,"end":2436,"said":"Bit","significant":false},{"start":2455,"end":2465,"said":"alright.","significant":false},{"start":2778,"end":2787,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back flares every few months over years; shoulder ~6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today, peaked 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","partial","Flare after pouring concrete with prolonged bending captured, but occupation as a full-time concreter is not stated."],["The output records that radicular symptoms and red flags were denied","yes","Denies leg radiation, pins and needles, numbness, night pain, bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy to lower back, glutes and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks (Thursday)\"."]],"claims":[],"note":"Subjective:\n\n- Lower back pain, primarily right-sided, radiating across bottom of back\n\n- Intermittent, flares every few months; current flare ~10 days ago after pouring concrete (prolonged bending)\n\n- Pain 6/10 today, peaked 8/10 on weekend\n\n- Aggravated by sitting, particularly morning drives\n\n- Relieved temporarily by hot showers (~1 hour)\n\n- Denies radiation down legs, pins and needles, numbness, night pain waking from sleep, bladder/bowel issues\n\n- Previous X-ray a few years ago: \"wear and tear\"\n\n- Right shoulder pain ~6 weeks; worse with overhead reaching; occasionally wakes at night if rolling onto it\n\n- Goal: complete a work week without pain exacerbation\n\n\n\n\nPast Medical History:\n\n- Hypertension (managed with medication)\n\n\n\n\nMedications:\n\n- Blood pressure tablets\n\n\n\n\nObjective:\n\n- Lower back: tightness through gluteal muscles rather than spinal structures\n\n- Right shoulder: tightness in upper trapezius\n\n\n\n\nAssessment:\n\n- Lower back tightness through glutes, consistent with lifting load\n\n- Right shoulder upper trapezius tightness\n\n\n\n\nPlan:\n\n- Manual therapy to lower back, glutes and right shoulder (upper trapezius); massage gun used\n\n- Post-treatment: reports feeling \"a lot looser\"\n\n- Hip flexor stretch: 90 seconds each side, twice daily\n\n- Lifting technique: keep load close to body before standing\n\n- Follow-up in 2 weeks (Thursday)\n\n- Receipt with provider number to be emailed for health fund claim\n\n- Advised to take it easy for remainder of day","review":80.75,"saved":91.25,"clean":false,"effort":6.25,"sig":[],"mb":173.596774,"latency":24.349,"signable":105.099},{"label":"Run 4","wer":8.503401360544217,"text":"Morning. Come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay. Let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where is it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles, numbness, anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto, I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah, that's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOoh, that's the spot. Too much? No, it's all right.\n\n\n\n\n\nI got a lot of easy pain in your mouth.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one. It's a bit loud. No worries.\n\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI thought I wanted to eat a pinch in your mouth like this. Shut up. I thought that I want to eat your mom like this.\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay. Sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":684,"end":692,"said":"where's","significant":false},{"start":1467,"end":1475,"said":"long's","significant":false},{"start":2262,"end":2264,"said":"Nah","significant":false},{"start":2271,"end":2326,"said":"alright.","significant":true},{"start":2493,"end":2503,"said":"alright.","significant":false},{"start":2560,"end":2676,"said":"","significant":true},{"start":2934,"end":2943,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain \"for years, on and off\"; shoulder \"~6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today, was 8/10 on the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Concrete slab pouring, bent over all day; occupational lifting."],["The output records that radicular symptoms and red flags were denied","yes","Denies radiating pain, pins and needles, numbness, nocturnal pain, bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Treatment to lower back, glutes and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch, 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks (Thursday)\"."]],"claims":[],"note":"Subjective\n\n- Lower back pain, bilateral, right worse, for years, on and off\n\n- Current flare started 10 days ago after pouring a concrete slab (bent over most of the day)\n\n- Pain 6/10 today, was 8/10 on the weekend\n\n- Worse with sitting, especially driving; improved with hot shower for ~1 hour\n\n- Denies radiating pain, pins and needles, numbness down legs\n\n- Denies nocturnal pain, bladder/bowel issues\n\n- Previous X-ray a few years ago: wear and tear, not concerning\n\n- Right shoulder pain ~6 weeks, worse with overhead reaching, wakes from sleep if rolling onto it\n\n- PMHx: hypertension\n\n- Medications: antihypertensive\n\n- Goal: get through a work week without pain exacerbation\n\n\n\n\nObjective\n\n- Lower back and glutes tight, consistent with lifting\n\n- Upper trapezius tight\n\n\n\n\nAssessment\n\n- Mechanical lower back pain with gluteal tightness, consistent with occupational lifting\n\n- Right shoulder pain with upper trapezius tightness\n\n\n\n\nPlan\n\n- Treatment to lower back, glutes and right shoulder\n\n- Hip flexor stretch, 90 seconds each side, twice daily\n\n- Counselled on proper lifting technique: keep load closer to body before standing\n\n- Follow-up in 2 weeks (Thursday)\n\n- Receipt with provider number to be emailed for health fund claim\n\n- Advised to take it easy for the remainder of the day","review":61.89473684210527,"saved":110.10526315789474,"clean":true,"effort":0.0,"sig":[],"mb":127.557511,"latency":26.637,"signable":88.53173684210526},{"label":"Run 5","wer":2.891156462585034,"text":"Morning, come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay, let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where is it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles, numbness, anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound all right? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah. That's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOoh, that's the spot. Too much? No, it's all right.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one.\n\nIt's a bit loud. No worries.\n\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay, sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does it Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":684,"end":692,"said":"where's","significant":false},{"start":1467,"end":1475,"said":"long's","significant":false},{"start":1914,"end":1923,"said":"alright","significant":false},{"start":2264,"end":2266,"said":"Nah","significant":false},{"start":2273,"end":2283,"said":"alright.","significant":false},{"start":2457,"end":2467,"said":"alright.","significant":false},{"start":2780,"end":2789,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"for many years\"; \"Right shoulder pain for 6 weeks.\""],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain 6/10 today, was 8/10 on weekend.\""],["The output notes the patient works in concreting with repeated bending and lifting","partial","Flare after pouring concrete while bent over is noted, but concreting as his 15-year occupation is not stated."],["The output records that radicular symptoms and red flags were denied","yes","Denies radiation, pins and needles, numbness, bladder/bowel issues, night pain."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Lower back and glutes treated, then right shoulder.\""],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily.\""],["The output notes a review in two weeks","yes","\"Follow-up booked Thursday in 2 weeks.\""]],"claims":[],"note":"Subjective\n\n- Lower back pain, right worse than left, for many years\n\n- Flares every few months; current flare started 10 days ago after pouring concrete, bent over most of the day\n\n- Pain 6/10 today, was 8/10 on weekend\n\n- Worse with sitting and driving\n\n- Hot shower helps for ~1 hour\n\n- Denies radiation down leg, pins and needles, numbness, bladder or bowel issues, night pain\n\n- Right shoulder pain for 6 weeks, worse with overhead reaching; wakes sometimes when rolling onto it\n\n- Goal: get through work week without pain seizing up\n\n\n\n\nPast History\n\n- Chronic lower back pain; X-ray a few years ago showed wear and tear\n\n- Hypertension, on blood pressure tablets\n\n\n\n\nObjective\n\n- Lumbar spine: tightness through glutes, not spine itself\n\n- Shoulder: upper trapezius tightness\n\n\n\n\nAssessment\n\n- Mechanical lower back pain with gluteal tightness\n\n- Right shoulder pain with upper trapezius tightness\n\n\n\n\nPlan\n\n- Lower back and glutes treated, then right shoulder\n\n- Home exercises:\n\n    - Hip flexor stretch: 90 seconds each side, twice daily\n\n    - Lifting technique: get load closer to body before standing\n\n- Follow-up booked Thursday in 2 weeks\n\n- Receipt with provider number to be emailed for health fund claim\n\n- Advised to take it easy for the rest of today","review":76.32894736842105,"saved":95.67105263157895,"clean":false,"effort":6.25,"sig":[],"mb":124.138906,"latency":27.03,"signable":103.35894736842106},{"label":"Run 6","wer":2.2108843537414966,"text":"Morning, come on through. Take a seat wherever's comfortable.\n\nThanks. So what's brought you in today? It's my lower back mostly, and the right shoulder has been playing up as well. Okay. Let's start with the back.\n\nWhereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment? Yeah. Started about ten days ago. Anything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time? Yeah. Fifteen years now. On a scale of one to ten, where's it sitting today? Probably a six. It was an eight on the weekend. What makes it worse?\n\nSitting's the worst. Driving to site in the morning, I'm stiff as anything. And what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles, numbness, anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No, none of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear, nothing to worry about. Right. And are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets, nothing else. Okay. Now the shoulder, how long has that been there? Maybe six weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up. That's fair. Here's what I'd suggest. I'll work through the lower back and the glutes, because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound all right? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto, I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\n\n\n\n\n\n\n\n\n\n\nHow's that pressure? Yeah, that's good.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nOoh, that's the spot. Too much? Nah, it's all right.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nI'm going to use the massage gun on this one. It's a bit loud. No worries.\n\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right.\n\nSing out if you want me to back off.\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nRight. Roll onto your back for me.\n\n\n\n\n\n\n\n\n\n\n\nOkay, sit yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? Two things. Hip flexor stretch, ninety seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in two weeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries. Take it easy for the rest of today.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":303,"end":311,"said":"long's","significant":false},{"start":1466,"end":1474,"said":"long's","significant":false},{"start":1913,"end":1922,"said":"alright","significant":false},{"start":2273,"end":2283,"said":"alright.","significant":false},{"start":2456,"end":2466,"said":"alright.","significant":false},{"start":2780,"end":2789,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"recurring every few months for years\"; \"Right shoulder pain ~6 weeks.\""],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"currently 6/10 (previously 8/10 over weekend).\""],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreter for 15 years\"; flare after pouring slab; lifting advice."],["The output records that radicular symptoms and red flags were denied","yes","Denies radicular symptoms, pins and needles, numbness, night pain, bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"lower back and gluteal work, followed by right shoulder treatment.\""],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretch, 90 seconds each side, twice daily.\""],["The output notes a review in two weeks","yes","\"re-book in 2 weeks, preferably Thursday.\""]],"claims":[],"note":"Subjective\n\n\n\n\n- Lower back pain, primarily right-sided, radiating across bottom of back\n\n- Ache, currently 6/10 (previously 8/10 over weekend)\n\n- Flare-up of chronic issue, recurring every few months for years\n\n- Current flare onset ~10 days ago, attributed to pouring concrete slab\n\n- Aggravated by sitting, particularly driving\n\n- Relieved temporarily by hot showers (~1 hour relief)\n\n- Denies radicular symptoms, pins and needles, numbness, night pain waking from sleep, bladder/bowel dysfunction\n\n- Prior X-ray a few years ago reported as \"wear and tear, nothing to worry about\"\n\n- Right shoulder pain ~6 weeks, worse with overhead reaching; occasionally wakes from sleep if rolling onto it\n\n- Goals: complete a work week without pain exacerbation\n\n- Occupation: concreter for 15 years\n\n- Medications: blood pressure tablets\n\n\n\n\nObjective\n\n\n\n\n- Assessment and treatment focused on lower back and glutes, with attention to right shoulder\n\n- Lower back: tightness through glutes more than spine itself\n\n- Shoulder: upper trapezius tightness\n\n\n\n\nAssessment\n\n\n\n\n- Chronic mechanical lower back pain, currently flared\n\n- Right shoulder pain, upper trapezius involvement\n\n\n\n\nPlan\n\n\n\n\n- Therapy: lower back and gluteal work, followed by right shoulder treatment\n\n- Massage gun utilised during treatment\n\n- Home exercises: hip flexor stretch, 90 seconds each side, twice daily\n\n- Lifting advice: keep load closer to body before standing\n\n- Follow-up: re-book in 2 weeks, preferably Thursday\n\n- Receipt with provider number for health fund claim to be emailed\n\n- Advised to take it easy for remainder of day","review":72.3157894736842,"saved":99.6842105263158,"clean":true,"effort":0.0,"sig":[],"mb":129.764261,"latency":26.9,"signable":99.2157894736842}],"freed":[{"label":"Run 1","wer":118.36734693877551,"text":"Morning.\nCome on through.\nTake a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back mostly, and the right shoulder's been playing up as well.\nOkay.\nLet's start with the back.\nWhereabouts is it?\nRight across the bottom.\nBoth sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it.\nAnd you're concreting full-time?\nYeah, 15 years now.\nOn a scale of one to 10, where's it sitting today?\nProbably a six.\nIt was an eight on the weekend.\nWhat makes it worse?\nSitting's the worst.\nDriving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour then it comes back.\nAnything shooting down the leg, pins and needles, numbness, anything like that?\nNo, nothing like that, it's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood.\nHave you had any imaging done or seen anyone else about it?\nI had an x-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight.\nAnd are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay, now the shoulder, how long's that been there?\nMaybe 6 weeks.\nIt's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest.\nI'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder.\nDoes that sound all right?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nWriter, I'll step out while you get comfortable.\nFace down for me, head in the cradle, and pull the towel up over you. It's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like, it's like.\nI'm going to go ahead and get started.\nYou're not going to get out of here, are you?\nHow's that pressure?\nYeah, that's good. Yeah.\nAll right.\nOoh, that's the spot. Too much?\nNah, it's alright.\nYou're not going to let that sink in, are you?\nSix.\nAnd there you have it, the most powerful and expensive, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and the most powerful, and...\nThank you for watching this video.\nof of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of...\nthe National Museum of the British Columbia.\nThe museum is located in the National Museum of the British Columbia.\nThe National Museum of the British Columbia is located in the National Museum of the British Columbia.\nI'm going to go ahead and put it in. What is that?\nI don't know, sir.\nIt's a...\nIt's not as bad as I thought it would be, but it's not as bad as I thought it would be.\nHowever, according to the map, it is located in the eastern part of the town.\nHowever, the city has been abandoned since the early 20th century after the German occupation.\nOver this period of time, Nusratullah's wife took him to the West for the reason that he was frequently being harassed and yelled at.\nHe later became a spy for the Islamist militants.\nHe later became a spy for the Islamist militants.\nHe...\nHow?\nYeah. Now.\nI'm going to use the massage gun on this one, it's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine.\nA bit intense, but it's all right.\nSing out if you want me to back off. I'm not going to tell you what I'm going to do.\nNow.\nSix.\nI don't like you.\nLet's see what we've got here. You're not going to get away with this.\nRight, roll onto your back for me.\nI'm going to show you how to do it.\nYeah. Okay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood.\nThe lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\n2 things.\nHip flexor stretch, 90 seconds each side, twice a day.\nAnd when you're lifting, get the load closer to you before you stand.\nYeah, right-o.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine.\nDo I get something for the health fund?\nI'll email the receipt through with the provider number on it.\nYou can claim it straight from that.\nPerfect.\nThanks very much.\nNo worries.\nTake it easy for the rest of today.\nYou're not going to get away with that.","marks":[{"start":1887,"end":1896,"said":"alright","significant":false},{"start":2011,"end":2017,"said":"Righto.","significant":false},{"start":2130,"end":2466,"said":"","significant":true},{"start":2508,"end":2524,"said":"","significant":false},{"start":2576,"end":5181,"said":"","significant":true},{"start":5318,"end":5328,"said":"alright.","significant":false},{"start":5366,"end":5512,"said":"","significant":true},{"start":5548,"end":5589,"said":"","significant":false},{"start":5788,"end":5797,"said":"shoulder's","significant":false},{"start":5997,"end":6005,"said":"righto.","significant":false},{"start":6290,"end":6329,"said":"","significant":true}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"two chief complaints: lower back pain and right shoulder pain\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"chronic lower back pain ... intermittently for years\" and shoulder pain \"present for approximately 6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"pain is rated 6 out of 10, having been as severe as 8 out of 10 over the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"works as a concreter full-time\" with \"prolonged bending\" and \"occupational lifting demands\"."],["The output records that radicular symptoms and red flags were denied","yes","\"denies any radiation of pain down the leg, pins and needles, numbness, night pain waking from sleep, or bladder or bowel dysfunction\"."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy focusing on lower back and glutes\" and \"Manual therapy addressing shoulder and upper trapezius\" (right shoulder)."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretches: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up appointment in 2 weeks\"."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 2996e1c3 presents with two chief complaints: lower back pain and right shoulder pain.\n\nThe patient reports chronic lower back pain that has been present intermittently for years, with flare-ups occurring every few months. The current episode began approximately 10 days ago after pouring a large concrete slab while bent over for most of the day. The pain is located across the lower back bilaterally, worse on the right side. Today, the pain is rated 6 out of 10, having been as severe as 8 out of 10 over the weekend. Sitting is the worst aggravating factor, and driving to work in the morning causes significant stiffness. A hot shower provides temporary relief for about an hour before the pain returns. The patient denies any radiation of pain down the leg, pins and needles, numbness, night pain waking from sleep, or bladder or bowel dysfunction. The patient had an x-ray a few years ago which showed \"wear and tear\" with nothing to worry about. The patient works as a concreter full-time for 15 years.\n\nThe patient also reports right shoulder pain that has been present for approximately 6 weeks. The pain worsens with overhead reaching and sometimes wakes the patient at night when rolling onto that side.\n\nThe patient's goal for today is to get through a work week without the pain seizing up.\n\nMedical History  \n- Hypertension\n\nMedications and Supplements  \n- Blood pressure medication\n\nSocial History  \n- Occupation: Works as a concreter full-time for 15 years\n\nObjective\nPhysical Examination  \n- Musculoskeletal: Lower back tightness noted through the gluteal region more than the spine. Right shoulder/upper trapezius tightness noted\n\nAssessment & Plan\nPatient presents with chronic lower back pain and right shoulder pain.\n\nChronic lower back pain\nAssessment: Chronic lower back pain ongoing for years with intermittent flares. Current episode began 10 days ago after a day of concrete work involving prolonged bending. Pain located across the lower back bilaterally but worse on the right side. Currently rates pain as 6/10, down from 8/10 over the weekend. Pain exacerbated by sitting and driving, improved temporarily by hot showers. No radicular symptoms, nocturnal pain, or bowel/bladder dysfunction. Previous x-ray several years ago showed wear and tear changes. Physical examination revealed tightness through the glutes more than the spine itself, consistent with occupational lifting demands. Patient works as a concrete contractor for 15 years with significant physical demands.\nPlan:\n- Manual therapy focusing on lower back and glutes\n- Hip flexor stretches: 90 seconds each side, twice daily\n- Lifting modification: get load closer before standing\n- Follow-up appointment in 2 weeks\n- Receipt provided for health fund claim\n\nRight shoulder pain\nAssessment: Right shoulder pain present for approximately 6 weeks. Pain worsens with overhead reaching and occasionally disrupts sleep when rolling onto the affected side. Physical examination revealed tightness in the upper trapezius region.\nPlan:\n- Manual therapy addressing shoulder and upper trapezius\n- Take it easy for the rest of today\n- Follow-up appointment in 2 weeks\n","review":157.26315789473685,"saved":14.73684210526315,"clean":true,"effort":0.0,"sig":[],"mb":56.946952,"latency":43.8,"signable":188.98215789473684},{"label":"Run 2","wer":65.3061224489796,"text":"Morning.\nCome on through.\nTake a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back mostly, and the right shoulder's been playing up as well.\nOkay.\nLet's start with the back.\nWhereabouts is it?\nRight across the bottom.\nBoth sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it.\nAnd you're concreting full-time?\nYeah, 15 years now.\nOn a scale of one to 10, where's it sitting today?\nProbably a six.\nIt was an eight on the weekend.\nWhat makes it worse?\nSitting's the worst.\nDriving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour then it comes back.\nAnything shooting down the leg, pins and needles, numbness, anything like that?\nNo, nothing like that, it's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood.\nHave you had any imaging done or seen anyone else about it?\nI had an x-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight.\nAnd are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay, now the shoulder, how long's that been there?\nMaybe 6 weeks.\nIt's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest.\nI'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder.\nDoes that sound all right?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nWriter, I'll step out while you get comfortable.\nFace down for me, head in the cradle, and pull the towel up over you. It was not mine.\nI'm going to go ahead and get started.\nI'm not going to do that.\nHow's that pressure?\nYeah, that's good. I'm going to go to the bathroom.\nSo, let's get started.\nOoh, that's the spot. Too much?\nNah, it's alright.\nI don't know what that looks like.\nI'm not sure if I'm going to be able to make it through the rest of the race.\nand I'll see you next time.\nand a half-and-a-half...\nThank you.\nThank you. What is that?\nI don't know.\nThere are many ways to use the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the power of the...\nSome of the tracks include one of a quantity of street jazz music, which is known to be a non-commercial, non-editorial work.\nIn the decision-making process, one-way communication is expressed over the internet with frequently used words and phrases, like, who are you, where are you from, what do you do, what are you doing, etc.\nYeah.\nNow. How?\nI'm going to use the massage gun on this one, it's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine.\nA bit intense, but it's all right.\nSing out if you want me to back off. I don't know.\nNow.\nSix.\nSix.\nI don't know. Thank you.\nRight, roll onto your back for me.\nAll right.\nYeah. Okay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood.\nThe lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\n2 things.\nHip flexor stretch, 90 seconds each side, twice a day.\nAnd when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine.\nDo I get something for the health fund?\nI'll email the receipt through with the provider number on it.\nYou can claim it straight from that.\nPerfect.\nThanks very much.\nNo worries.\nTake it easy for the rest of today.\nNow.","marks":[{"start":1887,"end":1896,"said":"alright","significant":false},{"start":2011,"end":2017,"said":"Righto.","significant":false},{"start":2130,"end":2211,"said":"","significant":false},{"start":2252,"end":2307,"said":"","significant":false},{"start":2359,"end":3890,"said":"","significant":false},{"start":4028,"end":4038,"said":"alright.","significant":false},{"start":4076,"end":4129,"said":"","significant":false},{"start":4165,"end":4181,"said":"","significant":false},{"start":4380,"end":4389,"said":"shoulder's","significant":false},{"start":4881,"end":4885,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 66edee41 presents with two chief complaints: lower back pain and right shoulder pain.\n\nThe patient reports chronic lower back pain that has been present for years, occurring intermittently with flare-ups every few months. The current flare-up began approximately 10 days ago after pouring a large concrete slab and being bent over most of the day. Pain is located across the lower back bilaterally, worse on the right side. Pain severity is currently 6 out of 10, having been as high as 8 out of 10 over the weekend. Pain is aggravated by sitting and driving to work in the morning, during which the patient feels very stiff. A hot shower provides temporary relief for about an hour before the pain returns. The patient denies any radiating pain down the leg, pins and needles, or numbness. The patient denies nocturnal pain waking them from sleep and denies any bladder or bowel dysfunction. The patient had an x-ray a few years ago which showed \"wear and tear\" with nothing to worry about.\n\nThe patient also reports right shoulder pain that has been present for approximately 6 weeks. Pain is worse with overhead reaching and sometimes wakes the patient at night when rolling onto the shoulder.\n\nThe patient's goal is to get through a work week without the pain seizing up.\n\nMedical History\n- Hypertension\n\nMedications and Supplements\n- Blood pressure medication\n\nSocial History\n- Occupation: Works as a concreter full-time for 15 years, involving frequent bending and lifting\n\nObjective\nPhysical Examination  \n- Musculoskeletal: Lower back tightness noted through the gluteal region more than the spine. Right shoulder/upper trapezius tightness noted\n\nAssessment & Plan\nPatient presents with chronic lower back pain flare and right shoulder pain.\n\nChronic lower back pain\nAssessment: Patient presents with an acute flare of chronic lower back pain, present for years with intermittent flares every few months. Current flare began 10 days ago after prolonged bending while pouring concrete at work. Pain is bilateral across the lower back but worse on the right side, currently rated 6/10, down from 8/10 over the weekend. Pain is exacerbated by sitting and driving, improved temporarily with hot showers. No radicular symptoms, nocturnal pain, or bowel/bladder dysfunction. Previous x-ray several years ago showed wear and tear. Physical examination revealed tightness through the glutes more than the spine itself, consistent with occupational lifting demands. Manual therapy treatment was performed targeting the lower back and glutes.\nPlan:\n- Hip flexor stretch 90 seconds each side, twice daily\n- Lifting modification: get load closer before standing\n- Take it easy for the rest of today\n- Follow-up appointment scheduled in 2 weeks\n\nRight shoulder pain\nAssessment: Patient reports 6-week history of right shoulder pain, worse with overhead reaching and occasionally waking him when rolling onto that side at night. Physical examination revealed tightness in the upper trapezius. Manual therapy treatment was performed targeting the shoulder and upper trapezius.\nPlan:\n- Follow-up appointment scheduled in 2 weeks\n","review":156.63157894736844,"saved":15.368421052631561,"clean":true,"effort":0.0,"sig":[],"mb":58.539234,"latency":47.016,"signable":189.48757894736843},{"label":"Run 3","wer":42.857142857142854,"text":"Morning.\nCome on through.\nTake a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back mostly, and the right shoulder's been playing up as well.\nOkay.\nLet's start with the back.\nWhereabouts is it?\nRight across the bottom.\nBoth sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it.\nAnd you're concreting full-time?\nYeah, 15 years now.\nOn a scale of one to 10, where's it sitting today?\nProbably a six.\nIt was an eight on the weekend.\nWhat makes it worse?\nSitting's the worst.\nDriving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour then it comes back.\nAnything shooting down the leg, pins and needles, numbness, anything like that?\nNo, nothing like that, it's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood.\nHave you had any imaging done or seen anyone else about it?\nI had an x-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight.\nAnd are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay, now the shoulder, how long's that been there?\nMaybe 6 weeks.\nIt's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest.\nI'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder.\nDoes that sound all right?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nWriter, I'll step out while you get comfortable.\nFace down for me, head in the cradle, and pull the towel up over you. What's that like?\nI'm going to go ahead and get started.\nHow?\nHow's that pressure?\nYeah, that's good. You're not going to get out of here, are you?\nI'm going to go ahead and start.\nOoh, that's the spot. Too much?\nNah, it's alright.\nSex, sex, sex.\nYou're not going to get me out of here, are you?\nThe red flag is up and the red flag is down.\nOh, yeah, yeah, yeah.\nI'm not sure what that is.\nAnd that's the end of the video.\nI'm going to go ahead and get started.\nDavid is the son of the President and the Chancellor of the United States. What is time?\nWhere are we?\nIt is late in the morning.\nThe project was funded by the Federal Institute of Technology, the American Academy of Sciences.\nHowever, according to the map, it is located in the eastern part of the National Park, on a mountain peak.\nIt has been known for many years as a tourist attraction.\nOver the history of one of India's capital cities, Maharashtra is a popular city, frequently being the land capital of East Bengal.\nMaharashtra is also known as the capital city of India, due to the common character of Maharashtra's name, which derives from the name of Maharashtra's capital city, Maharashtra.\nYeah.\nYeah. You're not going to get out of here, are you?\nI'm going to use the massage gun on this one, it's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine.\nA bit intense, but it's all right.\nSing out if you want me to back off. Oh!\nNow.\nThat's six.\nWhat the fuck?\nI don’t know. Now.\nRight, roll onto your back for me.\nI'm going to go ahead and get started.\nHow? Okay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood.\nThe lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\n2 things.\nHip flexor stretch, 90 seconds each side, twice a day.\nAnd when you're lifting, get the load closer to you before you stand.\nYeah, right-o.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine.\nDo I get something for the health fund?\nI'll email the receipt through with the provider number on it.\nYou can claim it straight from that.\nPerfect.\nThanks very much.\nNo worries.\nTake it easy for the rest of today.\nYou're not going to get out of here, are you?","marks":[{"start":1887,"end":1896,"said":"alright","significant":false},{"start":2011,"end":2017,"said":"Righto.","significant":false},{"start":2130,"end":2190,"said":"","significant":false},{"start":2232,"end":2310,"said":"","significant":false},{"start":2362,"end":3351,"said":"","significant":true},{"start":3489,"end":3499,"said":"alright.","significant":false},{"start":3537,"end":3591,"said":"","significant":true},{"start":3627,"end":3669,"said":"","significant":false},{"start":3869,"end":3878,"said":"shoulder's","significant":false},{"start":4078,"end":4086,"said":"righto.","significant":false},{"start":4371,"end":4415,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"Subjective\nCliniTech Benchmark f91d0f66 presents with two chief complaints: lower back pain and right shoulder pain.\n\nThe patient reports chronic lower back pain that has been present intermittently for years, with flare-ups occurring every few months. The current episode began approximately 10 days ago after pouring a large concrete slab while bent over for most of the day. The pain is located across the lower back bilaterally, worse on the right side. Today the pain is rated 6 out of 10, having been as severe as 8 out of 10 over the weekend. Sitting is the worst aggravating factor, and driving to work in the morning causes significant stiffness. A hot shower provides temporary relief for about an hour before the pain returns. The patient denies any radiation of pain down the leg, pins and needles, numbness, night pain waking them from sleep, or bladder or bowel dysfunction. The patient works as a concreter full-time and has been in the trade for 15 years, which involves frequent heavy lifting and prolonged bent-over postures. An x-ray performed a few years ago was reported as showing \"wear and tear\" with nothing to worry about.\n\nThe patient also reports right shoulder pain that has been present for approximately 6 weeks. The pain is worse with overhead reaching and sometimes wakes the patient at night when rolling onto that side.\n\nThe patient's goal for today was to be able to get through a work week without the pain seizing up.\n\nMedical History  \n- Hypertension\n\nMedications and Supplements  \n- Blood pressure medication\n\nSocial History  \n- Occupation: Works full-time as a concreter for 15 years, involving heavy lifting, prolonged bent-over postures, and pouring concrete slabs\n\nReview of Systems  \n- Neurological: Denies radicular symptoms, pins and needles, numbness in the legs\n\nObjective\nPhysical Examination  \n- Musculoskeletal: Lower back tightness noted, predominantly through the gluteal region rather than the spine. Right shoulder/upper trapezius tightness noted\n\nAssessment & Plan\nPatient presents with chronic lower back pain flare and right shoulder pain.\n\nChronic lower back pain flare  \nAssessment: Patient experiencing a 10-day flare of chronic lower back pain that has been ongoing for years with intermittent episodes. Pain is located across the lower back bilaterally but worse on the right side, currently rated 6/10, down from 8/10 over the weekend. Precipitated by prolonged bending while pouring concrete at work. Patient works as a concrete finisher for 15 years with repetitive lifting and bending. Pain worsens with sitting and driving, improves temporarily with hot showers. No radicular symptoms, nocturnal pain, or bowel/bladder dysfunction. Previous x-ray several years ago showed wear and tear changes. Physical examination revealed tightness through the glutes more than the spine itself, consistent with mechanical lower back pain related to occupational activities.  \nPlan:  \n- Hip flexor stretch 90 seconds each side twice daily  \n- Lifting modification: get load closer before standing  \n- Take it easy for the rest of today  \n- Follow-up appointment in 2 weeks on Thursday\n\nRight shoulder pain  \nAssessment: Six-week history of right shoulder pain, worse with overhead reaching and occasionally waking patient at night when rolling onto affected side. Physical examination revealed involvement of the upper trapezius muscle, consistent with mechanical shoulder pain likely related to occupational overhead activities.  \nPlan:  \n- Follow-up appointment in 2 weeks on Thursday\n","review":173.36842105263156,"saved":-1.368421052631561,"clean":true,"effort":0.0,"sig":[],"mb":58.237027,"latency":40.846,"signable":202.08342105263156},{"label":"Run 4","wer":44.5578231292517,"text":"Morning.\nCome on through.\nTake a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back mostly, and the right shoulder's been playing up as well.\nOkay.\nLet's start with the back.\nWhereabouts is it?\nRight across the bottom.\nBoth sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it.\nAnd you're concreting full-time?\nYeah, 15 years now.\nOn a scale of one to 10, where's it sitting today?\nProbably a six.\nIt was an eight on the weekend.\nWhat makes it worse?\nSitting's the worst.\nDriving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour then it comes back.\nAnything shooting down the leg, pins and needles, numbness, anything like that?\nNo, nothing like that, it's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood.\nHave you had any imaging done or seen anyone else about it?\nI had an x-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight.\nAnd are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay, now the shoulder, how long's that been there?\nMaybe 6 weeks.\nIt's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest.\nI'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder.\nDoes that sound all right?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nWriter, I'll step out while you get comfortable.\nFace down for me, head in the cradle, and pull the towel up over you. I don't know how long I'm going to be able to play this game.\nI don't know what I'm doing.\nYou're not going to get out of here, are you?\nHow's that pressure?\nYeah, that's good. You're not going to get out of here, are you?\nI'm going to go ahead and start.\nOoh, that's the spot. Too much?\nNah, it's alright.\nI'm not going to let that take the show.\nI can't believe it.\nI'm not sure I'm going to make it.\nThank you for watching my video today!\nI hope you enjoyed it!\nPlease subscribe, like, share and comment!\nThank you!\nOkay.\nThank you for watching!\nI'm going to go ahead and put it in there. What is that?\nI don't know, sir.\nIt's a...\nIt's not as bad as I thought it would be, but it's not as bad as I thought it would be.\nHowever, according to the map, it is located in the eastern part of the town.\nHowever, the city has been abandoned since the early 20th century after the German occupation.\nOver the history of the municipality of Marrakech, it has played a role of a leader and a frequent leader.\nThe land of Marrakech, where the people of Marrakech come from, is a central part of the Islamic Republic of Syria.\nThe Jewish people of Marrakech are the members of the Jewish community in the municipality of Marrakech.\nHow?\nYeah. Now.\nI'm going to use the massage gun on this one, it's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine.\nA bit intense, but it's all right.\nSing out if you want me to back off. Oh!\nNow.\nSix.\nOh my God!\nI'm sorry, I'm sorry. I don't know what that means.\nRight, roll onto your back for me.\nAll right.\nYou're not going to get out of here, are you? Okay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood.\nThe lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\n2 things.\nHip flexor stretch, 90 seconds each side, twice a day.\nAnd when you're lifting, get the load closer to you before you stand.\nYeah, right-o.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine.\nDo I get something for the health fund?\nI'll email the receipt through with the provider number on it.\nYou can claim it straight from that.\nPerfect.\nThanks very much.\nNo worries.\nTake it easy for the rest of today.\nHow?","marks":[{"start":1887,"end":1896,"said":"alright","significant":false},{"start":2011,"end":2017,"said":"Righto.","significant":false},{"start":2130,"end":2265,"said":"","significant":false},{"start":2307,"end":2385,"said":"","significant":false},{"start":2437,"end":3369,"said":"","significant":true},{"start":3506,"end":3516,"said":"alright.","significant":false},{"start":3554,"end":3630,"said":"","significant":true},{"start":3666,"end":3721,"said":"","significant":false},{"start":3921,"end":3930,"said":"shoulder's","significant":false},{"start":4130,"end":4138,"said":"righto.","significant":false},{"start":4423,"end":4426,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"two chief complaints: lower back pain and right shoulder pain\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"chronic lower back pain ... present intermittently for years\" and shoulder pain \"present for approximately 6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Current pain severity is 6 out of 10, having been as high as 8 out of 10 over the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"works as a concreter full-time\" and \"repetitive lifting and bending\"."],["The output records that radicular symptoms and red flags were denied","yes","\"denies any radiation of pain down the leg, pins and needles, numbness, night pain, or bladder or bowel dysfunction\"."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Manual therapy \"targeting lower back and glutes\" and \"targeting shoulder and upper trapezius\" (right shoulder)."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch 90 seconds each side twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up appointment scheduled for Thursday in 2 weeks\"."]],"claims":[],"note":"Subjective\nCliniTech Benchmark 5ede29b2 presents with two chief complaints: lower back pain and right shoulder pain.\n\nThe patient reports chronic lower back pain that has been present intermittently for years, with flare-ups occurring every few months. The current exacerbation began approximately 10 days ago after pouring a large concrete slab, which required prolonged bending over for most of the day. The patient works as a concreter full-time and has been in the trade for 15 years. Pain is located across the lower back bilaterally, worse on the right side. Current pain severity is 6 out of 10, having been as high as 8 out of 10 over the weekend. Pain is aggravated by sitting and driving to work in the morning, during which the patient reports significant stiffness. A hot shower provides temporary relief for approximately one hour before the pain returns. The patient denies any radiation of pain down the leg, pins and needles, numbness, night pain, or bladder or bowel dysfunction. The patient had an x-ray a few years ago, which showed wear and tear with no significant findings.\n\nThe patient also reports right shoulder pain that has been present for approximately 6 weeks. Pain is worse with overhead reaching and sometimes wakes the patient at night when rolling onto the affected side.\n\nThe patient's goal is to get through a work week without the pain seizing up.\n\nMedical History  \n- Hypertension\n\nMedications and Supplements  \n- Blood pressure medication\n\nSocial History  \n- Occupation: Works as a concreter full-time for 15 years\n\nObjective\nPhysical Examination  \n- Musculoskeletal: Lower back tightness noted, greater through the glutes than the spine. Right shoulder/upper trapezius tightness noted\n\nAssessment & Plan\nPatient presents with chronic lower back pain flare and right shoulder pain.\n\nChronic lower back pain  \nAssessment: Patient has chronic lower back pain affecting both sides with right side predominance, ongoing for years with intermittent flares every few months. Current flare began 10 days ago after prolonged bending while pouring concrete at work. Pain is currently 6/10, improved from 8/10 on weekend. Pain worsens with sitting and driving, improves temporarily with hot shower. No radicular symptoms, nocturnal pain, or bowel/bladder dysfunction. Previous x-ray several years ago showed wear and tear changes. Physical examination revealed tightness through the glutes more than the spine itself, consistent with occupational lifting demands. Patient works as concrete contractor for 15 years with repetitive lifting and bending.  \nPlan:  \n- Hip flexor stretch 90 seconds each side twice daily  \n- Lifting modification: get load closer before standing  \n- Manual therapy treatment performed targeting lower back and glutes  \n- Follow-up appointment scheduled\n\nRight shoulder pain  \nAssessment: Six-week history of right shoulder pain, worse with overhead reaching and occasionally waking patient at night when rolling onto affected side. Physical examination revealed involvement of upper trapezius musculature.  \nPlan:  \n- Manual therapy treatment performed targeting shoulder and upper trapezius  \n- Follow-up appointment scheduled for Thursday in 2 weeks\n","review":153.4736842105263,"saved":18.5263157894737,"clean":true,"effort":0.0,"sig":[],"mb":57.101069,"latency":46.978,"signable":188.2836842105263},{"label":"Run 5","wer":63.095238095238095,"text":"Morning.\nCome on through.\nTake a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back mostly, and the right shoulder's been playing up as well.\nOkay.\nLet's start with the back.\nWhereabouts is it?\nRight across the bottom.\nBoth sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it.\nAnd you're concreting full-time?\nYeah, 15 years now.\nOn a scale of one to 10, where's it sitting today?\nProbably a six.\nIt was an eight on the weekend.\nWhat makes it worse?\nSitting's the worst.\nDriving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour then it comes back.\nAnything shooting down the leg, pins and needles, numbness, anything like that?\nNo, nothing like that, it's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood.\nHave you had any imaging done or seen anyone else about it?\nI had an x-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight.\nAnd are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay, now the shoulder, how long's that been there?\nMaybe 6 weeks.\nIt's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest.\nI'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder.\nDoes that sound all right?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nWriter, I'll step out while you get comfortable.\nFace down for me, head in the cradle, and pull the towel up over you. Let's see what we have here.\nOh, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, You're not going to get out of there, are you?\nHow's that pressure?\nYeah, that's good. You're not going to get out of here, are you?\nI'm going to go ahead and get started.\nOoh, that's the spot. Too much?\nNah, it's alright.\nIt's not like I'm sick or anything.\nS. T. A. L. P. All right.\nThank you.\nIt's not a good time.\nIt's not a good time.\nThe city of San Francisco is home to the San Francisco City Council, a board of trustees that represents San Francisco County.\nand then, and then, and then, and then, and then, and then, and then, and then, and then, and then, and then, and then, and then, and then, What is that?\nI don't know, sir.\nIt's a...\nIt's not as bad as I thought it would be, but it's not as bad as I thought it would be.\nHowever, according to the map, it is located in the eastern part of the town.\nHowever, the city has been abandoned since the early 20th century after the German occupation.\nOver the history of the municipality of Marrakech, the district was a frequent meeting point for delegates from each side of the country.\nThe district of Marrakech is a dynamic area, with several historic landmarks, including the right square of the municipality of Marrakech.\nHow?\nYeah. Now.\nI'm going to use the massage gun on this one, it's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine.\nA bit intense, but it's all right.\nSing out if you want me to back off. Oh!\nNow.\nSix.\nI don't like it.\nLet's go. You're not going to tell me what to do, are you?\nRight, roll onto your back for me.\nAll right.\nYou're not going to get out of here, are you? Okay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood.\nThe lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\n2 things.\nHip flexor stretch, 90 seconds each side, twice a day.\nAnd when you're lifting, get the load closer to you before you stand.\nYeah, right-o.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine.\nDo I get something for the health fund?\nI'll email the receipt through with the provider number on it.\nYou can claim it straight from that.\nPerfect.\nThanks very much.\nNo worries.\nTake it easy for the rest of today.\nHow?","marks":[{"start":1887,"end":1896,"said":"alright","significant":false},{"start":2011,"end":2017,"said":"Righto.","significant":false},{"start":2130,"end":2874,"said":"","significant":false},{"start":2916,"end":3000,"said":"","significant":false},{"start":3052,"end":4032,"said":"","significant":true},{"start":4169,"end":4179,"said":"alright.","significant":false},{"start":4217,"end":4305,"said":"","significant":true},{"start":4342,"end":4397,"said":"","significant":false},{"start":4597,"end":4606,"said":"shoulder's","significant":false},{"start":4806,"end":4814,"said":"righto.","significant":false},{"start":5099,"end":5102,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"Subjective\nCliniTech Benchmark f99ba65e presents with two complaints: lower back pain and right shoulder pain.\n\nThe patient reports chronic lower back pain that has been present intermittently for years, with flare-ups occurring every few months. The current episode began approximately 10 days ago after pouring a large concrete slab while bent over for most of the day. The pain is located across the lower back, bilateral but worse on the right side. Today the pain is rated 6 out of 10, having been as high as 8 out of 10 over the weekend. Sitting is the worst aggravating factor, and driving to the worksite in the morning causes significant stiffness. A hot shower provides temporary relief for about an hour before the pain returns. The patient denies any radiation of pain down the leg, pins and needles, numbness, night pain waking from sleep, or bladder or bowel dysfunction. The patient had an x-ray a few years ago, which showed \"wear and tear\" and was told there was nothing to worry about.\n\nThe patient also reports right shoulder pain that has been present for approximately 6 weeks. The pain is worse with overhead reaching and sometimes wakes the patient at night when rolling onto that side.\n\nThe patient's goal is to get through a work week without the pain seizing up.\n\nMedical History  \n- Hypertension\n\nMedications and Supplements  \n- Blood pressure medication\n\nSocial History  \n- Occupation: Works as a concrete worker full-time for 15 years, involving heavy lifting and prolonged bent-over postures\n\nObjective\nPhysical Examination  \n- Musculoskeletal: Lower back tightness noted through the gluteal region more than the spine. Right shoulder/upper trapezius tightness noted\n\nAssessment & Plan\nPatient presents with chronic lower back pain and right shoulder pain.\n\nChronic lower back pain\nAssessment: Patient has chronic lower back pain that has been ongoing for years with intermittent flares every few months. Current flare began 10 days ago after a day of concrete work involving prolonged bending. Pain is located across the lower back bilaterally but worse on the right side. Currently rates pain as 6/10, down from 8/10 over the weekend. Pain is worse with sitting and driving, improved temporarily with hot showers. No radicular symptoms, nocturnal pain, or bowel/bladder dysfunction. Previous x-ray several years ago showed wear and tear changes. Physical examination revealed tightness through the glutes more than the spine itself, consistent with occupational lifting demands. Patient works as a concrete worker for 15 years with significant physical demands.\nPlan:\n- Manual therapy performed targeting lower back and glutes\n- Hip flexor stretch 90 seconds each side twice daily\n- Lifting modification: get load closer before standing\n- Follow-up appointment scheduled\n\nRight shoulder pain\nAssessment: Patient reports right shoulder pain present for approximately 6 weeks, worse with overhead reaching and occasionally waking patient at night when rolling onto the affected side. Physical examination revealed involvement of the upper trapezius muscle.\nPlan:\n- Manual therapy performed targeting shoulder and upper trapezius\n- Follow-up appointment scheduled for Thursday in 2 weeks\n","review":158.21052631578948,"saved":13.78947368421052,"clean":true,"effort":0.0,"sig":[],"mb":56.902435,"latency":44.969,"signable":190.98552631578949}],"cliniscripts":[{"label":"Run 1","wer":1.0204081632653061,"text":"Morning.\nCome on through. Take a seat wherever's comfortable.\nThanks.\nSo, what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay. Let's start with the back. Whereabouts is it?\nRight across the bottom. Both sides, but the right's worse.\nAnd how long's that been going on?\nYears. On and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah. Started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it. And you're concreting full-time?\nYeah, 15 years now.\nOn a scale of 1 to 10, where's it sitting today?\nProbably a 6. It was an 8 on the weekend.\nWhat makes it worse?\nSitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower. Helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins, a needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you? Or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done, or seen anyone else about it?\nI had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\nRight. And are you on any medications, or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay.\nNow, the shoulder—how long's that been there?\nMaybe 6 weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder.\nDoes that sound alright?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nRighto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\nHow's that pressure?\nYeah, that's good.\nOoh, that's the spot.\nToo much?\nNah, it's all right.\nI'm going to use the massage gun on this one. It's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine. Bit intense, but it's all right.\nSing out if you want me to back off.\nRight, roll onto your back for me.\nOkay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting.\nThe shoulders mostly the upper trap.\nSo what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks.\nDoes a Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.","marks":[{"start":2208,"end":2218,"said":"alright.","significant":false},{"start":2353,"end":2363,"said":"alright.","significant":false},{"start":2634,"end":2643,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"S (Subjective):\n- The patient presents with a chief complaint of lower back pain and right shoulder pain.\n- Lower back pain is located across the bottom, bilateral but worse on the right, described as an ache. It has been present for years, on and off, flaring up every few months. The current flare started approximately 10 days ago, triggered by pouring concrete and being bent over.\n- Current back pain severity is reported as 6/10, having been 8/10 on the weekend. Aggravated by sitting and driving. Partially alleviated by a hot shower for about an hour. Denies radicular symptoms, night pain, or bladder/bowel dysfunction.\n- Right shoulder pain has been present for about 6 weeks, worse with overhead reaching, and occasionally wakes them at night when rolling onto it.\n- The patient's occupation is full-time concreting for 15 years. They report a history of an X-ray a few years prior, diagnosed as \"wear and tear.\" Current medications include blood pressure tablets. Their primary goal is to get through a work week without seizing up.\n\nO (Objective):\n- The patient was cooperative throughout the session and provided clear feedback regarding palpation intensity.\n- Palpation revealed significant tightness in the gluteal muscles, more so than the spinal region, which is consistent with the patient's lifting-intensive occupation.\n- Assessment of the right shoulder indicated tightness primarily in the upper trapezius muscle.\n- During treatment, the patient tolerated the use of a massage gun on a tender spot, reporting it was \"bit intense, but it's all right.\"\n- Post-treatment, the patient reported feeling \"a lot looser.\"\n\nA (Assessment):\n- Chronic mechanical lower back pain with acute exacerbation, likely related to occupational demands and gluteal muscle tightness.\n- Right shoulder myalgia, specifically involving the upper trapezius, exacerbated by overhead activities.\n- Musculoskeletal dysfunction consistent with reported occupational stressors and previous \"wear and tear\" diagnosis, with current presentation primarily indicating soft tissue involvement.\n\nP (Plan):\n- In-session intervention included manual therapy targeting the lower back, glutes, and right shoulder (upper trap), with the application of a massage gun to specific tender areas.\n- The patient was educated on two home care strategies: performing hip flexor stretches for 90 seconds per side, twice daily, and improving lifting mechanics by keeping the load closer to the body before standing.\n- A follow-up appointment was scheduled for two weeks, on a Thursday.\n- An email receipt with the provider number will be sent to the patient for health fund claiming purposes.\n- The patient was advised to take it easy for the remainder of the day.\n","review":133.26315789473682,"saved":38.73684210526318,"clean":true,"effort":0.0,"sig":[],"mb":131.956519,"latency":29.357,"signable":150.2791578947368},{"label":"Run 2","wer":1.0204081632653061,"text":"Morning.\nCome on through. Take a seat wherever's comfortable.\nThanks.\nSo, what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay. Let's start with the back. Whereabouts is it?\nRight across the bottom. Both sides, but the right's worse.\nAnd how long's that been going on?\nYears. On and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah. Started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it. And you're concreting full-time?\nYeah, 15 years now.\nOn a scale of 1 to 10, where's it sitting today?\nProbably a 6. It was an 8 on the weekend.\nWhat makes it worse?\nSitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower. Helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins, a needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you? Or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done, or seen anyone else about it?\nI had an X-ray a few years back.\nThey said it was wear and tear, nothing to worry about.\nRight. And are you on any medications, or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay.\nNow, the shoulder. How long's that been there?\nMaybe 6 weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder.\nDoes that sound alright?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nRighto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\nHow's that pressure?\nYeah, that's good.\nOoh, that's the spot.\nToo much?\nNah, it's all right.\nI'm going to use the massage gun on this one.\nIt's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine. Bit intense, but it's all right.\nSing out if you want me to back off.\nRight, roll onto your back for me.\nOkay. Sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood. The lower back was tight through the glutes, more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\nSo what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks. Does a Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries.\nTake it easy for the rest of today.","marks":[{"start":2209,"end":2219,"said":"alright.","significant":false},{"start":2354,"end":2364,"said":"alright.","significant":false},{"start":2636,"end":2645,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","partial","\"full-time concrete worker for 15 years\" with lifting demands is noted, but the repeated bending component is not stated."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"S (Subjective):\n- Patient presents with lower back pain, primarily right-sided, and right shoulder pain.\n- Lower back pain described as an ache across the bottom, bilateral but worse on the right, present for years, flaring up every few months. Current flare started approximately 10 days ago after pouring a large concrete slab.\n- Severity of lower back pain is rated 6/10 today, previously 8/10 on the weekend. Aggravated by sitting, especially driving to work. Alleviated temporarily by a hot shower (approx. 1 hour relief).\n- Denies radiating pain, pins and needles, numbness, nocturnal pain, or issues with bladder/bowels.\n- Right shoulder pain present for approximately 6 weeks, worse with overhead reaching and sometimes wakes them when rolling onto it.\n- Patient's primary goal is to get through a work week without pain seizing up.\n\nO (Objective):\n- Patient is a full-time concrete worker for 15 years.\n- Physical examination revealed tightness through the glutes, more so than the spine itself, consistent with lifting activities.\n- Right shoulder examination indicated tightness primarily in the upper trapezius.\n- Patient reported tenderness during palpation and massage, specifically stating \"Ooh, that's the spot\" and tolerating intense pressure from a massage gun.\n\nA (Assessment):\n- Chronic lower back pain, likely exacerbated by occupational lifting demands, currently in an acute flare-up.\n- Right shoulder pain, potentially related to overuse or strain from overhead activities.\n- Previous X-ray of the back revealed \"wear and tear\" a few years prior.\n\nP (Plan):\n- Manual therapy session focused on the lower back and glutes, followed by the right shoulder, utilizing massage and potentially a massage gun.\n- Patient advised on home exercises: hip flexor stretch (90 seconds each side, twice daily).\n- Patient advised on ergonomic modifications: getting the load closer to the body when lifting.\n- Follow-up appointment scheduled for 2 weeks.\n- Receipt with provider number for health fund claim to be emailed to the patient.\n","review":113.27631578947368,"saved":58.723684210526315,"clean":false,"effort":6.25,"sig":[],"mb":132.02998,"latency":22.165,"signable":123.28931578947369},{"label":"Run 3","wer":1.1904761904761905,"text":"Morning.\nCome on through. Take a seat wherever's comfortable.\nThanks.\nSo, what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay. Let's start with the back. Whereabouts is it?\nRight across the bottom. Both sides, but the right's worse.\nAnd how long's that been going on?\nYears. On and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah. Started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it. And your concreting full-time?\nYeah, 15 years now.\nOn a scale of 1 to 10, where's it sitting today?\nProbably a 6. It was an 8 on the weekend.\nWhat makes it worse?\nSitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower. Helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins, a needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you? Or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done, or seen anyone else about it?\nI had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\nRight. And are you on any medications, or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay.\nNow, the shoulder—how long's that been there?\nMaybe 6 weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair.\nHere's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder. Does that sound alright?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nRighto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\nHow's that pressure?\nYeah, that's good.\nOoh, that's the spot.\nToo much?\nNah, it's all right.\nI'm going to use the massage gun on this one. It's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine. Bit intense, but it's all right.\nSing out if you want me to back off.\nRight, roll onto your back for me.\nOkay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\nSo what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks. Does a Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.","marks":[{"start":598,"end":602,"said":"you're","significant":false},{"start":2206,"end":2216,"said":"alright.","significant":false},{"start":2351,"end":2361,"said":"alright.","significant":false},{"start":2632,"end":2641,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States \"lower back pain, primarily right-sided across the bottom, and right shoulder pain\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"ongoing for years, flaring up every few months\" and shoulder \"present for approximately 6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"currently a 6/10, previously an 8/10 on the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"full-time concreter for 15 years\" and \"occupational activities involving heavy lifting and sustained bending\"."],["The output records that radicular symptoms and red flags were denied","yes","\"No reported neurological symptoms such as shooting pain, pins and needles, or numbness\" and no night pain or bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy was provided focusing on the lower back (glutes) and right shoulder (upper trap)\"."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch, 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up appointment scheduled in 2 weeks on a Thursday\"."]],"claims":[],"note":"S (Subjective):\n- Patient presents with lower back pain, primarily right-sided across the bottom, and right shoulder pain.\n- Lower back pain has been ongoing for years, flaring up every few months, with the current flare starting approximately 10 days ago.\n- Patient reports the back pain was initiated after pouring a large concrete slab, requiring them to be bent over most of the day.\n- Back pain severity is currently a 6/10, previously an 8/10 on the weekend. It is worsened by sitting, especially driving, and alleviated temporarily by hot showers.\n- Right shoulder pain has been present for approximately 6 weeks, worsened by reaching overhead and sometimes wakes them when rolling onto it.\n\nO (Objective):\n- Patient is a full-time concreter for 15 years.\n- Patient reports prior imaging (X-ray a few years ago) indicated \"wear and tear\" in their back.\n- Patient is cooperative during the interaction, providing clear history and feedback during treatment.\n- Physical assessment by the therapist identified tightness in the lower back through the glutes, more so than the spine itself, and tightness in the upper trapezius of the shoulder.\n- Patient tolerated massage gun use and manual therapy, noting tenderness in spots but affirming the pressure was acceptable.\n\nA (Assessment):\n- Musculoskeletal pain in the lower back, likely exacerbated by occupational activities involving heavy lifting and sustained bending.\n- Right shoulder pain, consistent with overuse or strain, potentially related to overhead reaching tasks.\n- No reported neurological symptoms such as shooting pain, pins and needles, or numbness in the legs.\n- No reported night pain waking them or issues with bladder/bowels.\n\nP (Plan):\n- Manual therapy was provided focusing on the lower back (glutes) and right shoulder (upper trap).\n- Patient advised on a home exercise program: Hip flexor stretch, 90 seconds each side, twice daily.\n- Patient educated on proper lifting mechanics: getting the load closer to the body before standing.\n- Follow-up appointment scheduled in 2 weeks on a Thursday.\n- Receipt with provider number to be emailed for health fund claim.\n","review":104.21052631578948,"saved":67.78947368421052,"clean":true,"effort":0.0,"sig":[],"mb":132.010722,"latency":24.201,"signable":114.17252631578948},{"label":"Run 4","wer":1.1904761904761905,"text":"Morning.\nCome on through. Take a seat wherever's comfortable.\nThanks.\nSo, what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay. Let's start with the back. Whereabouts is it?\nRight across the bottom. Both sides, but the right's worse.\nAnd how long's that been going on?\nYears. On and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah. Started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it. And your concreting full-time?\nYeah, 15 years now.\nOn a scale of 1 to 10, where's it sitting today?\nProbably a 6. It was an 8 on the weekend.\nWhat makes it worse?\nSitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower. Helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins, a needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you? Or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done, or seen anyone else about it?\nI had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\nRight. And are you on any medications, or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay.\nNow, the shoulder—how long's that been there?\nMaybe 6 weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder.\nDoes that sound alright?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nRighto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\nHow's that pressure?\nYeah, that's good.\nOoh, that's the spot.\nToo much?\nNah, it's all right.\nI'm going to use the massage gun on this one.\nIt's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine. Bit intense, but it's all right.\nSing out if you want me to back off.\nRight, roll onto your back for me.\nOkay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\nSo what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks. Does a Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries.\nTake it easy for the rest of today.","marks":[{"start":598,"end":602,"said":"you're","significant":false},{"start":2206,"end":2216,"said":"alright.","significant":false},{"start":2351,"end":2361,"said":"alright.","significant":false},{"start":2632,"end":2641,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"currently rated 6/10 (previously 8/10)\" captures today and worst; weekend timing omitted but meaning preserved."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","partial","Denies radiating pain, paresthesia, numbness and bladder/bowel dysfunction, but night pain waking was not recorded as denied."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"S (Subjective):\n- The patient reports a chief complaint of lower back pain, predominantly on the right side, and right shoulder pain.\n- Lower back pain is chronic, occurring \"on and off\" for years with flares every few months; the current flare began approximately 10 days ago after pouring concrete.\n- The patient describes their back pain as an ache, currently rated 6/10 (previously 8/10), worsened by sitting and driving, and temporarily alleviated by a hot shower for about an hour. They deny radiating pain, paresthesia, numbness, or bladder/bowel dysfunction.\n- Right shoulder pain has been present for approximately 6 weeks, aggravated by overhead reaching and occasionally causing nocturnal awakenings when rolling onto it.\n- Relevant history includes a prior X-ray years ago indicating \"wear and tear.\" The patient is currently taking blood pressure tablets. Their primary goal is to manage symptoms to complete their work week without a flare-up.\n\nO (Objective):\n- The patient was positioned prone with their head in a cradle for treatment.\n- The therapist applied manual pressure and utilized a massage gun on areas of tenderness in the lower back and shoulder.\n- During treatment, the patient verbally indicated tender spots and tolerated the intensity of the intervention, describing it as \"bit intense, but it's all right.\"\n- Post-treatment, the patient reported feeling \"a lot looser.\"\n- The therapist observed significant tightness in the gluteal region of the lower back, rather than the spine itself, and in the upper trapezius of the right shoulder.\n\nA (Assessment):\n- Musculoskeletal strain affecting the lower back, particularly the gluteal musculature, consistent with the patient's occupational demands involving heavy lifting and prolonged bending.\n- Musculoskeletal strain of the right upper trapezius, likely exacerbated by repetitive overhead reaching activities.\n- These findings correlate with the patient's reported symptoms and their work as a concreter for 15 years.\n\nP (Plan):\n- In-session manual therapy included addressing tightness in the lower back, glutes, and right upper trapezius.\n- Home exercise prescription includes hip flexor stretches, 90 seconds per side, performed twice daily.\n- Ergonomic advice was provided to keep loads closer to the body when lifting.\n- A follow-up appointment is scheduled for 2 weeks.\n- A receipt with the provider number will be emailed to the patient for health fund claiming purposes.\n- The patient was advised to take it easy for the remainder of the day.\n","review":132.7763157894737,"saved":39.2236842105263,"clean":false,"effort":6.25,"sig":[],"mb":132.004718,"latency":34.442,"signable":152.7893157894737},{"label":"Run 5","wer":1.0204081632653061,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo, what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay. Let's start with the back.\nWhereabouts is it?\nRight across the bottom. Both sides, but the right's worse.\nAnd how long's that been going on?\nYears. On and off.\nIt flares up every few months and settles down again.\nIs this a flare at the moment?\nYeah. Started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday.\nI was bent over most of the day.\nThat'll do it. And you're concreting full-time?\nYeah, 15 years now.\nOn a scale of 1 to 10, where's it sitting today?\nProbably a 6. It was an 8 on the weekend.\nWhat makes it worse?\nSitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower. Helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins, a needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you?\nOr any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done, or seen anyone else about it?\nI had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\nRight. And are you on any medications, or any other health conditions I should know about?\nJust blood pressure tablets, nothing else.\nOkay.\nNow, the shoulder—how long's that been there?\nMaybe 6 weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest: I'll work through the lower back and the glutes, because with the lifting that's usually where the load is, then come up to the right shoulder.\nDoes that sound alright?\nYeah, sounds good.\nIt can be a bit tender in spots.\nSing out if anything's too much, and I'll back off.\nWill do.\nRighto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\nHow's that pressure?\nYeah, that's good.\nOoh, that's the spot.\nToo much?\nNah, it's all right.\nI'm going to use the massage gun on this one.\nIt's a bit loud.\nNo worries.\nIs the pain okay?\nYeah, that's fine. Bit intense, but it's all right.\nSing out if you want me to back off.\nRight, roll onto your back for me.\nOkay, sit yourself up slowly when you're ready.\nThat feels a lot looser.\nGood. The lower back was tight through the glutes more than the spine itself. Which is what I'd expect with the lifting. The shoulders mostly the upper trap.\nSo what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, righto.\nI'd book you back in 2 weeks. Does a Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries.\nTake it easy for the rest of today.","marks":[{"start":2208,"end":2218,"said":"alright.","significant":false},{"start":2353,"end":2363,"said":"alright.","significant":false},{"start":2634,"end":2643,"said":"shoulder's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain and right shoulder pain as the presenting complaints."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain described as present on and off for years; shoulder pain approximately 6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","Records pain 6/10 today and 8/10 over the weekend."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Records full-time concreting for 15 years with bending and lifting demands."],["The output records that radicular symptoms and red flags were denied","yes","Records denial of radiating leg pain, pins and needles, numbness, night pain and bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Records manual therapy to the lower back, glutes and right shoulder/upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","Hip flexor stretch 90 seconds each side twice daily."],["The output notes a review in two weeks","yes","Follow-up scheduled in 2 weeks."]],"claims":[],"note":"S (Subjective):\n- The patient presents with a chief complaint of lower back pain and right shoulder pain.\n- Lower back pain is located across the bottom, bilateral but worse on the right, and has been intermittent for years, flaring every few months.\n- Current back flare began approximately 10 days ago, exacerbated by a day of concrete pouring involving prolonged bending; current severity is 6/10, previously 8/10 on the weekend.\n- Back pain is worsened by sitting and driving, and temporarily alleviated by hot showers (approx. 1 hour relief); denies radiating pain, paresthesia, numbness, nocturnal pain, or bladder/bowel dysfunction.\n- Right shoulder pain has been present for approximately 6 weeks, worse with overhead reaching, and occasionally wakes them if they roll onto it.\n- The patient works full-time as a concreter for 15 years, has a history of a back X-ray a few years prior showing \"wear and tear,\" takes blood pressure medication, and their primary goal is to manage symptoms to get through the work week without seizing up.\n\nO (Objective):\n- Palpation revealed significant tightness in the lower back through the glutes, more so than the spinal area.\n- The right shoulder presented with tightness predominantly in the upper trapezius muscle.\n- During treatment, the patient indicated a specific tender spot (\"Ooh, that's the spot\") and reported the intensity of a massage gun application as \"fine\" but \"a bit intense.\"\n- Post-treatment, the patient reported feeling \"a lot looser.\"\n\nA (Assessment):\n- The patient's lower back pain is assessed to be mechanical in nature, significantly influenced by occupational demands (heavy lifting, prolonged bending) leading to gluteal tightness.\n- Right shoulder pain appears to be musculoskeletal, primarily involving the upper trapezius, exacerbated by overhead activities.\n- Previous imaging indicating \"wear and tear\" in the lower back suggests a chronic degenerative component contributing to recurrent flare-ups.\n\nP (Plan):\n- Manual therapy was performed on the lower back, focusing on the glutes, followed by treatment of the right shoulder, specifically the upper trapezius, including the use of a massage gun.\n- Home exercise prescription includes hip flexor stretches, 90 seconds per side, twice daily.\n- Ergonomic advice provided to improve lifting mechanics by keeping the load closer to the body before standing.\n- Follow-up appointment scheduled for 2 weeks.\n- A receipt with the provider number will be emailed for health fund claims; patient advised to take it easy for the remainder of the day.\n","review":125.36842105263159,"saved":46.63157894736841,"clean":true,"effort":0.0,"sig":[],"mb":131.84231,"latency":27.908,"signable":141.3704210526316}],"lyrebird":[{"label":"Run 1","wer":5.272108843537415,"text":"Morning. Come on through. Take a seat wherever's comfortable. Thanks. So what's brought you in today? It's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Whereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment?\n\nYeah. Started about 10 days ago. Anything set it off that you can think of? We poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time?\n\nYeah. 15 years now. On a scale of 1 to 10, where is it sitting today? Probably a 6. It was an 8 on the weekend. What makes it worse? Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\nAnd what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No. None of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear. Nothing to worry about.\n\nRight. And are you on any medications or any other health conditions I should know about? Just blood pressure tablets. Nothing else. Okay. Now the shoulder. How long's that been there?\n\nMaybe 6 weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today? Honestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Right, Arms. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\nYeah.\n\nHow's that pressure? Yeah. That's good.\n\nOkay.\n\nOkay.\n\nOkay.\n\nOh, that's the spot. Too much? Nah. It's alright.\n\nOkay.\n\nOkay.\n\nOkay.\n\nOh\n\nOkay.\n\nOkay.\n\nI'm going to use the massage gun on this 1. It's a bit loud. No worries.\n\nIs the pain okay? Yeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nOkay.\n\nOkay.\n\nOkay.\n\nOkay.\n\nRight. Roll onto your back for me.\n\nHello?\n\nHello?\n\nOkay.\n\nOkay.\n\nOkay. Set yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? 2 things: hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in 2\n\nWeeks. Does a Thursday suit? Thursday's fine. Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries.\n\nTake it easy for the rest of today.\n\nOkay.\n\nOkay.\n\nOkay.\n\nXulane","marks":[{"start":300,"end":308,"said":"long's","significant":false},{"start":673,"end":681,"said":"where's","significant":false},{"start":2016,"end":2028,"said":"Righto.","significant":false},{"start":2189,"end":2212,"said":"Ooh","significant":false},{"start":2545,"end":2558,"said":"","significant":false},{"start":2568,"end":2584,"said":"sit","significant":false},{"start":2773,"end":2782,"said":"shoulder's","significant":false},{"start":3279,"end":3306,"said":"","significant":true}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and 'Right shoulder pain for 6 weeks' recorded."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","'Chronic intermittent lower back pain, years duration'; shoulder 'for 6 weeks'."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","'Pain 6/10 today (was 8/10 over the weekend)'."],["The output notes the patient works in concreting with repeated bending and lifting","yes","'Occupation: concreter for 15 years'; slab pour 'with prolonged forward flexion'."],["The output records that radicular symptoms and red flags were denied","yes","Denies radiculopathy, paraesthesia, numbness, night pain, bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","'Manual therapy performed to lower back, gluteal muscles, and right shoulder'."],["The output mentions a hip flexor stretch as home advice","yes","'hip flexor stretches, 90 seconds each side, twice daily'."],["The output notes a review in two weeks","yes","'Follow-up appointment in 2 weeks'."]],"claims":[["Right shoulder pain, likely rotator cuff or subacromial pathology","Transcript attributes the shoulder to the upper trap ('The shoulder's mostly the upper trap'); rotator cuff/subacromial pathology never mentioned."],["Tightness through bilateral gluteal muscles, right greater than left","Clinician said tight 'through the glutes more than the spine'; no side asymmetry of gluteal tightness was stated (R>L referred to back pain only)."],["Flare commenced 11/09/2026, onset after pouring slab on 17/09/2026","Invented specific dates that are internally contradictory (trigger dated after flare onset); transcript gives only 'about ten days ago' and 'the Thursday'."]],"note":"SOAP NOTES\n\n\n\n\nSubjective:\n\nChronic intermittent lower back pain, years duration, flares every few months\n\nCurrent flare commenced 10 days ago (11/09/2026), onset after pouring concrete slab on 17/09/2026 (Thursday) with prolonged forward flexion\n\nPain bilateral lower back, right worse than left\n\nPain 6/10 today (was 8/10 over the weekend)\n\nExacerbated by sitting and driving to work site in the morning\n\nRelieved temporarily by hot shower (approximately 1 hour relief)\n\nNo radiculopathy, paraesthesia, or numbness\n\nNo night pain\n\nNo bladder or bowel dysfunction\n\nPrevious X-ray several years ago showed degenerative changes\n\nRight shoulder pain for 6 weeks\n\nShoulder pain worse with overhead reaching\n\nOccasional night pain when rolling onto right side\n\nOccupation: concreter for 15 years\n\nPatient's goal: to complete work week without pain flare\n\n\n\n\nObjective:\n\nMusculoskeletal examination: tightness through bilateral gluteal muscles, right greater than left\n\nLumbar spine unremarkable on examination\n\nRight shoulder: tightness in upper trapezius\n\nManual therapy and massage gun applied to lower back and gluteal region\n\nManual therapy applied to right shoulder\n\n\n\n\nAssessment:\n\nChronic mechanical lower back pain with acute exacerbation secondary to occupational strain\n\nRight shoulder pain, likely rotator cuff or subacromial pathology\n\n\n\n\nPlan:\n\nManual therapy performed to lower back, gluteal muscles, and right shoulder\n\nHome exercise programme: hip flexor stretches, 90 seconds each side, twice daily\n\nErgonomic advice: bring load closer to body before lifting\n\nFollow-up appointment in 2 weeks (05/10/2026, Thursday)\n\nReceipt with provider number to be emailed for health fund claim","review":114.63157894736842,"saved":57.368421052631575,"clean":false,"effort":56.25,"sig":[["fabrication","Right shoulder pain, likely rotator cuff or subacromial pathology","The rotator cuff/subacromial diagnosis is invented and contradicts the clinician's upper-trap attribution."],["fabrication","Tightness through bilateral gluteal muscles, right greater than left","The note invents a side asymmetry (R>L) for the gluteal exam finding; R>L applied only to reported back pain."],["fabrication","Flare commenced 11/09/2026, onset after pouring slab on 17/09/2026","The onset and trigger dates are invented and contradict each other, which corrupts the record of an occupational injury."]],"mb":59.549763,"latency":25.534,"signable":140.16557894736843},{"label":"Run 2","wer":4.931972789115646,"text":"Morning. Come on through. Take a seat wherever's comfortable. Thanks. So what's brought you in today? It's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Whereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment?\n\nYeah. Started about 10 days ago. Anything set it off that you can think of? We poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time?\n\nYeah. 15 years now. On a scale of 1 to 10, where is it sitting today? Probably a 6. It was an 8 on the weekend. What makes it worse? Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\nAnd what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No. None of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear. Nothing to worry about.\n\nRight. And are you on any medications or any other health conditions I should know about? Just blood pressure tablets. Nothing else. Okay. Now the shoulder. How long has that been there?\n\nMaybe 6 weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today? Honestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\nYeah.\n\nOkay.\n\nHow's that pressure? Yeah. That's good.\n\nOkay.\n\nOkay.\n\nOkay.\n\nOh, that's the spot. Too much? Nah. It's alright.\n\nOkay.\n\nOkay.\n\nOh\n\nOh\n\nOkay.\n\nOkay.\n\nI'm going to use the massage gun on this 1. It's a bit loud. No worries.\n\nIs the pain okay? Yeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nOkay.\n\nOkay.\n\nOkay.\n\nRight. Roll onto your back for me.\n\nHello?\n\nOkay.\n\nOkay. Set yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? 2 things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in 2\n\nDoes a Thursday suit? Thursday's fine. Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries.\n\nTake it easy for the rest of today.\n\nOkay.\n\nOkay.\n\nZoloft","marks":[{"start":300,"end":308,"said":"long's","significant":false},{"start":673,"end":681,"said":"where's","significant":false},{"start":1450,"end":1458,"said":"long's","significant":false},{"start":2192,"end":2215,"said":"Ooh","significant":false},{"start":2538,"end":2543,"said":"","significant":false},{"start":2553,"end":2562,"said":"sit","significant":false},{"start":2751,"end":2760,"said":"shoulder's","significant":false},{"start":2992,"end":2992,"said":"weeks.","significant":true},{"start":3250,"end":3270,"said":"","significant":true}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Chronic lower back pain and right shoulder pain both recorded."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"Chronic intermittent lower back pain\" and \"Right shoulder pain for 6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain severity 6/10 today, was 8/10 over the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreter for 15 years\" with prolonged bending and occupational lifting."],["The output records that radicular symptoms and red flags were denied","yes","\"No radicular symptoms, paraesthesia, or numbness\"; no night pain or bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy performed to lower back, gluteal muscles, and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretches 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","partial","Follow-up dated \"Thursday 01/10/2026\", which is 9 days after a flare dated 10 days before 12/09 implies session 22/09, not two weeks; 'two weeks' not stated."]],"claims":[["Triggered by concrete slab work on 17/09/2026","Transcript says the slab was poured 'on the Thursday' that set off a flare starting ~10 days ago; the note's own flare start of 12/09 precedes this invented trigger date, so the date is unsupported."],["Follow-up appointment scheduled for Thursday 01/10/2026","Clinician said 'back in two weeks' on a Thursday; 01/10 is 9 days after the implied session date, so the specific date is unsupported."]],"note":"SOAP NOTES\n\n\n\n\nSubjective:\n\nChronic intermittent lower back pain, flares every few months\n\nCurrent flare commenced approximately 12/09/2026 (10 days ago)\n\nTriggered by concrete slab work on 17/09/2026 involving prolonged bending\n\nBilateral lumbar pain, right side worse than left\n\nPain severity 6/10 today, was 8/10 over the weekend\n\nExacerbated by sitting and driving to work site in the morning\n\nTemporary relief with hot shower lasting approximately 1 hour\n\nNo radicular symptoms, paraesthesia, or numbness\n\nNo night pain, no bladder or bowel dysfunction\n\nPrevious X-ray several years ago demonstrated degenerative changes\n\nOccupation: concreter for 15 years\n\nRight shoulder pain for 6 weeks duration\n\nWorse with overhead reaching\n\nOccasional night pain when rolling onto right side\n\nCurrent medications: antihypertensive agent (specific medication not stated)\n\nPatient goal: to complete work week without pain flare\n\n\n\n\nObjective:\n\nLower back: tightness predominantly through gluteal muscles, spine itself less affected\n\nRight shoulder: tight upper trapezius muscle\n\nManual therapy performed to lower back, gluteal muscles, and right shoulder\n\nMassage gun utilised during treatment\n\n\n\n\nAssessment:\n\nMechanical lower back pain secondary to occupational lifting and prolonged bending\n\nRight shoulder pain, likely upper trapezius strain\n\n\n\n\nPlan:\n\nManual therapy completed today\n\nHome exercise programme: hip flexor stretches 90 seconds each side, twice daily\n\nErgonomic advice: bring load closer to body before standing when lifting\n\nFollow-up appointment scheduled for Thursday 01/10/2026\n\nReceipt with provider number to be emailed for health fund claim","review":110.1578947368421,"saved":61.842105263157904,"clean":false,"effort":37.5,"sig":[["partial","The output notes a review in two weeks","Follow-up recorded as 9 days out on a specific date instead of the two weeks stated."]],"mb":60.02862,"latency":22.769,"signable":132.9268947368421},{"label":"Run 3","wer":4.931972789115646,"text":"Morning. Come on through. Take a seat wherever's comfortable. Thanks. So what's brought you in today? It's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Whereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment?\n\nYeah. Started about 10 days ago. Anything set it off that you can think of? We poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time?\n\nYeah. 15 years now. On a scale of 1 to 10, where is it sitting today? Probably a 6. It was an 8 on the weekend. What makes it worse? Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\nAnd what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No. None of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear. Nothing to worry about.\n\nRight. And are you on any medications or any other health conditions I should know about? Just blood pressure tablets. Nothing else. Okay. Now the shoulder. How long has that been there?\n\nMaybe 6 weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today? Honestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\nYeah.\n\nOkay.\n\nHow's that pressure? Yeah. That's good.\n\nOkay.\n\nOkay.\n\nYeah.\n\nOh, that's the spot. Too much? Nah. It's alright.\n\nOkay.\n\nOh\n\nOh\n\nOkay.\n\nOkay.\n\nI'm going to use the massage gun on this 1. It's a bit loud. No worries.\n\nIs the pain okay? Yeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nOkay.\n\nOkay.\n\nRight. Roll onto your back for me.\n\nHello?\n\nOkay.\n\nOkay.\n\nOkay. Set yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? 2 things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in 2\n\nDoes it Thursday suit? Thursday's fine. Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries.\n\nTake it easy for the rest of today.\n\nOkay.\n\nOkay.\n\nZoloft","marks":[{"start":300,"end":308,"said":"long's","significant":false},{"start":673,"end":681,"said":"where's","significant":false},{"start":1450,"end":1458,"said":"long's","significant":false},{"start":2192,"end":2215,"said":"Ooh","significant":false},{"start":2524,"end":2529,"said":"","significant":false},{"start":2539,"end":2555,"said":"sit","significant":false},{"start":2744,"end":2753,"said":"shoulder's","significant":false},{"start":2985,"end":2985,"said":"weeks.","significant":true},{"start":3244,"end":3264,"said":"","significant":true}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Years-duration back pain; shoulder ~6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain currently 6/10, was 8/10 over the weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","Concreter 15 years; flare after concrete slab work with prolonged bending."],["The output records that radicular symptoms and red flags were denied","yes","No radicular symptoms, paraesthesia, numbness, night pain, bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy performed to lower back, gluteal muscles, and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretches, 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","no","Follow-up is dated \"Thursday 24/09/2026\", two days after the session, not two weeks."]],"claims":[["Follow-up appointment scheduled for Thursday 24/09/2026","Clinician said \"I'd book you back in two weeks\" on a Thursday; 24/09/2026 is two days after the session, not two weeks."],["Right shoulder pain, likely rotator cuff or subacromial pathology","No rotator cuff or subacromial diagnosis was raised; the clinician said \"The shoulder's mostly the upper trap.\""]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nChronic intermittent lower back pain, years duration, flares every few months\n\nCurrent flare commenced approximately 10 days ago (12/09/2026)\n\nTriggered by concrete slab work on 11/09/2026 involving prolonged bending\n\nBilateral lower back pain, right side worse than left\n\nPain currently 6/10, was 8/10 over the weekend\n\nExacerbated by sitting and driving to work site in the morning\n\nRelieved temporarily by hot shower (approximately 1 hour duration)\n\nNo radicular symptoms, paraesthesia, or numbness\n\nNo night pain, no bladder or bowel dysfunction\n\nPrevious X-ray several years ago demonstrated degenerative changes\n\nOccupation: concreter for 15 years\n\nRight shoulder pain for approximately 6 weeks\n\nShoulder pain worse with overhead reaching\n\nOccasional night pain when rolling onto right side\n\nPatient goal: to complete work week without pain flare\n\n\n\n\nObjective:\n\nMusculoskeletal examination: tightness through bilateral gluteal muscles, spine unremarkable\n\nRight shoulder: tightness in upper trapezius muscle\n\nManual therapy performed to lower back, gluteal muscles, and right shoulder\n\nMassage gun therapy applied\n\n\n\n\nAssessment:\n\nChronic mechanical lower back pain with acute exacerbation\n\nRight shoulder pain, likely rotator cuff or subacromial pathology\n\n\n\n\nPlan:\n\nManual therapy and massage gun therapy completed during consultation\n\nHome management: hip flexor stretches, 90 seconds each side, twice daily\n\nErgonomic advice: bring load closer to body before lifting\n\nFollow-up appointment scheduled for Thursday 24/09/2026\n\nReceipt with provider number to be emailed for health fund claim","review":114.57894736842105,"saved":57.421052631578945,"clean":false,"effort":43.75,"sig":[["missing","The output notes a review in two weeks","Review recorded as two days away instead of two weeks; follow-up timing wrong."],["fabrication","Right shoulder pain, likely rotator cuff or subacromial pathology","Rotator cuff/subacromial pathology invented; clinician attributed shoulder to upper trap."]],"mb":59.637222,"latency":21.109,"signable":135.68794736842105},{"label":"Run 4","wer":4.931972789115646,"text":"Morning. Come on through. Take a seat wherever's comfortable. Thanks. So what's brought you in today? It's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Whereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment?\n\nYeah. Started about 10 days ago. Anything set it off that you can think of? We poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time?\n\nYeah. 15 years now. On a scale of 1 to 10, where is it sitting today? Probably a 6. It was an 8 on the weekend. What makes it worse? Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\nAnd what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you, or any trouble with the bladder or bowels? No. None of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear. Nothing to worry about.\n\nRight. And are you on any medications or any other health conditions I should know about? Just blood pressure tablets. Nothing else. Okay. Now the shoulder. How long has that been there?\n\nMaybe 6 weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today? Honestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\nYeah.\n\nOkay.\n\nHow's that pressure? Yeah. That's good.\n\nOkay.\n\nOkay.\n\nOkay.\n\nOh, that's the spot. Too much? Nah. It's alright.\n\nOkay.\n\nOkay.\n\nOh\n\nOh\n\nOkay.\n\nOkay.\n\nI'm going to use the massage gun on this 1. It's a bit loud. No worries.\n\nIs the pain okay? Yeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nOkay.\n\nOkay.\n\nOkay.\n\nRight. Roll onto your back for me.\n\nHello?\n\nOkay.\n\nOkay. Set yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? 2 things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in 2\n\nDoes it Thursday suit? Thursday's fine. Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries.\n\nTake it easy for the rest of today.\n\nOkay.\n\nLucent","marks":[{"start":300,"end":308,"said":"long's","significant":false},{"start":673,"end":681,"said":"where's","significant":false},{"start":1450,"end":1458,"said":"long's","significant":false},{"start":2192,"end":2215,"said":"Ooh","significant":false},{"start":2538,"end":2543,"said":"","significant":false},{"start":2553,"end":2562,"said":"sit","significant":false},{"start":2751,"end":2760,"said":"shoulder's","significant":false},{"start":2992,"end":2992,"said":"weeks.","significant":true},{"start":3251,"end":3264,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"Chief complaints: lower back pain and right shoulder pain\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"chronic intermittent, present for years\" and \"Right shoulder pain: 6 weeks duration\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain severity: 6/10 today, was 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreting for 15 years\"; \"occupational lifting and repetitive bending\"."],["The output records that radicular symptoms and red flags were denied","yes","\"No radicular symptoms, paraesthesia, or numbness\"; \"No night pain, no bladder or bowel dysfunction\"."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy performed to lower back, gluteal region, and right shoulder\"."],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretches, 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","partial","Follow-up recorded as \"scheduled for 01/10/2026\", about 9 days after the session rather than two weeks."]],"claims":[["Follow-up appointment scheduled for 01/10/2026","Clinician said to book back in two weeks on a Thursday; 01/10/2026 is only 9 days after the 22/09 session."],["Lumbar spine: unremarkable on examination","Transcript only says tightness was in the glutes \"more than the spine itself\"; no spinal exam finding of unremarkable was stated."]],"note":"SOAP Notes\n\n\n\n\nSubjective:\n\nChief complaints: lower back pain and right shoulder pain\n\nLower back pain: chronic intermittent, present for years with flares every few months\n\nCurrent flare commenced approximately 10 days ago (around 12/09/2026)\n\nTriggered by prolonged bending during concrete slab work on 17/09/2026\n\nPain location: bilateral lower back, right side worse than left\n\nPain severity: 6/10 today, was 8/10 on weekend (approximately 19-20/09/2026)\n\nAggravating factors: sitting, driving to work site in morning causes significant stiffness\n\nRelieving factors: hot shower provides approximately 1 hour relief\n\nNo radicular symptoms, paraesthesia, or numbness\n\nNo night pain, no bladder or bowel dysfunction\n\nPrevious imaging: X-ray performed several years ago showed degenerative changes\n\nRight shoulder pain: 6 weeks duration\n\nWorse with overhead reaching\n\nOccasional night pain when rolling onto affected shoulder\n\nPatient goal: to complete work week without pain flare\n\nOccupation: concreting for 15 years\n\nPast medical history: hypertension\n\nCurrent medications: antihypertensive agent (unspecified)\n\n\n\n\nObjective:\n\nMusculoskeletal examination performed\n\nLower back: tightness noted through gluteal muscles bilaterally\n\nLumbar spine: unremarkable on examination\n\nRight shoulder: upper trapezius tightness identified\n\nManual therapy performed to lower back, gluteal region, and right shoulder\n\nMassage gun therapy applied\n\nPatient tolerated treatment well\n\n\n\n\nAssessment:\n\nMechanical lower back pain secondary to occupational lifting and repetitive bending\n\nGluteal muscle tightness\n\nRight shoulder pain, likely upper trapezius strain\n\n\n\n\nPlan:\n\nManual therapy completed during consultation\n\nHome exercise programme prescribed: hip flexor stretches, 90 seconds each side, twice daily\n\nErgonomic advice provided: modify lifting technique by bringing load closer to body before standing\n\nFollow-up appointment scheduled for 01/10/2026\n\nReceipt with provider number to be emailed for private health insurance claim\n\nAdvised to take it easy for remainder of day","review":125.3157894736842,"saved":46.684210526315795,"clean":false,"effort":37.5,"sig":[["partial","The output notes a review in two weeks","Follow-up recorded as 01/10/2026 (~9 days) instead of two weeks."],["fabrication","Lumbar spine: unremarkable on examination","'Lumbar spine unremarkable on examination' is an invented exam finding."]],"mb":59.543043,"latency":22.976,"signable":148.29178947368422},{"label":"Run 5","wer":5.442176870748299,"text":"Morning. Come on through. Take a seat wherever's comfortable. Thanks. So what's brought you in today? It's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Whereabouts is it? Right across the bottom. Both sides, but the right's worse. And how long has that been going on? Years. On and off. It flares up every few months and settles down again. Is this a flare at the moment?\n\nYeah. Started about 10 days ago. Anything set it off that you can think of? We poured a big slab on the Thursday. I was bent over most of the day. That'll do it. And you're concreting full time?\n\nYeah. 15 years now. On a scale of 1 to 10, where is it sitting today? Probably a 6. It was an 8 on the weekend. What makes it worse? Sitting's the worst. Driving to site in the morning, I'm stiff as anything.\n\nAnd what helps? A hot shower. Helps for about an hour, then it comes back. Anything shooting down the leg? Pins and needles? Numbness? Anything like that? No. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you or any trouble with the bladder or bowels? No. None of that. Good. Have you had any imaging done or seen anyone else about it? I had an X-ray a few years back. They said it was wear and tear. Nothing to worry about.\n\nRight. And are you on any medications or any other health conditions I should know about? Just blood pressure tablets. Nothing else. Okay. Now the shoulder. How long has that been there?\n\nMaybe 6 weeks. It's worse when I'm reaching overhead. Does it wake you if you roll onto it? Sometimes, yeah. And what would you like to get out of today? Honestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is, then come up to the right shoulder. Does that sound alright? Yeah. Sounds good. It can be a bit tender in spots. Sing out if anything's too much, and I'll back off.\n\nWill do. Righto. I'll step out while you get comfortable. Face down for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure? Yeah. That's good.\n\nOkay.\n\nLidex\n\nOkay.\n\nOkay.\n\nYeah.\n\nOh, that's the spot. Too much? No. It's alright.\n\nOkay.\n\nOkay.\n\nOkay.\n\nYes, stop.\n\nI'm going to use the massage gun on this 1. It's a bit loud. No worries.\n\nIs the pain okay? Yeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nOh\n\nOkay.\n\nOkay.\n\nRight. Roll onto your back for me.\n\nHello?\n\nOkay.\n\nOkay.\n\nOkay.\n\nOkay. Set yourself up slowly when you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly the upper trap.\n\nSo what should I be doing at home? 2 things: hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand. Yeah. Righto. I'd book you back in 2\n\nDoes it Thursday suit? Thursday's fine. Do I get something for the health fund? I'll email the receipt through with the provider number on it. You can claim it straight from that. Perfect. Thanks very much. No worries.\n\nTake it easy for the rest of today.\n\nOkay.\n\nOkay.\n\nLucent","marks":[{"start":300,"end":308,"said":"long's","significant":false},{"start":673,"end":681,"said":"where's","significant":false},{"start":1449,"end":1457,"said":"long's","significant":false},{"start":2178,"end":2215,"said":"Ooh","significant":true},{"start":2244,"end":2247,"said":"Nah","significant":false},{"start":2263,"end":2294,"said":"","significant":false},{"start":2531,"end":2536,"said":"","significant":false},{"start":2546,"end":2569,"said":"sit","significant":false},{"start":2758,"end":2767,"said":"shoulder's","significant":false},{"start":2999,"end":2999,"said":"weeks.","significant":true},{"start":3258,"end":3278,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain both documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"chronic intermittent, years duration\"; \"Right shoulder pain, 6 weeks duration.\""],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 today, was 8/10 over the weekend.\""],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreting for 15 years\", flare after pouring slab, lifting advice."],["The output records that radicular symptoms and red flags were denied","yes","No radicular symptoms, paraesthesia, numbness, night pain or bladder/bowel dysfunction."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Manual therapy performed to lower back, gluteal muscles and right shoulder.\""],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretches 90 seconds each side, twice daily.\""],["The output notes a review in two weeks","no","States follow-up \"Thursday 24/09/2026\", two days after the session, not the two-week review."]],"claims":[["Follow-up appointment scheduled for Thursday 24/09/2026","Clinician said \"book you back in two weeks\" on a Thursday; 24/09 is two days after the session date, not two weeks."],["Right shoulder pain, likely rotator cuff/upper trapezius strain","Clinician only said \"the shoulder's mostly the upper trap\"; rotator cuff is never mentioned."]],"note":"Subjective:\n\nLower back pain, chronic intermittent, years duration\n\nCurrent flare commenced 10 days ago (12/09/2026) following pouring concrete slab\n\nPain bilateral lumbar region, right worse than left\n\nPain severity 6/10 today, was 8/10 over the weekend\n\nExacerbated by sitting and driving to work site\n\nRelieved temporarily by hot shower (approximately 1 hour duration)\n\nNo radicular symptoms, paraesthesia or numbness\n\nNo night pain, no bladder or bowel dysfunction\n\nPrevious X-ray several years ago demonstrated degenerative changes\n\nOccupation: concreting for 15 years\n\nRight shoulder pain, 6 weeks duration\n\nWorse with overhead reaching\n\nOccasional night pain when rolling onto affected side\n\nPatient goal: to complete work week without pain flare\n\n\n\n\nObjective:\n\nMusculoskeletal examination: tightness through gluteal muscles bilaterally, spine unremarkable\n\nRight shoulder: tightness upper trapezius muscle\n\nManual therapy performed to lower back, gluteal muscles and right shoulder\n\nMassage gun therapy applied\n\n\n\n\nAssessment:\n\nChronic mechanical lower back pain with acute exacerbation\n\nRight shoulder pain, likely rotator cuff/upper trapezius strain\n\n\n\n\nPlan:\n\nManual therapy completed today\n\nHome exercise programme: hip flexor stretches 90 seconds each side, twice daily\n\nErgonomic advice: bring load closer to body before lifting\n\nFollow-up appointment scheduled for Thursday 24/09/2026\n\nReceipt with provider number to be emailed for health fund claim","review":106.36842105263159,"saved":65.63157894736841,"clean":false,"effort":43.75,"sig":[["missing","The output notes a review in two weeks","Follow-up recorded as two days away (24/09) instead of the two-week review; wrong follow-up timing."],["fabrication","Right shoulder pain, likely rotator cuff/upper trapezius strain","Adds rotator cuff to the shoulder assessment, a structural diagnosis never raised that could prompt different investigation or referral."]],"mb":59.507254,"latency":19.898,"signable":126.26642105263159}],"preve":[{"label":"Run 1","wer":3.571428571428571,"text":"Morning. Come on through. Take a seat wherever is comfortable.\n\nThanks.\n\nSo what's brought you in today?\n\nIt's my lower back mostly, and the right shoulder has been playing up as well.\n\nOkay. Let's start with the back. We're about to\n\nit?\n\nRight across the bottom.\n\nBoth sides, but the right's worse.\n\nAnd how long has that been going on?\n\nYears on and off,\n\nIt flares up every few months and settles down again.\n\nIs this a flare at the moment?\n\nYeah. Started about ten days\n\nago.\n\nAnything set it off that you can think\n\nof?\n\nWe poured a big slab on the Thursday. I was bent over most of the day.\n\nThat'll do it. And you're concreting full time?\n\nYeah. Fifteen years now.\n\nOn a scale of one to 10, where is it sitting today?\n\nHi.\n\nProbably a six. It was an eight on the weekend.\n\nWhat makes it worse?\n\nSitting's the worst. Driving\n\nto sight in the morning, I'm stiff as anything.\n\nAnd what helps?\n\nA hot shower helps for about an hour then it comes back.\n\nAnything shooting down the leg?\n\nPins and needles, numbness, anything like that?\n\nNo. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you or any trouble with the bladder or bowels?\n\nNo. None\n\nof that.\n\nGood.\n\nHave you had any imaging done or seen anyone else about it?\n\nI had an\n\nX-ray a few years back. They said it was wear and tear, nothing to worry about.\n\nRight.\n\nAnd are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets. Nothing else.\n\nOkay. Now the shoulder, how long has that been there?\n\nMaybe six weeks.\n\nIt's worse when I'm reaching overhead.\n\nDoes it wake you if you roll onto it?\n\nSometimes, yeah.\n\nAnd what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest.\n\nI'll work through the lower back and the glutes because with the lifting,\n\nthat's usually where the load is, then come up to the right shoulder.\n\nDoes that sound alright?\n\nYeah. Sounds good.\n\nIt can be a bit tender in spots. Sing out\n\nanything's too much, and I'll back off.\n\nWill do.\n\nRighto. I'll step out while you get comfortable.\n\nFace down for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure?\n\nYeah. That's good.\n\nOh, that's the spot.\n\nToo much?\n\nNah. It's alright.\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo\n\nworries.\n\nIs the pain okay?\n\nYeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nRight. Roll onto your back for me.\n\nOkay. Sit yourself up slowly when you're ready.\n\nThat feels a lot looser.\n\nGood. The lower back was tight through the glute\n\nmore than the spine itself which is what I'd expect with the lifting.\n\nThe shoulders mostly the upper trap.\n\nSo what should I be doing at home?\n\nTwo\n\nthings:\n\nhip flexor stretch ninety seconds each side twice a\n\nday. And when you're lifting, get the load closer to you before you stand.\n\nYeah. Righto.\n\nI'd book you back in two weeks. Does a Thursday\n\nsuit?\n\nThursday is fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\n\nPerfect.\n\nThanks very much.\n\nNo\n\nworries. Take it easy for the rest of today.","marks":[{"start":38,"end":49,"said":"wherever's","significant":false},{"start":147,"end":159,"said":"shoulder's","significant":false},{"start":219,"end":233,"said":"Whereabouts is","significant":false},{"start":310,"end":318,"said":"long's","significant":false},{"start":699,"end":707,"said":"where's","significant":false},{"start":727,"end":730,"said":"","significant":false},{"start":836,"end":841,"said":"site","significant":false},{"start":1502,"end":1510,"said":"long's","significant":false},{"start":2028,"end":2028,"said":"if","significant":false},{"start":2244,"end":2246,"said":"Ooh","significant":false},{"start":2637,"end":2642,"said":"glutes","significant":false},{"start":2719,"end":2728,"said":"shoulder's","significant":false},{"start":3003,"end":3014,"said":"Thursday's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","States lower back pain (bilateral, R worse) and 'R shoulder pain ~6 weeks'."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","'Chronic pattern: years on/off' and 'R shoulder pain ~6 weeks'."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","'Pain today 6/10; peak 8/10 on weekend'."],["The output notes the patient works in concreting with repeated bending and lifting","yes","'Concreter full time for 15 years'; flare after 'full day bent over pouring a concrete slab'; lifting advice recorded."],["The output records that radicular symptoms and red flags were denied","yes","Red flag section denies radicular symptoms, paraesthesia/numbness, night pain and bladder/bowel changes."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Soft tissue massage to lumbar/gluteal region and R upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","'Hip flexor stretch: 90 seconds each side, twice daily'."],["The output notes a review in two weeks","yes","'Review in 2 weeks (Thursday)'."]],"claims":[],"note":"Presenting Condition\n\nLower back pain across lumbar region, bilateral with R worse\n\nCurrent flare started ~10 days ago after full day bent over pouring a concrete slab\n\nChronic pattern: years on/off, flares every few months then settles\n\nPain today 6/10; peak 8/10 on weekend\n\nAgg: sitting, driving to site in morning; morning stiffness\n\nEase: hot shower gives ~1 hour relief\n\nNo leg pain, pins/needles, or numbness reported\n\nNo night pain waking related to back; no bladder/bowel issues\n\nR shoulder pain ~6 weeks, worse with overhead reach; sometimes wakes when rolling onto it\n\nGoal: get through a work week without back seizing up\n\n\n\n\nRadiology\n\nPrior lumbar X-ray “a few years back”: wear and tear, nothing concerning per report to patient\n\n\n\n\nPast Medical History\n\nHypertension\n\n\n\n\nMedications\n\nAntihypertensive tablets (unspecified)\n\n\n\n\nRed Flag/Screening Questions\n\nRadicular Sx: denies\n\nParaesthesia/numbness: denies\n\nNight pain waking (back): denies\n\nBladder/bowel changes: denies\n\n\n\n\nSocial History\n\nConcreter full time for 15 years\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation:\n\nLumbopelvic/gluteal soft tissue tightness > spinal segmental tenderness per clinician comment\n\nR shoulder upper trapezius tightness\n\n\n\n\nDiagnosis\n\nMechanical low back pain with gluteal soft tissue overload\n\nR shoulder upper trapezius overactivity/strain pattern\n\nPrognosis: improving post-session; expect short‑term symptom relief with manual Rx and loading advice\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nHands-on:\n\nSoft tissue massage to lumbar/gluteal region\n\nPercussive massage gun to involved areas\n\nSoft tissue work to R upper trapezius\n\nEducation:\n\nLifting tip: bring load closer before standing\n\n// Patient reported feeling “a lot looser” post-treatment\n\n\n\n\nHome Exercise Program\n\nHip flexor stretch: 90 seconds each side, twice daily\n\n\n\n\nPlan\n\nReview in 2 weeks (Thursday)\n\nContinue HEP and lifting modification until next appointment\n\nEmail receipt with provider number for health fund claiming\n","review":90.94736842105263,"saved":81.05263157894737,"clean":true,"effort":0.0,"sig":[],"mb":56.732809,"signable":115.48936842105263},{"label":"Run 2","wer":3.571428571428571,"text":"Morning. Come on through. Take a seat wherever is comfortable.\n\nThanks.\n\nSo what's brought you in today?\n\nIt's my lower back mostly, and the right shoulder has been playing up as well.\n\nOkay. Let's start with the back. We're about to\n\nit?\n\nRight across the bottom.\n\nBoth sides, but the right's worse.\n\nAnd how long has that been going on?\n\nYears on and off,\n\nIt flares up every few months and settles down again.\n\nIs this a flare at the moment?\n\nYeah. Started about ten days\n\nago.\n\nAnything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day.\n\nThat'll do it. And you're concreting full time?\n\nYeah. Fifteen years now.\n\nOn a scale of one to 10, where is it sitting today?\n\nHi.\n\nProbably a six. It was an eight on the weekend.\n\nWhat makes it worse?\n\nSitting's the worst. Driving\n\nto sight in the morning, I'm stiff as anything.\n\nAnd what helps?\n\nA hot shower helps for about an hour then it comes back.\n\nAnything shooting down the leg?\n\nPins and needles, numbness, anything like that?\n\nNo. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you or any trouble with the bladder or bowels?\n\nNo. None\n\nof that.\n\nGood.\n\nHave you had any imaging done or seen anyone else about it?\n\nI had an\n\nX-ray a few years back. They said it was wear and tear, nothing to worry about.\n\nRight.\n\nAnd are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets. Nothing else.\n\nOkay. Now the shoulder, how long has that been there?\n\nMaybe six weeks.\n\nIt's worse when I'm reaching overhead.\n\nDoes it wake you if you roll onto it?\n\nSometimes, yeah.\n\nAnd what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest.\n\nI'll work through the lower back and the glutes because with the lifting\n\nthat's usually where the load is, then come up to the right shoulder.\n\nDoes that sound alright?\n\nYeah. Sounds good.\n\nIt can be a bit tender in spots. Sing out\n\nanything's too much, and I'll back off.\n\nWill do.\n\nRighto. I'll step out while you get comfortable.\n\nFace down for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure?\n\nYeah. That's good.\n\nOh, that's the spot.\n\nToo much?\n\nNah. It's alright.\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo\n\nworries.\n\nIs the pain okay?\n\nYeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nRight. Roll onto your back for me.\n\nOkay. Sit yourself up slowly when you're ready.\n\nThat feels a lot looser.\n\nGood. The lower back was tight through the glute\n\nmore than the spine itself which is what I'd expect with the lifting.\n\nThe shoulders mostly the upper trap.\n\nSo what should I be doing at home?\n\nTwo\n\nthings:\n\nhip flexor stretch ninety seconds each side twice a\n\nday. And when you're lifting, get the load closer to you before you stand.\n\nYeah. Righto.\n\nI'd book you back in two weeks. Does a Thursday\n\nsuit?\n\nThursday is fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\n\nPerfect.\n\nThanks very much.\n\nNo\n\nworries. Take it easy for the rest of today.","marks":[{"start":38,"end":49,"said":"wherever's","significant":false},{"start":147,"end":159,"said":"shoulder's","significant":false},{"start":219,"end":233,"said":"Whereabouts is","significant":false},{"start":310,"end":318,"said":"long's","significant":false},{"start":698,"end":706,"said":"where's","significant":false},{"start":726,"end":729,"said":"","significant":false},{"start":835,"end":840,"said":"site","significant":false},{"start":1501,"end":1509,"said":"long's","significant":false},{"start":2026,"end":2026,"said":"if","significant":false},{"start":2242,"end":2244,"said":"Ooh","significant":false},{"start":2635,"end":2640,"said":"glutes","significant":false},{"start":2717,"end":2726,"said":"shoulder's","significant":false},{"start":3001,"end":3012,"said":"Thursday's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Low back pain and right shoulder pain both recorded."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"recurrent 'years on and off'\" and \"Right shoulder pain ~6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 today; peaked 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreter full time, 15 years\"; \"Occupational heavy lifting and bending\"."],["The output records that radicular symptoms and red flags were denied","yes","Red flag section: radicular symptoms, night pain waking, bladder/bowel all denied."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Soft tissue to glutes and lumbar region, massage gun, and right upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Review in 2 weeks (Thursday)\"."]],"claims":[["Prognosis: favourable with load management, soft tissue work, and mobility work","The clinician never stated a prognosis; this is an invented clinical judgement."],["Likely next session: reassess symptoms; progress mobility and introduce trunk/hip strengthening","No next-session plan or strengthening was discussed; only a two-week rebook was mentioned."]],"note":"Presenting Condition\n\nLow back pain across bilateral lumbar region, worse on right\n\nMechanism: prolonged bending while pouring a large concrete slab\n\nDuration: recurrent “years on and off”; current flare started ~10 days ago\n\nPain intensity: 6/10 today; peaked 8/10 on weekend\n\nPain type: dull ache; no radiation\n\nAggravating factors: sitting; driving to site in the morning; overhead reaching aggravates right shoulder\n\nEasing factors: hot shower gives ~1 hour relief\n\n24‑hour pattern: morning stiffness when driving\n\nNeuro signs: denies pins/needles or numbness\n\nAssociated symptoms: denies night pain waking, bladder/bowel issues\n\nReasons for visit/goals: get through a work week without back seizing up\n\nRight shoulder pain ~6 weeks; worse with reaching overhead; sometimes wakes when rolling onto it\n\nProgression: recurrent flares every few months\n\n\n\n\nRadiology\n\nPrior lumbar X‑ray “a few years back”: reported as wear and tear, nothing concerning\n\n\n\n\nPast Medical History\n\nHypertension\n\n\n\n\nMedications\n\nAntihypertensive (“blood pressure tablets”)\n\n\n\n\nRed Flag/Screening Questions\n\nRadicular symptoms: denies\n\nNight pain waking: denies\n\nBladder/bowel dysfunction: denies\n\n\n\n\nSocial History\n\nOccupation: concreter full time, 15 years\n\n\n\n\nSport & Exercise History\n\nOccupational heavy lifting and bending noted\n\n\n\n\nGoals\n\nShort-term: complete a work week without back seizing\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: increased tissue tension in glutes > lumbar paraspinals\n\nPalpation: tenderness/tightness greater in gluteal region than lumbar spine; right upper trapezius tightness\n\n\n\n\nDiagnosis\n\nMechanical low back pain with gluteal muscle overload related to lifting/bending\n\nRight shoulder upper trapezius overactivity/strain pattern\n\nPrognosis: favourable with load management, soft tissue work, and mobility work\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nHands-on:\n\nSoft tissue techniques to glutes and lumbar region\n\nMassage gun applied to involved areas\n\nSoft tissue release to right upper trapezius\n\nEducation:\n\nLift with load kept closer to body before standing\n\nActive therapy/exercises:\n\nHip flexor stretch prescribed\n\n// Patient reported feeling “a lot looser” post-session\n\n\n\n\nHome Exercise Program\n\nHip flexor stretch: 90 seconds each side, twice daily\n\n\n\n\nPlan\n\nReview in 2 weeks (Thursday)\n\nContinue HEP and lifting modification at work\n\nLikely next session: reassess symptoms; progress mobility and introduce trunk/hip strengthening\n\nAdmin: receipt with provider number to be emailed for health fund claim\n","review":134.8421052631579,"saved":37.15789473684211,"clean":false,"effort":37.5,"sig":[],"mb":56.782499,"signable":174.3661052631579},{"label":"Run 3","wer":2.5510204081632653,"text":"Morning. Come on through. Take a seat wherever is comfortable.\n\nThanks.\n\nSo what's brought you in today?\n\nIt's my lower back mostly, and the right shoulder's been playing up as well.\n\nOkay. Let's start with the back. Where about to\n\nit?\n\nRight across the bottom.\n\nBoth sides, but the right's worse.\n\nAnd how long has that been going on?\n\nYears on and off\n\nIt flares up every few months and settles down again.\n\nIs this a flare at the moment?\n\nYeah. Started about ten days\n\nago.\n\nAnything set it off that you can think of?\n\nWe poured a big slab on the Thursday. I was bent over most of the day.\n\nThat'll do it. And you're concreting full time?\n\nYeah. Fifteen years now.\n\nOn a scale of one to 10, where is it sitting today?\n\nProbably a six.\n\nIt was an eight on the weekend.\n\nWhat makes it worse?\n\nSitting's the worst. Driving to sight in the morning, I'm stiff as anything.\n\nAnd what helps?\n\nA hot shower helps for about an hour then it comes back.\n\nAnything shooting down the leg?\n\nPins and needles? Numbness? Anything like that?\n\nNo. Nothing like that. It's just an ache.\n\nAny pain at\n\nnight that wakes you or any trouble with the bladder or bowels?\n\nNo.\n\nNone of that.\n\nGood. Have you had any imaging done or seen anyone else about it?\n\nI had an X-ray a few years back. They said it was wear and tear, nothing to worry about.\n\nRight.\n\nAnd are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets. Nothing else.\n\nOkay. Now the shoulder, how long has that been there?\n\nMaybe six weeks.\n\nIt's worse when I'm reaching overhead.\n\nDoes it wake you if you roll onto it?\n\nSometimes, yeah.\n\nAnd what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up,\n\nThat's fair.\n\nHere's what I'd suggest. I'll work through the lower back and the glutes.\n\nBecause with the lifting, that's usually where the load is,\n\nthen come up to the right shoulder. Does that sound alright?\n\nYeah. Sounds good.\n\nIt can be a bit tender in spots,\n\nSing out if anything's too much, and I'll back off.\n\nWill do.\n\nRighto. I'll step out while you get comfortable. Face\n\ndown for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure?\n\nYeah.\n\nThat's good.\n\nOh, that's the spot.\n\nToo much?\n\nNah. It's alright.\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo\n\nworries.\n\nIs the pain okay?\n\nYeah. That's\n\nfine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nRight. Roll onto your back for me.\n\nOkay. Sit yourself up slowly when you're ready.\n\nThat feels a lot looser.\n\nGood. The lower back was tight through the glutes more than the spine itself.\n\nWhich is what I'd expect with the lifting. The shoulders mostly the upper trap\n\nSo what should I be doing at home?\n\nTwo things. Hip flexor stretch, ninety seconds each side, twice a\n\nday. And when you're lifting, get the load closer to you before you stand.\n\nYeah.\n\nI'd book you back in two weeks.\n\nDoes a Thursday suit?\n\nThursday's fine.\n\nDo I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\n\nPerfect.\n\nThanks very much.\n\nNo worries. Take it easy for the rest of today.","marks":[{"start":38,"end":49,"said":"wherever's","significant":false},{"start":217,"end":231,"said":"Whereabouts is","significant":false},{"start":308,"end":316,"said":"long's","significant":false},{"start":695,"end":703,"said":"where's","significant":false},{"start":827,"end":832,"said":"site","significant":false},{"start":1492,"end":1500,"said":"long's","significant":false},{"start":2239,"end":2241,"said":"Ooh","significant":false},{"start":2716,"end":2725,"said":"shoulder's","significant":false},{"start":2933,"end":2933,"said":"righto.","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Back pain and R shoulder pain as reasons for visit."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","partial","Back pain recorded as chronic over years, but the shoulder pain's ~6-week duration is not stated."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain today 6/10; peaked at 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Concreter, full time, ~15 years\"; bent over pouring slab; occupational heavy lifting."],["The output records that radicular symptoms and red flags were denied","yes","Denies neuro symptoms, night pain waking, bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","Soft tissue to glutes and lumbar region, massage gun, R upper trapezius."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Review in 2 weeks (Thursday)\"."]],"claims":[["Prognosis: good with load modification, soft-tissue work, and mobility","No prognosis was stated anywhere in the session."],["Education: Expected post-treatment soreness","The clinician only said \"Take it easy for the rest of today\"; post-treatment soreness was never discussed."]],"note":"Presenting Condition\n\nLower back pain across lumbosacral region, R>L; current flare started ~10 days ago after day bent over pouring a concrete slab\n\nChronic, recurrent flares every few months over years\n\nPain today 6/10; peaked at 8/10 on weekend\n\nPain type: dull ache; no leg radiation, no pins/needles, no numbness reported\n\nAgg: sitting, driving to site in morning; feels very stiff\n\nEase: hot shower gives ~1 hour relief\n\nNight pain: denies sleep disturbance from back\n\nReasons for visit: back pain and R shoulder pain management\n\nImpact: wants to get through a work week without back seizing up\n\n\n\n\nRadiology\n\nLumbar X-ray a few years ago reportedly “wear and tear,” nothing concerning\n\n\n\n\nPast Medical History\n\nHypertension\n\n\n\n\nMedications\n\nAntihypertensive tablets (unspecified)\n\n\n\n\nRed Flag/Screening Questions\n\nNight pain waking: denies\n\nBladder/bowel issues: denies\n\nNeuro symptoms (leg pain, pins/needles, numbness): denies\n\n\n\n\nSocial History\n\nOccupation: Concreter, full time, ~15 years\n\n\n\n\nSport & Exercise History\n\nOccupational heavy lifting and overhead reaching noted\n\n\n\n\nGoals\n\nShort-term: get through a work week without back seizing up\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Increased soft-tissue tightness noted in glutes > lumbar spine; R shoulder upper trapezius tightness\n\nPalpation: Tender, tight gluteal musculature; tight R upper trapezius\n\n\n\n\nDiagnosis\n\nMechanical/nonspecific low back pain with gluteal muscle tightness\n\nRight shoulder upper trapezius overactivity/tightness with overhead aggravation\n\nPrognosis: good with load modification, soft-tissue work, and mobility\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nHands-on:\n\nSoft tissue techniques to glutes and lumbar region\n\nMassage gun applied to involved areas\n\nSoft tissue to R upper trapezius\n\nEducation:\n\nLifting strategy: bring load closer before standing\n\nExpected post-treatment soreness and to take it easy rest of day\n\n// Patient reported feeling “a lot looser” post-session\n\n\n\n\nHome Exercise Program\n\nHip flexor stretch: 90 seconds each side, twice daily\n\n\n\n\nPlan\n\nReview in 2 weeks (Thursday)\n\nContinue HEP and lifting modifications until next appointment\n\nLikely further soft-tissue work and progress exercises for lumbar/hip and shoulder as tolerated\n\nEmail receipt with provider number for health fund claim\n","review":144.34210526315792,"saved":27.65789473684208,"clean":false,"effort":43.75,"sig":[],"mb":56.88655,"signable":167.0011052631579},{"label":"Run 4","wer":3.571428571428571,"text":"Morning. Come on through. Take a seat wherever is comfortable.\n\nThanks.\n\nSo what's brought you in today?\n\nIt's my lower back mostly, and the right shoulder has been playing up as well.\n\nOkay. Let's start with the back. We're about to\n\nit?\n\nRight across the bottom.\n\nBoth sides, but the right's worse.\n\nAnd how long has that been going on?\n\nYears on and off,\n\nIt flares up every few months and settles down again.\n\nIs this a flare at the moment?\n\nYeah. Started about ten days\n\nago.\n\nAnything set it off that you can think\n\nof?\n\nWe poured a big slab on the Thursday. I was bent over most of the day.\n\nThat'll do it. And you're concreting full time?\n\nYeah. Fifteen years now.\n\nOn a scale of one to 10, where is it sitting today?\n\nHi.\n\nProbably a six. It was an eight on the weekend.\n\nWhat makes it worse?\n\nSitting's the worst. Driving\n\nto sight in the morning, I'm stiff as anything.\n\nAnd what helps?\n\nA hot shower helps for about an hour then it comes back.\n\nAnything shooting down the leg?\n\nPins and needles, numbness, anything like that?\n\nNo. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you or any trouble with the bladder or bowels?\n\nNo. None\n\nof that.\n\nGood.\n\nHave you had any imaging done or seen anyone else about it?\n\nI had an\n\nX-ray a few years back. They said it was wear and tear, nothing to worry about.\n\nRight.\n\nAnd are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets. Nothing else.\n\nOkay. Now the shoulder, how long has that been there?\n\nMaybe six weeks.\n\nIt's worse when I'm reaching overhead.\n\nDoes it wake you if you roll onto it?\n\nSometimes, yeah.\n\nAnd what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest.\n\nI'll work through the lower back and the glutes because with the lifting,\n\nthat's usually where the load is, then come up to the right shoulder.\n\nDoes that sound alright?\n\nYeah. Sounds good.\n\nIt can be a bit tender in spots. Sing out\n\nanything's too much, and I'll back off.\n\nWill do.\n\nRighto. I'll step out while you get comfortable.\n\nFace down for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure?\n\nYeah. That's good.\n\nOh, that's the spot.\n\nToo much?\n\nNah. It's alright.\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo\n\nworries.\n\nIs the pain okay?\n\nYeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nRight. Roll onto your back for me.\n\nOkay. Sit yourself up slowly when you're ready.\n\nThat feels a lot looser.\n\nGood. The lower back was tight through the glute\n\nmore than the spine itself which is what I'd expect with the lifting.\n\nThe shoulders mostly the upper trap.\n\nSo what should I be doing at home?\n\nTwo\n\nthings:\n\nhip flexor stretch ninety seconds each side twice a\n\nday. And when you're lifting, get the load closer to you before you stand.\n\nYeah. Righto.\n\nI'd book you back in two weeks. Does a Thursday\n\nsuit?\n\nThursday is fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\n\nPerfect.\n\nThanks very much.\n\nNo\n\nworries. Take it easy for the rest of today.","marks":[{"start":38,"end":49,"said":"wherever's","significant":false},{"start":147,"end":159,"said":"shoulder's","significant":false},{"start":219,"end":233,"said":"Whereabouts is","significant":false},{"start":310,"end":318,"said":"long's","significant":false},{"start":699,"end":707,"said":"where's","significant":false},{"start":727,"end":730,"said":"","significant":false},{"start":836,"end":841,"said":"site","significant":false},{"start":1502,"end":1510,"said":"long's","significant":false},{"start":2028,"end":2028,"said":"if","significant":false},{"start":2244,"end":2246,"said":"Ooh","significant":false},{"start":2637,"end":2642,"said":"glutes","significant":false},{"start":2719,"end":2728,"said":"shoulder's","significant":false},{"start":3003,"end":3014,"said":"Thursday's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Lower back pain and right shoulder pain documented."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"years on/off\"; \"Right shoulder pain ~6 weeks\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 today, 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Concreter full time, ~15 years\"; bent over pouring slab; lifting posture."],["The output records that radicular symptoms and red flags were denied","yes","Denies leg pain, pins/needles, numbness, night pain waking, bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","partial","Treatment to glutes and right upper trapezius documented, but lower back treatment is not listed."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Review in 2 weeks (Thursday)\"."]],"claims":[["Palpation: Tenderness/tightness R gluteal region","No side was given for gluteal tightness or tenderness; clinician only said the back was \"tight through the glutes\"."],["Prognosis: Favourable with load management, soft-tissue work, and mobility","No prognosis was stated anywhere in the session."]],"note":"Presenting Condition\n\nLower back pain across the low back, R>L\n\nCurrent flare started ~10 days ago after a full day bent over pouring a concrete slab\n\nPain intensity: 6/10 today, 8/10 on weekend\n\nPain type: ache; no leg symptoms\n\nAggravating factors: sitting, driving to site in the morning\n\nEasing factors: hot shower helps ~1 hour\n\nDuration/progression: years on/off; flares every few months and settles\n\nRight shoulder pain ~6 weeks, worse reaching overhead\n\nNight pain: sometimes when rolling onto right shoulder\n\nReason for visit/goal: get through a work week without back seizing up\n\n\n\n\nRadiology\n\nPrior lumbar X-ray “a few years back” reported as wear and tear, nothing concerning\n\n\n\n\nPast Medical History\n\nHypertension\n\n\n\n\nMedications\n\nBlood pressure tablets\n\n\n\n\nRed Flag/Screening Questions\n\nDenies leg pain, pins/needles, numbness\n\nDenies night back pain waking, bladder/bowel issues\n\n\n\n\nSocial History\n\nOccupation: Concreter full time, ~15 years\n\n\n\n\nGoals\n\nShort-term: Work a full week without back seizing up\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Increased soft-tissue tightness in glutes > lumbar spine\n\nPalpation: Tenderness/tightness R gluteal region\n\nShoulder: Tightness predominantly right upper trapezius\n\n\n\n\nDiagnosis\n\nMechanical low back pain with gluteal soft-tissue overload related to lifting posture\n\nRight shoulder upper trapezius overactivity/strain pattern\n\nPrognosis: Favourable with load management, soft-tissue work, and mobility\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nHands-on:\n\nSoft-tissue release to gluteal region\n\nMassage gun to gluteal area\n\nSoft-tissue work to right upper trapezius\n\nEducation:\n\nLift with load closer to the body before standing\n\n// Patient reported feeling “a lot looser” post-session\n\n\n\n\nHome Exercise Program\n\nHip flexor stretch: 90 seconds each side, twice daily\n\n\n\n\nPlan\n\nReview in 2 weeks (Thursday)\n\nContinue HEP and lifting cue; monitor symptom response\n\nEmail receipt with provider number for health fund claim\n","review":129.57894736842104,"saved":42.42105263157896,"clean":false,"effort":43.75,"sig":[],"mb":56.520355,"signable":161.22494736842106},{"label":"Run 5","wer":3.571428571428571,"text":"Morning. Come on through. Take a seat wherever is comfortable.\n\nThanks.\n\nSo what's brought you in today?\n\nIt's my lower back mostly, and the right shoulder has been playing up as well.\n\nOkay. Let's start with the back. We're about to\n\nit?\n\nRight across the bottom.\n\nBoth sides, but the right's worse.\n\nAnd how long has that been going on?\n\nYears on and off,\n\nIt flares up every few months and settles down again.\n\nIs this a flare at the moment?\n\nYeah. Started about ten days\n\nago.\n\nAnything set it off that you can think\n\nof?\n\nWe poured a big slab on the Thursday. I was bent over most of the day.\n\nThat'll do it. And you're concreting full time?\n\nYeah. Fifteen years now.\n\nOn a scale of one to 10, where is it sitting today?\n\nHi.\n\nProbably a six. It was an eight on the weekend.\n\nWhat makes it worse?\n\nSitting's the worst. Driving\n\nto sight in the morning, I'm stiff as anything.\n\nAnd what helps?\n\nA hot shower helps for about an hour then it comes back.\n\nAnything shooting down the leg?\n\nPins and needles, numbness, anything like that?\n\nNo. Nothing like that. It's just an ache.\n\nAny pain at night that wakes you or any trouble with the bladder or bowels?\n\nNo. None\n\nof that.\n\nGood.\n\nHave you had any imaging done or seen anyone else about it?\n\nI had an\n\nX-ray a few years back. They said it was wear and tear, nothing to worry about.\n\nRight.\n\nAnd are you on any medications or any other health conditions I should know about?\n\nJust blood pressure tablets. Nothing else.\n\nOkay. Now the shoulder, how long has that been there?\n\nMaybe six weeks.\n\nIt's worse when I'm reaching overhead.\n\nDoes it wake you if you roll onto it?\n\nSometimes, yeah.\n\nAnd what would you like to get out of today?\n\nHonestly, just to get through a work week without it seizing up.\n\nThat's fair. Here's what I'd suggest.\n\nI'll work through the lower back and the glutes because with the lifting\n\nthat's usually where the load is, then come up to the right shoulder.\n\nDoes that sound alright?\n\nYeah. Sounds good.\n\nIt can be a bit tender in spots. Sing out\n\nanything's too much, and I'll back off.\n\nWill do.\n\nRighto. I'll step out while you get comfortable.\n\nFace down for me, head in the cradle, and pull the towel up over you.\n\nHow's that pressure?\n\nYeah. That's good.\n\nOh, that's the spot.\n\nToo much?\n\nNah. It's alright.\n\nI'm going to use the massage gun on this one. It's a bit loud.\n\nNo\n\nworries.\n\nIs the pain okay?\n\nYeah. That's fine. Bit intense, but it's alright.\n\nSing out if you want me to back off.\n\nRight. Roll onto your back for me.\n\nOkay. Sit yourself up slowly when you're ready.\n\nThat feels a lot looser.\n\nGood. The lower back was tight through the glute\n\nmore than the spine itself which is what I'd expect with the lifting.\n\nThe shoulders mostly the upper trap.\n\nSo what should I be doing at home?\n\nTwo\n\nthings:\n\nhip flexor stretch ninety seconds each side twice a\n\nday. And when you're lifting, get the load closer to you before you stand.\n\nYeah. Righto.\n\nI'd book you back in two weeks. Does a Thursday\n\nsuit?\n\nThursday is fine. Do I get something for the health fund?\n\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\n\nPerfect.\n\nThanks very much.\n\nNo\n\nworries. Take it easy for the rest of today.","marks":[{"start":38,"end":49,"said":"wherever's","significant":false},{"start":147,"end":159,"said":"shoulder's","significant":false},{"start":219,"end":233,"said":"Whereabouts is","significant":false},{"start":310,"end":318,"said":"long's","significant":false},{"start":699,"end":707,"said":"where's","significant":false},{"start":727,"end":730,"said":"","significant":false},{"start":836,"end":841,"said":"site","significant":false},{"start":1502,"end":1510,"said":"long's","significant":false},{"start":2027,"end":2027,"said":"if","significant":false},{"start":2243,"end":2245,"said":"Ooh","significant":false},{"start":2636,"end":2641,"said":"glutes","significant":false},{"start":2718,"end":2727,"said":"shoulder's","significant":false},{"start":3002,"end":3013,"said":"Thursday's","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","Low back pain is the presenting condition and right shoulder symptoms are documented (\"overhead reach aggravates R shoulder\")."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","partial","Back is \"Chronic recurrent pattern for years\", but the shoulder's ~6-week duration is not stated."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain intensity today 6/10; peaked 8/10 on weekend\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"concreter full time x15 years\", flare after \"a full day bent over pouring a concrete slab\", \"Lifting at work noted\"."],["The output records that radicular symptoms and red flags were denied","yes","\"Denies leg symptoms (radicular), pins/needles, numbness\", night pain and bladder/bowel issues."],["The output notes treatment covered the lower back, glutes and right shoulder","yes","\"Soft tissue massage to lumbar/gluteal region\" and \"Soft tissue work to R upper trapezius\"."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch: 90 seconds each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Review in 2 weeks (Thursday)\"."]],"claims":[],"note":"Presenting Condition\n\nLow back pain across lumbar region, R > L\n\nChronic recurrent pattern for years; flares every few months and settles\n\nCurrent flare began ~10 days ago after a full day bent over pouring a concrete slab\n\nPain intensity today 6/10; peaked 8/10 on weekend\n\nAgg: sitting, driving to site in the morning, overhead reach aggravates R shoulder\n\nEase: hot shower provides ~1 hour relief\n\nNo leg pain, pins/needles, or numbness reported\n\nNo night pain waking him due to back; R shoulder sometimes wakes when rolled onto\n\nGoal: get through a work week without back seizing up\n\nWork: concreter full time x15 years\n\n\n\n\nRadiology\n\nPrior lumbar X-ray “a few years back”: wear and tear, nothing concerning per report\n\n\n\n\nPast Medical History\n\nHypertension\n\n\n\n\nMedications\n\nBlood pressure tablets\n\n\n\n\nRed Flag/Screening Questions\n\nDenies leg symptoms (radicular), pins/needles, numbness\n\nDenies night pain waking (for back)\n\nDenies bladder or bowel issues\n\n\n\n\nSocial History\n\nOccupation: concreter, full time\n\n\n\n\nSport & Exercise History\n\nLifting at work noted\n\n\n\n\nObjective\n\n(Consent obtained)\n\nObservation: Lumbar region reported tight; therapist notes greater tightness through gluteals vs spinal segments\n\nPalpation: Increased tone/tenderness in gluteals; R shoulder upper trapezius predominant tightness\n\n\n\n\nDiagnosis\n\nMechanical low back pain with gluteal overload related to lifting/bent postures\n\nRight shoulder upper trapezius overactivity/strain pattern\n\nPrognosis: Expected to improve with load management, manual therapy, and HEP\n\n\n\n\nTreatment\n\n(Consent obtained)\n\nHands-on:\n\nSoft tissue massage to lumbar/gluteal region\n\nMassage gun applied to gluteals\n\nSoft tissue work to R upper trapezius\n\nEducation:\n\nBring load closer before lifting/standing to reduce lumbar load\n\nActive therapy/exercises:\n\nHip flexor stretch prescribed\n\n// Patient reported feeling “a lot looser” post-session\n\n\n\n\nHome Exercise Program\n\nHip flexor stretch: 90 seconds each side, twice daily\n\n\n\n\nPlan\n\nReview in 2 weeks (Thursday)\n\nContinue HEP and lifting modification\n\nEmail receipt with provider number for health fund claim\n","review":112.44736842105263,"saved":59.55263157894737,"clean":false,"effort":6.25,"sig":[],"mb":56.59917,"signable":134.00036842105263}],"patientnotes":[{"label":"Run 1","wer":8.503401360544217,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back, mostly. And the right shoulder has been playing up as well.\nOkay, let's start with the back. Whereabouts is it?\nRight across the bottom, both sides. But the right's worse.\nAnd how long's that been going on?\nYears, on and off. It flares up every few months and settles down again. It.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday. I was bent over most of the day.\nThat'll do it. And you're concreting full time?\nYeah, 15 years now.\nOn a scale of one to ten, where's it sitting today?\nProbably a six. It was an eight on the weekend.\nWhat makes it worse,\nsitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins and needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done or seen anyone else about it?\nI had an X ray a few years back. They said it was wear and tear, Nothing to do.\nWorry about.\nRight. And are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay. Now, the shoulder. How long's that been there?\nMaybe six weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, Just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is. Then come up to the right shoulder. Does that sound all right? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off. Will do. Righto. I'll step out while you get comfortable. Face down for me. Head in the cradle and pull the towel up over you. It.\nIt's it.\nHow's that pressure? Yeah, that's good.\nIt. It's. It.\nIt's it.\nOh, that's the spot. Too much? Nah, it's all right.\nThere's.\nIt's it.\nIt's it.\nIt. It's.\nIt, Sam, It.\nIt's it.\nIt's it.\nI'm going to use the massage gun on this one. It's a bit loud. No worries. It. Sam.\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\nIt. It's.\nIt. It's it.\nRight, roll onto your back for.\nIt's it.\nIt's it.\nOkay. Sit yourself up slowly. When you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly. The upper trap. So what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, right. O.\nI'd book you back in two weeks. Does it Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.\nIt's it.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":1281,"end":1284,"said":"","significant":false},{"start":1903,"end":1912,"said":"alright","significant":false},{"start":2144,"end":2156,"said":"","significant":false},{"start":2197,"end":2222,"said":"Ooh","significant":false},{"start":2261,"end":2339,"said":"alright.","significant":false},{"start":2415,"end":2423,"said":"","significant":false},{"start":2483,"end":2493,"said":"alright.","significant":false},{"start":2531,"end":2553,"said":"","significant":false},{"start":2586,"end":2603,"said":"me.","significant":false},{"start":2803,"end":2812,"said":"shoulder's","significant":false},{"start":3016,"end":3025,"said":"righto.","significant":false},{"start":3313,"end":3321,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","'Patient presents with lower back pain and right shoulder pain.'"],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back 'chronic years with intermittent flares'; shoulder '~6 weeks'."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","'rated 8/10 over weekend, now 6/10'."],["The output notes the patient works in concreting with repeated bending and lifting","partial","Mentions 'bending while pouring slab' but never states the patient works as a concreter."],["The output records that radicular symptoms and red flags were denied","partial","'No leg radiation, numbness, or night pain' but bladder/bowel denial omitted."],["The output notes treatment covered the lower back, glutes and right shoulder","no","No treatment delivered in session is documented; only home advice and follow-up in plan."],["The output mentions a hip flexor stretch as home advice","yes","'Hip flexor stretch 90 seconds each side, twice daily'."],["The output notes a review in two weeks","yes","'Follow-up appointment in two weeks on Thursday'."]],"claims":[["Right shoulder discomfort likely overuse/impingement of upper trapezius","Clinician only said 'The shoulder's mostly the upper trap'; impingement was never raised or suggested."]],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with lower back pain and right shoulder pain.\n\nHistory of Presenting Complaint::\n\nSubjective:\n\nLower back pain across lower lumbar region bilaterally, worse on right, chronic years with intermittent flares; current flare 10 days after bending while pouring slab.\n\nPain aggravated by sitting and driving to site in the morning, rated 8/10 over weekend, now 6/10.\n\nRelief from hot shower ~1 hour.\n\nNo leg radiation, numbness, or night pain.\n\nRight shoulder pain ~6 weeks, worsens with overhead reaching, occasionally wakes patient when rolling onto it.\n\nObjective\n\nObjective:\n\nTightness noted in lower back gluteal region more than spine.\n\nTenderness in right upper trapezius.\n\nPatient rates current lower back pain as 6/10, peaked at 8/10 over the weekend.\n\nAssessment\n\nAssessment:\n\nChronic mechanical lower back pain with recent activity‑related flare.\n\nRight shoulder discomfort likely overuse/impingement of upper trapezius.\n\nPlan\n\nMedications::\n\nPatient is taking blood pressure tablets.\n\nPlan:\n\nHip flexor stretch 90 seconds each side, twice daily.\n\nKeep load close to body when lifting.\n\nFollow‑up appointment in two weeks on Thursday.\n\nEmail receipt with provider number for health fund claim.","review":119.05263157894737,"saved":52.94736842105263,"clean":false,"effort":43.75,"sig":[["partial","The output records that radicular symptoms and red flags were denied","The bladder/bowel (cauda equina) screen was asked and denied but is missing from the record."],["missing","The output notes treatment covered the lower back, glutes and right shoulder","No treatment given in the session is documented, so the legal record of the intervention is missing."],["fabrication","Right shoulder discomfort likely overuse/impingement of upper trapezius","Impingement was never raised; the clinician only attributed the shoulder to the upper trap."]],"mb":122.15436,"latency":68.269,"signable":187.32163157894738},{"label":"Run 2","wer":6.802721088435375,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay, let's start with the back. Whereabouts is it?\nRight across the bottom, both sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off. It flares up every few months and settles down again. It.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday. I was bent over most of the day.\nThat'll do it. And you're concreting full time?\nYeah, 15 years now.\nOn a scale of one to ten, where's it sitting today?\nProbably a six. It was an eight on the weekend.\nWhat makes it worse,\nsitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins and needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done or seen anyone else about it?\nI had an X ray a few years back. They said it was wear and tear. Nothing.\nWorry about.\nRight. And are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay. Now, the shoulder. How long's that been there?\nMaybe six weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, Just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is. Then come up to the right shoulder. Does that sound all right? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off. Will do. Righto. I'll step out while you get comfortable. Face down for me. Head in the cradle and pull the towel up over you. It.\nIt's it.\nHow's that pressure? Yeah, that's good.\nIt's it.\nOh, that's the spot. Too much? Nah, it's all right.\nIt's it.\nIt's it.\nIt's.\nIt. It's.\nIt's it.\nIt's it.\nI'm going to use the massage gun on this one. It's a bit loud. No worries.\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\nIt. It's.\nIt. It's it.\nRight, roll onto your back for.\nIt's it.\nIt's it.\nOkay. Sit yourself up slowly. When you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly. The upper trap. So what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, right. O.\nI'd book you back in two weeks. Does it Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.\nIt's it.","marks":[{"start":1895,"end":1904,"said":"alright","significant":false},{"start":2136,"end":2148,"said":"","significant":false},{"start":2189,"end":2200,"said":"Ooh","significant":false},{"start":2239,"end":2301,"said":"alright.","significant":false},{"start":2436,"end":2446,"said":"alright.","significant":false},{"start":2484,"end":2506,"said":"","significant":false},{"start":2539,"end":2556,"said":"me.","significant":false},{"start":2756,"end":2765,"said":"shoulder's","significant":false},{"start":2969,"end":2978,"said":"righto.","significant":false},{"start":3266,"end":3274,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"lower back pain and right shoulder discomfort\"."],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"years duration, intermittent\" and \"~6 weeks duration\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"Pain intensity 6/10 currently (was 8/10 over weekend)\"."],["The output notes the patient works in concreting with repeated bending and lifting","partial","\"after concrete work\" and \"occupational lifting and prolonged flexion\" but occupation as concreter not explicit."],["The output records that radicular symptoms and red flags were denied","no","No record that radicular symptoms, night pain or bladder/bowel red flags were denied."],["The output notes treatment covered the lower back, glutes and right shoulder","no","Treatment delivered (lower back, glutes, right shoulder) is not documented."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch 90 seconds each side, twice daily.\""],["The output notes a review in two weeks","yes","\"Follow-up appointment in 2 weeks on Thursday.\""]],"claims":[["Right shoulder discomfort consistent with overuse/possible impingement","Clinician only said 'the shoulder's mostly the upper trap'; impingement is never raised in the transcript."]],"note":"Subjective\n\nChief Complaint::\n\nPatient reports lower back pain and right shoulder discomfort.\n\nHistory of Presenting Complaint::\n\nLower back pain: years duration, intermittent; current flare started 10 days ago after concrete work; worsened by sitting and driving; hot shower provides ~1 hour relief.\n\nRight shoulder pain: ~6 weeks duration; aggravated by overhead reach and occasionally wakes patient when rolling onto it.\n\nObjective\n\nExamination: gluteal tightness greater than lumbar spine tension; tenderness noted in lower back region; upper trapezius tension on right shoulder.\n\nPain intensity 6/10 currently (was 8/10 over weekend).\n\nAssessment\n\nMechanical low back pain likely related to occupational lifting and prolonged flexion posture.\n\nRight shoulder discomfort consistent with overuse/possible impingement affecting upper trapezius.\n\nPlan\n\nMedications::\n\nBlood pressure tablets.\n\nHip flexor stretch 90 seconds each side, twice daily.\n\nMaintain load close to body when lifting.\n\nFollow‑up appointment in 2 weeks on Thursday.\n\nEmail receipt with provider number for health fund claim.","review":113.88157894736841,"saved":58.11842105263159,"clean":false,"effort":50.0,"sig":[["missing","The output records that radicular symptoms and red flags were denied","Negative screen for radicular symptoms, night pain and cauda equina features not documented."],["missing","The output notes treatment covered the lower back, glutes and right shoulder","The treatment actually delivered is absent from the record."],["fabrication","Right shoulder discomfort consistent with overuse/possible impingement","Invented shoulder impingement differential never raised by the clinician."]],"mb":120.846997,"latency":66.394,"signable":180.27557894736842},{"label":"Run 3","wer":8.503401360544217,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back, mostly. And the right shoulder has been playing up as well.\nOkay, let's start with the back. Whereabouts is it?\nRight across the bottom, both sides. But the right's worse.\nAnd how long's that been going on?\nYears, on and off. It flares up every few months and settles down again. It.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday. I was bent over most of the day.\nThat'll do it. And you're concreting full time?\nYeah, 15 years now.\nOn a scale of one to ten, where's it sitting today?\nProbably a six. It was an eight on the weekend.\nWhat makes it worse,\nsitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins and needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done or seen anyone else about it?\nI had an X ray a few years back. They said it was wear and tear, Nothing to do.\nWorry about.\nRight. And are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay. Now, the shoulder. How long's that been there?\nMaybe six weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, Just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is. Then come up to the right shoulder. Does that sound all right? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off. Will do. Righto. I'll step out while you get comfortable. Face down for me. Head in the cradle and pull the towel up over you. It.\nIt's it.\nHow's that pressure? Yeah, that's good.\nIt. It's. It.\nIt's it.\nOh, that's the spot. Too much? Nah, it's all right.\nThere's.\nIt's it.\nIt's it.\nIt. It's.\nIt, Sam, It.\nIt's it.\nIt's it.\nI'm going to use the massage gun on this one. It's a bit loud. No worries. It. Sam.\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\nIt. It's.\nIt. It's it.\nRight, roll onto your back for.\nIt's it.\nIt's it.\nOkay. Sit yourself up slowly. When you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly. The upper trap. So what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, right. O.\nI'd book you back in two weeks. Does it Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.\nIt's it.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":1281,"end":1284,"said":"","significant":false},{"start":1903,"end":1912,"said":"alright","significant":false},{"start":2144,"end":2156,"said":"","significant":false},{"start":2197,"end":2222,"said":"Ooh","significant":false},{"start":2261,"end":2339,"said":"alright.","significant":false},{"start":2415,"end":2423,"said":"","significant":false},{"start":2483,"end":2493,"said":"alright.","significant":false},{"start":2531,"end":2553,"said":"","significant":false},{"start":2586,"end":2603,"said":"me.","significant":false},{"start":2803,"end":2812,"said":"shoulder's","significant":false},{"start":3016,"end":3025,"said":"righto.","significant":false},{"start":3313,"end":3321,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"Lower back pain and right shoulder pain.\""],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain for years, intermittent; shoulder ~6 weeks."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"current pain 6/10 (up to 8/10 weekend)\"."],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"Occupation: concreting 15 yrs\"; flare after heavy bending; occupational lifting."],["The output records that radicular symptoms and red flags were denied","yes","\"No leg radiation, nocturnal pain, bladder/bowel issues\"."],["The output notes treatment covered the lower back, glutes and right shoulder","no","Only exam findings are recorded; the treatment delivered to lower back, glutes and right shoulder is not documented."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch 90 s each side, twice daily\"."],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks Thursday\"."]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nLower back pain and right shoulder pain.\n\nHistory of Presenting Complaint::\n\nOnset: years, intermittent, flare 10 days ago after heavy bending.\n\nLocation: lower back across both sides, right worse.\n\nAggravators: sitting, driving, lifting.\n\nRelievers: hot shower (~1 hr).\n\nShoulder: ~6 weeks, worse with overhead reach, occasional night pain when rolling.\n\nNo leg radiation, nocturnal pain, bladder/bowel issues.\n\nPrior X‑ray: wear‑and‑tear.\n\nOccupation: concreting 15 yrs.\n\nObjective\n\nExamination: gluteal tightness > lumbar spine.\n\nUpper trapezius tension on right.\n\nPatient reports current pain 6/10 (up to 8/10 weekend).\n\nPain score today: 6/10.\n\nPeak pain score weekend: 8/10.\n\nAssessment\n\nLower back pain likely mechanical related to occupational lifting with gluteal dysfunction.\n\nRight shoulder pain likely overuse/upper trap strain from overhead activity.\n\nPlan\n\nMedications::\n\nBlood pressure tablets.\n\nHip flexor stretch 90 s each side, twice daily.\n\nKeep load close to body when lifting.\n\nFollow‑up in 2 weeks Thursday.\n\nEmail receipt with provider number for health fund claim.\n\nAdvise to take it easy today.","review":76.68421052631578,"saved":95.31578947368422,"clean":false,"effort":12.5,"sig":[["missing","The output notes treatment covered the lower back, glutes and right shoulder","Treatment actually delivered is absent, leaving no legal record of what was done."]],"mb":120.500521,"latency":30.281,"signable":106.96521052631579},{"label":"Run 4","wer":8.503401360544217,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back, mostly. And the right shoulder has been playing up as well.\nOkay, let's start with the back. Whereabouts is it?\nRight across the bottom, both sides. But the right's worse.\nAnd how long's that been going on?\nYears, on and off. It flares up every few months and settles down again. It.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday. I was bent over most of the day.\nThat'll do it. And you're concreting full time?\nYeah, 15 years now.\nOn a scale of one to ten, where's it sitting today?\nProbably a six. It was an eight on the weekend.\nWhat makes it worse,\nsitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins and needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done or seen anyone else about it?\nI had an X ray a few years back. They said it was wear and tear, Nothing to do.\nWorry about.\nRight. And are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay. Now, the shoulder. How long's that been there?\nMaybe six weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, Just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is. Then come up to the right shoulder. Does that sound all right? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off. Will do. Righto. I'll step out while you get comfortable. Face down for me. Head in the cradle and pull the towel up over you. It.\nIt's it.\nHow's that pressure? Yeah, that's good.\nIt. It's. It.\nIt's it.\nOh, that's the spot. Too much? Nah, it's all right.\nThere's.\nIt's it.\nIt's it.\nIt. It's.\nIt, Sam, It.\nIt's it.\nIt's it.\nI'm going to use the massage gun on this one. It's a bit loud. No worries. It. Sam.\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off.\nIt. It's.\nIt. It's it.\nRight, roll onto your back for.\nIt's it.\nIt's it.\nOkay. Sit yourself up slowly. When you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly. The upper trap. So what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, right. O.\nI'd book you back in two weeks. Does it Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.\nIt's it.","marks":[{"start":144,"end":156,"said":"shoulder's","significant":false},{"start":1281,"end":1284,"said":"","significant":false},{"start":1903,"end":1912,"said":"alright","significant":false},{"start":2144,"end":2156,"said":"","significant":false},{"start":2197,"end":2222,"said":"Ooh","significant":false},{"start":2261,"end":2339,"said":"alright.","significant":false},{"start":2415,"end":2423,"said":"","significant":false},{"start":2483,"end":2493,"said":"alright.","significant":false},{"start":2531,"end":2553,"said":"","significant":false},{"start":2586,"end":2603,"said":"me.","significant":false},{"start":2803,"end":2812,"said":"shoulder's","significant":false},{"start":3016,"end":3025,"said":"righto.","significant":false},{"start":3313,"end":3321,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"lower back pain and right shoulder pain.\""],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","Back pain present \"for years on and off\"; shoulder began \"approximately six weeks ago\"."],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 currently and 8/10 over the weekend.\""],["The output notes the patient works in concreting with repeated bending and lifting","partial","Slab-pouring job with prolonged bending and lifting noted, but concreting as his occupation is not stated."],["The output records that radicular symptoms and red flags were denied","yes","\"no leg radiation, numbness, night pain, or bladder/bowel disturbance.\""],["The output notes treatment covered the lower back, glutes and right shoulder","partial","Findings in lower back, glutes and shoulder are described, but the treatment delivered to those areas is not documented."],["The output mentions a hip flexor stretch as home advice","yes","\"hip flexor stretches for 90 seconds each side twice daily.\""],["The output notes a review in two weeks","yes","\"follow-up appointment was scheduled for two weeks later on Thursday.\""]],"claims":[],"note":"Subjective\n\nChief Complaint::\n\nPatient presents with lower back pain and right shoulder pain.\n\nHistory of Presenting Complaint::\n\nThe patient reports lower back pain that has been present for years on and off, flaring up every few months and currently active for about 10 days after a heavy slab‑pouring job that involved prolonged bending. The pain is described as an ache, worsened by sitting, driving to the site in the morning, and activity, and is temporarily relieved by a hot shower for about an hour. There is no leg radiation, numbness, night pain, or bladder/bowel disturbance. The right shoulder pain began approximately six weeks ago, is aggravated by reaching overhead and sometimes wakes the patient when rolling onto it.\n\nObjective\n\nExamination revealed tenderness in the lower back region with tightness noted through the glutes more than the spine itself. The right shoulder examination showed tightness in the upper trapezius.\n\nPain intensity reported as 6/10 currently and 8/10 over the weekend.\n\nAssessment\n\nClinician attributes the lower back pain to mechanical strain from lifting with associated gluteal tightness, and the shoulder pain to involvement of the upper trapezius with overhead activity.\n\nPlan\n\nMedications::\n\nPatient is taking blood pressure tablets.\n\nPatient advised to perform hip flexor stretches for 90 seconds each side twice daily and to keep the load close to the body when lifting.\n\nA follow‑up appointment was scheduled for two weeks later on Thursday, with the receipt to be emailed for health fund claim.","review":106.75,"saved":65.25,"clean":false,"effort":12.5,"sig":[["partial","The output notes treatment covered the lower back, glutes and right shoulder","Hands-on treatment actually delivered (lower back, glutes, shoulder, massage gun) is not recorded, a gap in the legal record of the session."]],"mb":120.3519,"latency":29.135,"signable":135.885},{"label":"Run 5","wer":9.183673469387756,"text":"Morning. Come on through. Take a seat wherever's comfortable.\nThanks.\nSo what's brought you in today?\nIt's my lower back, mostly. And the right shoulder's been playing up as well.\nOkay, let's start with the back. Whereabouts is it?\nRight across the bottom, both sides, but the right's worse.\nAnd how long's that been going on?\nYears, on and off. It flares up every few months and settles down again. It.\nIs this a flare at the moment?\nYeah, started about 10 days ago.\nAnything set it off that you can think of?\nWe poured a big slab on the Thursday. I was bent over most of the day.\nThat'll do it. And you're concreting full time?\nYeah, 15 years now.\nOn a scale of one to ten, where's it sitting today?\nProbably a six. It was an eight on the weekend.\nWhat makes it worse,\nsitting's the worst. Driving to site in the morning, I'm stiff as anything.\nAnd what helps?\nA hot shower helps for about an hour, then it comes back.\nAnything shooting down the leg? Pins and needles, numbness, anything like that?\nNo, nothing like that. It's just an ache.\nAny pain at night that wakes you or any trouble with the bladder or bowels?\nNo, none of that.\nGood. Have you had any imaging done or seen anyone else about it?\nI had an X ray a few years back. They said it was wear and tear, Nothing to do.\nWorry about.\nRight. And are you on any medications or any other health conditions I should know about?\nJust blood pressure tablets. Nothing else.\nOkay. Now, the shoulder. How long's that been there?\nMaybe six weeks. It's worse when I'm reaching overhead.\nDoes it wake you if you roll onto it?\nSometimes, yeah.\nAnd what would you like to get out of today?\nHonestly, Just to get through a work week without it seizing up.\nThat's fair. Here's what I'd suggest. I'll work through the lower back and the glutes because with the lifting, that's usually where the load is. Then come up to the right shoulder. Does that sound all right? Yeah, sounds good. It can be a bit tender in spots. Sing out if anything's too much and I'll back off. Will do. Ryder. I'll step out while you get comfortable. Face down for me. Head in the cradle and pull the towel up over you. It.\nIt's it.\nHow's that pressure? Yeah, that's good.\nIt. It's it.\nIt. It's. It.\nIt's it.\nOh, that's the spot. Too much? Nah, it's all right.\nThat. It's. It.\nIt's it.\nIt's it.\nIt. It's it.\nIt, Sam, It.\nIt's it.\nIt's it.\nI'm going to use the massage gun on this one. It's a bit loud. No worries.\nIs the pain okay? Yeah, that's fine. Bit intense, but it's all right. Sing out if you want me to back off. It.\nIt's it.\nIt. It's it.\nRight, roll onto your back for.\nIt's it.\nIt's it.\nOkay. Sit yourself up slowly. When you're ready. That feels a lot looser. Good. The lower back was tight through the glutes more than the spine itself, which is what I'd expect with the lifting. The shoulders, mostly. The upper trap. So what should I be doing at home?\nTwo things. Hip flexor stretch, 90 seconds each side, twice a day. And when you're lifting, get the load closer to you before you stand.\nYeah, right. O.\nI'd book you back in two weeks. Does it Thursday suit?\nThursday's fine. Do I get something for the health fund?\nI'll email the receipt through with the provider number on it. You can claim it straight from that.\nPerfect. Thanks very much.\nNo worries. Take it easy for the rest of today.\nIt's it.","marks":[{"start":1279,"end":1282,"said":"","significant":false},{"start":1901,"end":1910,"said":"alright","significant":false},{"start":2024,"end":2030,"said":"Righto.","significant":false},{"start":2141,"end":2153,"said":"","significant":false},{"start":2194,"end":2232,"said":"Ooh","significant":false},{"start":2271,"end":2359,"said":"alright.","significant":false},{"start":2494,"end":2504,"said":"alright.","significant":false},{"start":2542,"end":2567,"said":"","significant":false},{"start":2600,"end":2617,"said":"me.","significant":false},{"start":2817,"end":2826,"said":"shoulder's","significant":false},{"start":3030,"end":3039,"said":"righto.","significant":false},{"start":3327,"end":3335,"said":"","significant":false}],"facts":[["The output states the presenting complaint is lower back pain and right shoulder pain","yes","\"Lower back pain and right shoulder discomfort.\""],["The output states the back pain is longstanding and the shoulder pain is about six weeks old","yes","\"Onset: years, intermittent\"; \"right shoulder pain ~6 weeks.\""],["The output records pain as six out of ten today, eight at worst on the weekend","yes","\"6/10 currently (was 8/10 weekend).\""],["The output notes the patient works in concreting with repeated bending and lifting","yes","\"heavy concrete work (bending)\" and \"occupational lifting.\""],["The output records that radicular symptoms and red flags were denied","yes","\"No radiculopathy, night pain, bladder/bowel issues.\""],["The output notes treatment covered the lower back, glutes and right shoulder","no","Treatment delivered to lower back, glutes and shoulder is not documented."],["The output mentions a hip flexor stretch as home advice","yes","\"Hip flexor stretch 90s each side, twice daily.\""],["The output notes a review in two weeks","yes","\"Follow-up in 2 weeks Thursday.\""]],"claims":[["relieving: hot shower ~1h, rest","Only a hot shower was reported to help; rest as a relieving factor is not mentioned."]],"note":"Subjective\n\nChief Complaint::\n\nLower back pain and right shoulder discomfort.\n\nHistory of Presenting Complaint::\n\nOnset: years, intermittent, flare 10 days after heavy concrete work (bending).\n\nLocation: lower back bilateral, right worse; right shoulder pain ~6 weeks, worse with overhead reach.\n\nAggravating: sitting, driving, lifting; relieving: hot shower ~1h, rest.\n\nNo radiculopathy, night pain, bladder/bowel issues.\n\nObjective\n\nTenderness lower back with gluteal tightness > spine; upper trapezius tension on right shoulder.\n\nPain intensity 6/10 currently (was 8/10 weekend).\n\nAssessment\n\nMechanical low back pain secondary to occupational lifting with gluteal tightness.\n\nRight shoulder strain involving upper trapezius.\n\nPlan\n\nMedications::\n\nBlood pressure tablets.\n\nHip flexor stretch 90s each side, twice daily.\n\nKeep load close to body when lifting.\n\nFollow‑up in 2 weeks Thursday.\n\nEmail receipt with provider number for health fund claim.","review":76.6842105263158,"saved":95.3157894736842,"clean":false,"effort":31.25,"sig":[["missing","The output notes treatment covered the lower back, glutes and right shoulder","Treatment delivered in session is not documented at all, a gap in the legal record of the session."]],"mb":122.042069,"latency":32.212,"signable":108.8962105263158}]}}]}