Expand CCS patient history
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@@ -13,17 +13,20 @@
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"experienceMode": "graphical_interview",
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"graphicalPresentation": {
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"sceneKey": "doctor_office",
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"patientAssetKey": "patient_44_white_male"
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"patientAssetKey": "patient_44_white_male",
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"interviewRevision": 2
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},
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"initialChart": {
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"patientSummary": "44-year-old man attending an office visit",
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"reasonForEncounter": "The reason for the visit has not yet been elicited.",
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"appearance": "He is seated comfortably, attentive, and in no acute distress.",
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"history": "Several weeks of intermittent lightheadedness and fatigue accompany sleep-disrupting, gnawing epigastric discomfort that is worse on an empty stomach and temporarily relieved by food or antacids. He has no symptoms of gastrointestinal bleeding or other alarm features.",
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"history": "Several weeks of intermittent lightheadedness and fatigue accompany three weeks of sleep-disrupting, burning epigastric discomfort rated 4/10. Food and antacids provide temporary relief. He reports belching, fullness, and occasional black stool without frank blood. He has hyperlipidemia and no recent sick contacts, travel, or antibiotic use.",
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"historySections": [
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{ "code": "chief_concern", "title": "Chief concern", "text": "Intermittent lightheadedness and fatigue for several weeks." },
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{ "code": "abdominal_symptoms", "title": "Abdominal symptoms", "text": "Gnawing epigastric discomfort occurs when his stomach is empty and at night, and improves temporarily after food or antacids." },
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{ "code": "alarm_features", "title": "Alarm features", "text": "No melena, hematemesis, persistent vomiting, dysphagia, unintentional weight loss, or syncope." }
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{ "code": "abdominal_symptoms", "title": "Abdominal symptoms", "text": "Burning, non-radiating epigastric discomfort has been present for three weeks, is rated 4/10, is unaffected by position or movement, and improves temporarily after food or antacids." },
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{ "code": "associated_symptoms", "title": "Associated symptoms", "text": "Belching, fullness, sleep disruption, and occasional black stool without frank blood." },
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{ "code": "past_medical_history", "title": "Past medical history", "text": "Hyperlipidemia" },
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{ "code": "exposure_history", "title": "Exposure history", "text": "No recent sick contacts, travel, or antibiotic use." }
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],
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"vitals": {
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"temperature": "36.8 C (98.2 F)",
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@@ -56,17 +59,53 @@
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{
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"id": "fatigue_course",
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"clinicianText": "How has the fatigue affected you, and how have you been sleeping and eating?",
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"patientText": "My energy is down by the afternoon, even on days when I sleep normally. I have not noticed fever, shortness of breath, chest pain, or a major change in my appetite.",
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"patientText": "My energy is down by the afternoon. My appetite is about the same, but lately a burning discomfort high in my abdomen sometimes wakes me at night.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "abdominal_character",
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"clinicianText": "Tell me more about the abdominal discomfort—where is it, what does it feel like, and how long has it been happening?",
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"patientText": "It started about three weeks ago. It is a burning pain in the upper middle part of my abdomen. It does not spread anywhere, I would rate it about a four out of ten, and changing position or moving does not make it better or worse.",
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"required": true,
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"prerequisiteTopicIds": ["fatigue_course"]
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},
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{
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"id": "relieving_factors",
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"clinicianText": "Does anything make the discomfort better or worse?",
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"patientText": "Eating usually settles it for a while, and antacids help too. Position and movement do not seem to change it.",
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"required": true,
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"prerequisiteTopicIds": ["abdominal_character"]
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},
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{
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"id": "associated_gi",
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"clinicianText": "Have you noticed belching, fullness, vomiting, or any blood or change in the color of your stool?",
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"patientText": "I have been belching more and sometimes feel unusually full. I have not vomited or seen red blood, but my stool has looked black on occasion.",
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"required": true,
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"prerequisiteTopicIds": ["abdominal_character"]
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},
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{
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"id": "exposure_history",
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"clinicianText": "Have you had any sick contacts, recent travel, or antibiotic use?",
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"patientText": "No. I have not been around anyone sick, traveled recently, or taken antibiotics.",
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"required": true,
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"prerequisiteTopicIds": ["abdominal_character"]
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},
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{
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"id": "past_medical_history",
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"clinicianText": "Do you have any past medical conditions?",
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"patientText": "I have hyperlipidemia.",
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"required": false,
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"prerequisiteTopicIds": ["chief_concern"]
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}
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],
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"debrief": {
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"likelyDiagnosis": "Lightheadedness and fatigue requiring further evaluation",
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"summary": "The focused opening interview identifies intermittent orthostatic lightheadedness without vertigo or syncope and several weeks of nonspecific fatigue. Additional clinical assessment would be needed before assigning a diagnosis.",
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"likelyDiagnosis": "Peptic ulcer disease with possible intermittent upper gastrointestinal bleeding",
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"summary": "The history identifies orthostatic lightheadedness and fatigue accompanying burning epigastric pain relieved by food and antacids, with occasional black stool concerning for intermittent upper gastrointestinal bleeding.",
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"teachingPoints": [
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"Clarify whether dizziness is vertigo, presyncope, or disequilibrium and screen for neurologic and cardiac warning symptoms.",
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"Characterize the timing and functional impact of fatigue and ask about sleep, intake, and associated systemic symptoms."
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"Characterize epigastric pain by timing, quality, severity, radiation, triggers, and relieving factors.",
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"Ask specifically about melena or hematemesis because occult or intermittent bleeding can present with fatigue and lightheadedness."
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]
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}
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},
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@@ -77,7 +116,11 @@
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"scoringCriteria": [
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{ "id": "elicit_chief_concern", "title": "Elicit the chief concern", "actionType": "dialogue_choice", "targetCode": "chief_concern", "points": 10, "rationale": "An open-ended opening allows the patient to identify lightheadedness and fatigue in his own words." },
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{ "id": "characterize_dizziness", "title": "Characterize the dizziness", "actionType": "dialogue_choice", "targetCode": "dizziness_character", "points": 15, "rationale": "Distinguishing presyncope from vertigo and screening for neurologic and cardiac warning symptoms focuses the differential." },
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{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "The course and associated symptoms help characterize the nonspecific fatigue." }
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{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "The course and associated symptoms help characterize the nonspecific fatigue." },
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{ "id": "characterize_abdominal_pain", "title": "Characterize the abdominal discomfort", "actionType": "dialogue_choice", "targetCode": "abdominal_character", "points": 15, "rationale": "Location, quality, duration, severity, and radiation help characterize the source of pain." },
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{ "id": "identify_relief", "title": "Identify relieving and aggravating factors", "actionType": "dialogue_choice", "targetCode": "relieving_factors", "points": 10, "rationale": "Temporary relief with food or antacids supports an acid-related pattern." },
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{ "id": "screen_gi_bleeding", "title": "Screen for gastrointestinal bleeding", "actionType": "dialogue_choice", "targetCode": "associated_gi", "points": 15, "rationale": "Occasional black stool may represent melena and requires recognition." },
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{ "id": "review_exposures", "title": "Review relevant exposures", "actionType": "dialogue_choice", "targetCode": "exposure_history", "points": 5, "rationale": "Recent illness, travel, and antibiotic exposure help refine the gastrointestinal differential." }
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],
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"references": [
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{
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