Nurse Pat

Hello, this is Patricia, a digital nurse from pristeen Health System. I'm calling based on a referral from Doctor Samuel Johnson. We recently sent an email with the subject line 'Upcoming screening for your healthcare appointment,' and I'm following up on that. You can verify that I am legitimate by scrolling to the Unique code for you in that email listed as 1-0-M-N-A-Z. I repeat - the unique code in the email sent to you is 1-0-M-N-A-Z. Should I wait for you to open the email and verify the code, or are you okay for me to proceed?

You can go ahead.

Thank you. My job today is to take some notes about your health and pass them along to the nursing team, which is led by Nancy Cobblestone. A member of Nancy's team will review the information I collect and will call you back with a final plan for your surgery. At the end of our discussion, I will also set up some time for you to chat with a nurse. At any point, you may ask me to work with you so you can handle interruptions. I can hold on the line, call you back and pick up where we left off and more. First, can I confirm I'm speaking with Charlotte or an authorized healthcare delegate for her?

Yep. This is Charlotte.

Thank you. This will be a 15 to 20-minute, confidential, and important conversation. Since we will be chatting about your medical information, you may want to make sure you are in a private place and not on speakerphone. Do I have your consent to proceed?

Great. Pristeen Health is committed to patient safety, and we want to make sure that you are well prepared for your procedure coming up in a few weeks. According to Doctor Samuel Johnson, the procedure will require you to undergo general anesthesia, and for your safety, I need to gather some information to make sure that we provide the right care. I will have a quick touch base on your daily activities, reconfirm the medications you are taking, discuss your respiratory health, and get some previous medical history. One quick thing - I will try to make this conversation a bit lighter by telling jokes or asking about your interests. It’s my way of showing I'm a friendly digital assistant—or at least I'm just trying to be funny, Charlotte. You don't have to go along with any of the chit-chat - just tell me if you want me to skip it. May I proceed and get to the first step of today's call?

Şort.

To understand your current physical fitness and the demands you place on your body regularly, which helps us assess your heart and lung function under stress, I have one general question about your activity level that I will use to guide further conversation. How often do you engage in activities that require moderate effort, such as brisk walking, running, cycling, weight lifting, swimming or competitive sports?

I would say about three, four times a week.

You know what, we are well on our way to getting you prepared for this procedure. I am going to shift my focus to your medication history. Charlotte, aside from any daily vitamins, what medications are you on today?

I do take a pill, but I can't remember what it is.

I understand. It can be hard to remember all the details. Do you have the pill bottle with you so you can read the name? Or, if not,

You know, I don't have it. It's elsewhere.

No problem at all, Charlotte. We can make a note of that for the nursing team. Our records indicate that you may also have a prescription for apixaban. Are you currently taking it?

Oh yes ayo

Gotcha, Charlotte. Thank you for that information. Charlotte, I know this is some serious stuff. I thought I would chit chat about something that has no impact on your clinical care. Are you a cat person or a dog person?

Neither.

I see, thank you for sharing. That's wonderful to hear. I do need to get back to getting your history. Pristeen Health wants to make sure that you are prepared for surgery, so I am going to be a good digital nurse and get that done. Charlotte, I am going to ask you a few questions so we can make sure that we schedule your surgery at the right venue with the right equipment. Have you ever had a problem with anesthesia, like being hard to wake up or hard to breathe for?

Okay. Can you open your mouth wide enough to fit three of your own fingers stacked up and down?

Yes.

Okay. Do you have any loose teeth, chipped teeth, or caps or crowns?

Okay. Can you touch your chin to your chest and look all the way up at the ceiling without pain?

Yes.

Thank you. I just want to quickly confirm what I've noted down. You have not had a problem with anesthesia in the past, you can open your mouth wide enough for three fingers, you do not have any loose teeth, chipped teeth, or caps or crowns, and you have full neck mobility without pain. Is that all correct?

Actually, I wanna change one of the answers. I have one slightly chipped front tooth.

My apologies. Let me correct that. Just to be sure, I want to summarize one more time. You have not had a problem with anesthesia in the past, you can open your mouth wide enough for three fingers, you do have one slightly chipped front tooth, and you have full neck mobility without pain. Is that correct now?

Yes.

Okay - let us move on to questions around sleep patterns. This helps us understand your breathing while you sleep. I am trying to determine if your neck size necessitates us to make some adjustments on our end. One way to understand this is to know if you wear shirt collars size 17 or bigger. Is that true?

No. I don't have that bigger color.

Gotcha. Have you ever had radiation or surgery on your

No.

Okay. Do you snore loudly?

I don't think so.

Uhuh. Do you often feel tired, fatigued, or sleepy during

Okay. Has anyone observed you stop breathing, or choking or

Okay. Do you have or are you being treated for high blood pressure?

No.

Thank you for that. Just to be sure I have everything right, I've noted that you do not wear a shirt collar size 17 or bigger, you have not had radiation or surgery on your neck, you do not think you snore loudly, you do not often feel tired or fatigued during the daytime, no one has observed you stop breathing in your sleep, and you do not have high blood pressure. Is that correct?

Yes.

I need to ask about some lifestyle factors—like smoking,

You said you would ask me you tell me a joke. Can you tell me a joke?

Of course, Charlotte. I'd be happy to. Why don't scientists trust atoms? Because they make up everything. Okay, I do need to get back to the questionnaire.

I'm glad you liked it. Now, to get back to it. I need to ask about some lifestyle factors—like smoking, alcohol use, and recreational drug use. These details are incredibly important because they can significantly impact how your body responds to anesthesia, the surgery itself, and your subsequent

I'll make it very short. I do not smoke. I do not drink alcohol, and I have never done and never will do recreational drugs.

Gotcha. Thank you for being so direct. Thank you for sharing that. Just to make sure I have it all correct, I've noted the following: For smoking, I heard you say that you do not smoke. For alcohol, you said you do not drink. And for other substances, I have that you have never used and will not use recreational drugs. Is that all correct?

Yap.

I am now going to quickly review your chart and go through a few body systems such as your heart, your lungs and so on. If I find specific events from your medical history that are relevant, I will dive deeper. If I find no medical history in a relevant area, I will ask you to reconfirm. For example, I might say, 'My records show you do not have any history of some kind of disease. I will then ask you to confirm or correct me' You will see more about how I work once I get going. Does that sound like a plan?

Now on to cardiology. I did some research on your health records and it shows no documented conditions related to your heart or cardiovascular system, such as Coronary Artery Disease, or C-A-D, Congestive Heart Failure, or C-H-F, a history of Heart Attack, or significant Arrhythmias like A-Fib. I want to make sure I am correct.

That is correct.

Okay, your cardiology history is done. Now I will move to the next body system. Moving on to hematology and oncology. Hey Charlotte, my records show no history of blood disorders or cancer. If this is the latest status and you have no new information to share on your hematology and cancer related issues, let me know and I will jump ahead.

Ok, your hematology and oncology history is done. Now moving to the next body system. Ok Charlotte, we are making good progress here. I also looked at your file to see if I could find any documented conditions related to your neurological system, such as seizures or Epilepsy, Stroke or a T-I-A, Parkinson's Disease, or Multiple Sclerosis. It does not appear that you have any documented history. I want to make sure I am correct.

Я!

We got that done. Let us keep going. And now we will chat about your endocrine health. The endocrine system disorders are those such as Diabetes, which is high blood sugar, or Thyroid Disease, like hypothyroidism or hyperthyroidism. I did not find any past history. Charlotte, I want to make sure I am correct. Will you please say let me know if I can skip asking more questions in this area or whether you have any updates?

You can skip.

Thanks Charlotte. We are getting there — we will be done soon, I promise! Charlotte, we are on the home stretch. We have three more body systems to review, Liver, Kidney and lung. Thank you for staying with me. Now, we need to focus specifically on your liver health. This is a crucial topic because the liver is responsible for breaking down almost all anesthetic drugs. Looking at your liver health history, my records show a history of Hepatitis B with no viral load, diagnosed in December 2015 by Doctor Michael Fitzgerald. If this is the latest status on your liver health and you have no new information, let me know. You may say,

I do have I do have some updates there.

Okay, thank you for letting me know. Just to be sure I have all the details, I'll ask a few more specific questions about that. What is the specific diagnosis of your liver disease? For example, Cirrhosis, Hepatitis C, Autoimmune Hepatitis, or Non-Alcoholic Steatohepatitis, also known as N-A-S-H?

Now the diagnosis is still hepatitis b. You have that. But I continue to get annual blood tests, and there is no viral load, not just in 2015, but every year moving forward from there.

Gotcha. Thank you for that clarification. Have you ever been told you have cirrhosis, which is scarring of the liver?

Okay. Do you currently experience jaundice, which is a yellowing of the skin or eyes?

No.

Okay. Have you had any bleeding problems related to your liver disease, like bleeding

Okay. Do you ever experience significant confusion or

No.

Okay. Do you have a history of ascites, which is fluid build-up in

No.

Who is the doctor primarily managing your liver condition? That would be your Hepatologist or Gastroenterologist.

I don't see a hepatologist or a gastroenterologist. I see doctor Michael Fitzgerald, who is a primary care physician. And as long as the viral load is zero, I don't treat it anymore.

Thank you for that information, Charlotte. That was a lot of details - thank you Charlotte. We have just two more body system to go, and then we are done with the medical history, I promise! Charlotte, now on to your Kidney History. This is essential because the kidneys are vital for filtering waste products from your blood, balancing fluids, and eliminating many anesthetic and pain medications. Kidney dysfunction can lead to medication accumulation and electrolyte imbalances. Charlotte, am I correct that you do not have any documented conditions related to your kidneys, such as Chronic Kidney Disease, or C-K-D, a need for Dialysis, Kidney Transplants, or a history of Acute Kidney Injury, or A-K-I?

That would be correct.

Thank you again. This information helps the anesthesia team safely select medications and manage your fluids and electrolytes throughout your hospital stay. You made it - we are in the last body system. Hang tight... Now we need to cover your Pulmonary, or Lung History. Lung health is essential because a healthy respiratory system is necessary to keep your blood oxygenated, especially when you are under anesthesia. Charlotte, with respect to your lungs or breathing medical history, I did not find anything such as Asthma, Chronic Obstructive Pulmonary Disease, or C-O-P-D, which includes Chronic Bronchitis or Emphysema, a history of a Pulmonary Embolism, or P-E, which is a blood clot in the lung, or a need for continuous Supplemental Oxygen. Does that sound right? Say you

Yep.

Alright - that was a lot of work. We are now finished with the medical history review, and we're on the final step. Woo-hoo Charlotte, I am thrilled that we are here. I have collected all the information and the only step that remains is booking time with Nancy's team. I will send Nancy my summary so they can come prepared to only ask you about follow up questions to our call. Let's get the call with Nancy's team scheduled. And I almost forgot - if you hang on after the meeting is scheduled, I have a very special gift for you as a thank you. What day and time work best for you in the next few days to speak with the nurse?

How about Tuesday at 10AM?

Perfect. I have you scheduled for a call back from the nursing team on Tuesday at ten a.m. Is that correct?

Yes.

Now for that special thank you I mentioned. I'd like to teach you how to say 'hello' in five different languages I know. Would you be

No. I'm good. Anything else?

Of course, no problem at all. Thank you for your time today, Charlotte. The nursing team will be in touch soon. Have a great day.