Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-06-03 Encounter: Spruce text message followed by in-person office visit (June 4) CC: Worsening cough with wheezy breathing sounds, disrupted sleep and eating, and periods of faster respirations. HPI: Elsie, approximately 7 months old, had a cough that had progressed since her prior illness in mid-May. On the evening of June 3, the parent described a heavy cough with wheezy (non-high-pitched) breathing sounds that were disrupting sleep and eating. Overnight into June 4, the parent noted shorter, quicker, stronger breaths without nasal congestion or active wheezing while sleeping; she did not feel warm. Respiratory rate was measured at 32 breaths per minute overnight, then rose to the mid-50s later that night. She vomited once from coughing but did not repeat this. The parent kept her home from daycare on June 4. She had been seen in office on June 4 for a lung exam. By June 5–6, symptoms were improving: coughing became rare, congestion was lessening, energy and color had returned, sleep was better, though appetite remained slightly reduced. Assessment: Viral lower respiratory illness (consistent with a cold/bronchiolitis picture) in a young infant. Respiratory rate of 32 was reassuring and normal for a cold; mid-50s breathing was noted but resolved. Lung exam performed in office on June 4. Clinical trajectory was as expected, with gradual improvement over several days. Plan: Parent instructed to count respiratory rate (measured 32 bpm, deemed normal). In-person office visit on June 4 at 12:45pm for lung auscultation. Dr. Hobbs followed up on June 5 to check on progress. Parent offered return visit on June 6 but did not attend due to timing; provided update via message. Dr. Hobbs confirmed clinical trajectory was on track and cleared mother to travel for work. No medications prescribed. Key clinical quotes: "great, totally normal for a cold" "And don't expect them to sound great. It will be many days before she sounds like herself again" "That all sounds great! Totally on track and acting as expected" Source: Spruce conversation t_2JKAFP7F8NO00