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{"ops":[{"insert":"You ask Duncan if he feels breathless when exercising. He responds that he doesn\u0027t really exercise, but that he does feel breathless after walking several blocks, or if he tries to walk briskly. You ask if he feels breathless when performing his activities of daily living, to which he responds in the negative.\n\nYou also ask Duncan if he\u0027s experienced any chest pain or discomfort, or any other symptoms at all \u2013 no matter how small. After some thought, he says \u0022no\u0022.\n\nInquiring about his family and social history, you find out that Duncan\u0027s father died of a \u0022heart attack\u0022 at age 60. His family history is unremarkable otherwise. Duncan smoked for a short time in his early youth, but stopped afterwards. He only drinks socially. He is divorced and lives alone. He has one adult child, a son who lives on the opposite side of the country.\n\nYou gently ask why he suddenly stopped going to his old cardiology clinic. He looks vaguely embarrassed and mumbles, \u0022well, my insurance co-pay was just too much, doctor.\u0022\n\nYou feel grim. This is a sad story you\u0027ve heard just too many times.\n"}]}