CONTACTS
0201 - Kaiser Permanente
020101 - Dr. Vincent E. Yamamoto, M.D.; Orthopedic Surgon
020102 - Orthopedic Department
SUBJECTS
Knee Examination re MRI Right Knee
Multiple Medical Charts for Each Facility
Patient Communication Omitted from Medical Chart
Medical Chart Missing Information
1406 -
1406 - ..
1407 - Summary/Objective
1408 -
140801 - Follow up ref SDS 71 0000, ref SDS 70 0000.
140802 -
140803 - Vincent confirmed Craig's recommentation that an MRI is not useful for
140804 - the right knee. ref SDS 0 2860 He identified possible causes of pain
140805 - in the right knee due to arthritis. ref SDS 0 2860 The right knee can
140806 - become painful from compensating for loss of capability in the damaged
140807 - left knee. The doctor indicated knee replacement surgery will likely
140808 - be needed within 5 years. ref SDS 0 HU5O He suggested shoes and
140809 - training methods that reduce stress and loss of cartilage which cause
140810 - pain in knee and ankle joints. Vincent is taking Glucosamine and
140811 - Chrodroitin. He reports success for himself and patients, but no
140812 - evidence of restoring lost cartilage. ref SDS 0 1680 Vincent will
140813 - submit recommended specifications for shoes that minimize stress
140814 - during tennis and other high stress activity. ref SDS 0 4160
140815 -
140816 - [On 000226 submitted letter to Vincent. ref SDS 73 0001]
140817 -
140819 - ..
1409 -
1410 -
1411 - Discussion
141201 - ..
141202 - Medical Chart Omits Communication from Patient
141203 -
141204 - Met with Doctor Vincent Yamamoto in Kaiser Orthopedic Department.
141205 -
141206 - We reviewed the medical chart, as called out in Kaiser's Healthwise
141207 - Handbook, reported on 990625. ref SDS 13 0794
141209 - ..
141210 - Jeanne's letter on 000120, ref DRP 8 0001, and received on 000121,
141211 - ref SDS 71 0863, was in the medical chart record, and Vincent had
141212 - reviewed her letter.
141214 - ..
141215 - There were no communications in the record from the patient on the
141216 - purpose of the meeting, as listed in the record on 000121. ref SDS 71
141217 - 0863 This appears to conflict with Jeannie's report that the medical
141218 - chart is automatically provided to the attending physician, and so
141219 - would be in this case. ref SDS 71 0001
141220 -
141221 - [below, this may indicate multiple medical charts are being used.
141222 - ref SDS 0 2065]
141224 - ..
141225 - Vincint advised that communication from patients is not included in
141226 - Kaiser's medical chart record that is reviewed by the doctor. He
141227 - explained that some patients have threatened doctors, and as a result
141228 - Kaiser has a policy of not providing communication from patients in
141229 - the record of medical history for review by doctors.
141230 -
141231 - [...today an article reports treatment is witheld for reasons of
141232 - adverse personality. ref SDS 72 0001]
141234 - ..
141235 - [On 050311 doctors have difficulty with communication and
141236 - collaboration among themselves preparing timely reports,
141237 - distribution, review, and feedback. ref SDS 77 PB8N
141239 - ..
141240 - This aligns with the record on 990816 that revealed a lot of missing
141241 - information in the Medical Chart. ref SDS 21 2601
141243 - ..
141244 - The policy of shielding doctors from communication with the patient
141245 - conflicts with Kaiser's Healthwise Handbook that calls for patients to
141246 - submit medical history, including symptoms, to doctors, reported on
141247 - 990625. ref SDS 13 5740
141248 -
141249 - 1. What happens to this history if it is not reviewed by the
141250 - doctor and incorporated into the record?
141252 - ..
141253 - 2. Why submit information, if it is not reviewed by the doctor?
141255 - ..
141256 - 3. Who reviews the record, and how is critical information passed
141257 - forward to the doctor?
141259 - ..
141260 - 4. Who has reviewed the Welch record, and where is the record of
141261 - follow up action?
141263 - ..
141264 - Vincint advised that patient communication is maintained by Kaiser's
141265 - administrative staff. He is not sure where, because it is witheld
141266 - from doctors.
141268 - ..
141269 - He said patients can request inclusion of patient communication in the
141270 - Medical Chart in order to ensure the doctor sees information on
141271 - medical history.
141273 - ..
141274 - Vincint will include an explanation of this policy in his letter on
141275 - our meeting today.
141276 -
141277 -
141279 - ..
141280 - Multiple Medical Charts Confuse Physicians under Team Care
141281 -
141282 - We discussed the meeting with Christy in Physical Therapy on 990816,
141283 - that showed the report on 8 new therapies was included in the Medical
141284 - Chart, along with a number of patient communications, called "SDS
141285 - records." ref SDS 21 2601
141287 - ..
141288 - However, this medical chart was not submitted for the meeting with
141289 - Craig on 990910, and so the objective of meeting to obtain an opinion
141290 - on the 8 new therapies, was not accomplished. ref SDS 23 3038 and
141291 - ref SDS 23 7802
141293 - ..
141294 - Vincint recalled the article on 8 new therapies that came to his
141295 - attention from another patient. He said it was very helpful for due
141296 - diligence that patients and doctors have a comprehensive checklist of
141297 - issues to consider in evaluating treatment choices. This aligns with
141298 - Doctor Sylvia Connolly's recommendation to obtain expert opinion on
141299 - application of these 8 new therapies in the Welch case, during the
141300 - meeting on 990625. ref SDS 13 5400 At that time, review of Kaiser's
141301 - Healthwise Handbook found a comprehensive checklist for communication
141302 - that makes the doctor/patient partnership effective. ref SDS 13 0806
141304 - ..
141305 - The fact that the medical chart at Park Shadelands has a lot of
141306 - information that is not contained in the chart Vincent showed today,
141307 - per above, ref SDS 0 3862, suggests there are multiple medical charts,
141308 - each with a different body of information.
141310 - ..
141311 - Who is responsible for reviewing the record and coordinating to ensure
141312 - that each doctor sees needed information for effective Team Care. Who
141313 - reviews for conflicting information?
141315 - ..
141316 - Jeanne is the Site Coordinator, and so may be involved in this
141317 - process. She reported on 000121 that Kaiser will roll out in late
141318 - 2001 a technology solution. ref SDS 71 7654 She directly coordinated
141319 - the medical chart issue to help Doctor Yamamoto, yet the complexity of
141320 - the process caused another failure. ref SDS 0 3862
141321 -
141322 - [On 000207 submitted letter on this. ref SDS 73 0004]
141323 -
141324 -
141325 -
1414 -
SUBJECTS
Knee Examination re MRI Right Knee
Therapies - 8 New Proceddures
Xrays on Knees, 990910
Shoes Special Soles Relieve Stress on Knee Joints
Strength Relieves Stress on Knee Joints
Right Knee Arthritic
Compensatory Pain Due to Left Knee Injury
2209 -
221001 - ..
221002 - MRI Not Required Absent Specific Acute Injury
221003 - Xray Shows Right Knee Suffers General Arthritis
221004 - Compensatory and Cartilage Wear Causes Pain in Right Knee
221005 -
221006 - Vincint clarified evaluation of xray issues for right knee.
221007 -
221008 - He identified defects in the cartilage of the right knee by measuring
221009 - a 7 millimeter cartilage separation on one side and a 5 millmeter gap
221010 - on the other side of a slight ridge in the lower bone. Vincent noted
221011 - that a 1 millimeter difference in these measurements is normal, but
221012 - the additional millmeter establishes cartilage deterioriation in the
221013 - right knee, i.e., arthritis, which contributes to pain during heavy
221014 - physical activity.
221016 - ..
221017 - Vincent advised that an MRI would disclose spot loss of material in
221018 - the center of the cartilage mass, that is not evident to normal xray,
221019 - and which can be repaired in some cases by injection treatments,
221020 - and/or replacement therapies, cited in the record on 990625, leading
221021 - to the examination on 990910. ref SDS 23 7802
221023 - ..
221024 - Vincent explained the right knee assumes a greater load than the left
221025 - knee in order to compensate for injury to the left knee. He had me
221026 - walk down the hall, and reported observing a distinct favoring of the
221027 - right knee, even though there is no mental awarensss of compensation.
221029 - ..
221030 - In strenuous activity for example running, tennis, etc., this
221031 - compensation burden on the right knee causes pain, in combination with
221032 - the evident cartilage loss reported today.
221034 - ..
221035 - Under these conditions, Vincent feels an MRI is not needed, confirming
221036 - Craig's report on 991028. ref SDS 33 5820
221037 -
221038 -
221040 - ..
221041 - Left Knee Prognosis Replacement Surgery in 5 Years
221042 -
221043 - The doctor said that after 2 surgeries (1974, 1988), and now
221044 - continuing pain from tennis and running, left knee replacement surgery
221045 - will likely be needed in 5 years. He feels this might be stretched
221046 - out with remedial measures, including Glucosamine Chondroitin
221047 - explained below. ref SDS 0 1680
221048 -
221049 -
221051 - ..
221052 - Cross Training Shoes, Biking, Circular Exercise for Knees, Strength
221053 -
221054 - Vincint says he wears cross-training shoes for tennis because they
221055 - have greater cushioning in the sole than regular tennis shoes. He
221056 - advised that increased cushioning in shoes for tennis reduces strain
221057 - on knees and so helps slow down the natural wear and loss of
221058 - cartilage.
221060 - ..
221061 - Vincint will submit suggestions on athletic shoes to minmize stress,
221062 - in his report and indicate the style or vendor that might be
221063 - considered.
221065 - ..
221066 - He recommends against a vertical stair master type exercise, because
221067 - it places a lot of stress on the knee joint.
221069 - ..
221070 - Biking, stationary bikes, or other circular motion exercise, is
221071 - recommended to build strength and maintain motion in the knee joint.
221073 - ..
221074 - Vincint confirmed Christy's suggestion on 990816 to build strength in
221075 - the leg muscles to further reduce stress on the knee joint.
221076 - ref SDS 21 5612
221077 -
221078 -
221079 -
221080 -
2211 -
SUBJECTS
Glucosamine Chondroitin
Rosacia, 940624
2404 -
240501 - ..
240502 - Glucosamine, Chrondroitin Treatment Follow Vendors Instructions
240503 -
240504 - Follow up ref SDS 71 1680, ref SDS 28 3040.
240505 -
240506 - Vincent advised that he has been taking Glucosamine and Chondroitin
240507 - for about 2 years and reports it has helped him alot. He, also, has
240508 - patients who take this treatment. Vincent recommends treatment
240509 - according to the vendors recommendations, as set out in Jeanne's
240510 - letter on 000121. ref SDS 71 1680
240512 - ..
240513 - We reviewed reports in the Medical Letter submitted to Craig that,
240514 - seem to relate cartilage growth. ref SDS 33 2596
240516 - ..
240517 - Vincent advised that he has not seen any evidence of cartilage
240518 - restoration. He is not familiar with the Medical Letter.
240520 - ..
240521 - We did not review today the duration for taking 3 pills a day spread
240522 - out at approximate each meal time. The record so far suggests this
240523 - is a continuous regimine, that lasts for life, rather than a process
240524 - that completes a particular mission.
240526 - ..
240527 - Need opinion on problems taking Glucosamine and Chrondroitin in
240528 - combination with Tetracycline medication for rosacea, prescribed by
240529 - Doctor Kory Zipperstein on 940624, ref SDS 5 0001, and received in the
240530 - record on 940628. ref SDS 6 0877
240532 - ..
240533 - What experience does Kaiser have on this issue?
240535 - ..
240536 - We did not have time to review this issue today. It probably needs
240537 - consideration to avoid adverse impacts.
240539 - ..
240540 - Glucosamine and Chrondroitin are taken 3 times a day during meals, as
240541 - reported on 991011, ref SDS 29 9702, while rosacea treatment is taken
240542 - 2 - 4 times a day on an empty stomache, as shown on 940628.
240543 - ref SDS 6 6016 Does this relieve or compound any conflict, if a
240544 - conflict exists?
240545 -
240546 - [On 000206 submitted letter asking about this issue. ref SDS 73
240547 - 0001]
240549 - ..
240550 - [On 000216 received letter from Kory indicating there is no
240551 - evident conflict. ref SDS 74 8944]
240553 - ..
240554 - Over next few months tried Glucosamine Chondroitin but could not
240555 - swallow pills, so ended efforts to try this treatment.
240557 - ..
240558 - [On 030807 case study shows personal history using liquid
240559 - Glucosamine Chondroiten and clincial research. ref SDS 75
240560 - FN9N
240562 - ..
240563 - [On 040529 0248 report that Glucosamine Chondroitin in liquid
240564 - form relieved knee pain from hiking 3 - 10 miles per day.
240565 - ref SDS 76 MN9P
240566 -
240567 -
240568 -
240569 -
240570 -
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2406 -
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