CONTACTS 

SUBJECTS
CA 15-3 from Blood Test on 020511 is 117 Elevated from 81 Indicating

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 32 0000, ref SDS 28 0000.
130502 -
130503 - The doctor reported good news that CA 15-3 cancer marker has turned
130504 - down again.  It reached the lowest level so far as of the test on
130505 - 020717.  The doctor remains concerned about erratic changes in the CA
130506 - 15-3 test results, and feels this requires continued close scrutiny.
130507 - ref SDS 0 MN5N  He has done research, including submitting Millie's
130508 - case to the Tumor Board for additional guidance on this issue.
130509 - ref SDS 0 WF42  The doctor was pleased to hear that so far, the only
130510 - side effects radiation treatment have been difficulty sleeping.
130511 - ref SDS 0 4Y5I  The doctor is counting on the radiologist for backup,
130512 - 2nd opinion on evaluating testing for diagnosis and treatment ideas.
130513 - ref SDS 0 MO37  He will be on vacation during August, and will see
130514 - Millie again at that time. ref SDS 0 Q15H  Results of the MRI on
130515 - Millie's spine show no evidence of distant metatasis. ref SDS 0 NU4F
130516 - Evidence of beginning stages of arthritis are attributed to age and
130517 - can be treated with exercise and over-the-counter medications.  A
130518 - referral for further evaluation is not recommended at this time.
130519 - ref SDS 0 I95S
130520 -
130521 -
130522 -
130523 -
130525 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Recovery Progress CA 15-3 Cancer Marker Drops to Lowest Level
130902 - CA 15-3 Cancer Marker Drops to Lowest Level Progress Toward Recovery
130903 -
130904 - The doctor came into the examination room briefly about 1627 for the
130905 - meeting scheduled to start at 1600.  He apologized saying there is a
130906 - lot going on today.  Things have been hectic.  He returned about 10
130907 - minutes later and performed the scheduled examination.
130908 -
130909 -       [On 050329 hectic schedule not enough time to collaborate with
130910 -       surgry department on results of examination. ref SDS 44 XQ41
130912 -  ..
130913 - Results of blood test on 020717 show CA 15-3 has dropped from 75 on
130914 - 020629 down to 59.  Doctor printed a report showing...
130915 -
130916 -            020717.............. 59 H?
130917 -            020629.............. 75 H
130918 -            020608............. 108 H
130919 -            020511............. 117 H
130920 -            020419.............. 81 H
130921 -            020321.............. 85 H
130923 -        ..
130924 -       [On 020924 CA 15-3 dropped to 36. ref SDS 35 FC3K
130926 -  ..
130927 - The doctor said that even though the most recent tests seem favorable,
130928 - this record of persistant elevated CA 15-3 test results remains
130929 - troubling, as he related during the meeting on 020628. ref SDS 32 QB22
130930 - Later during the meeting, the doctor reported Millie's patient profile
130931 - is more complex that most breast cancer cases, and so he increased
130932 - radiation from 4 to 6 weeks. ref SDS 0 MO37
130934 -  ..
130935 - The significance of the "?" appended to the test results for 020717
130936 - was not clear.  Previously, the doctor has called staff from the
130937 - examination room for clarifications of test reports, for example on
130938 - 020628. ref SDS 32 5S5M  Today the original source was not
130939 - investigated to discover reasons and implications of this unique
130940 - notation that seems intended to catch the attention of people
130941 - reviewing the report.
130943 -  ..
130944 - The doctor indicated the next test for CA 15-3 can be performed at end
130945 - of Millie's radiation treatments in about 6 weeks, around 020829,
130946 - rather than follow the two (2) week cycle of testing for effectiveness
130947 - of chemotherapy, which was a concern on 020603, ref SDS 28 HT4O, and
130948 - raised orignially on 020321. ref SDS 13 I18L
130949 -
130950 -      This aligns with radiologist planning on 020708. ref SDS 33 3B4O
130952 -       ..
130953 -      When Millie gets the schedule for the next meeting with the
130954 -      doctor, we will obtain a blood test for CA 15-3 a week prior to
130955 -      that date, so that results are available for review during the
130956 -      meeting with the doctor, similar to planning on 020708 for the
130957 -      meeting today. ref SDS 33 CW9J
130958 -
130959 -
130960 -
130961 -
1310 -

SUBJECTS
Start Radiation Treatment Schedule Lost Doctor Cannot Find in Patien
Radiation Schedule Lost Doctor Cannot Find in Patient Medical Chart

2204 -
220501 -  ..
220502 - Radiation Treatment Schedule Began on 020723
220503 - Treatment Schedule Lost Cannot Find Date Radiation Began
220504 -
220505 - The doctor looked through Millie's medical chart folder to find the
220506 - date when radiation treatment begins.  He checked the computer in the
220507 - examination room.  He said information is too hard to find, and asked
220508 - Millie if she recalls when treatment is schedueld to start at Mount
220509 - Diablo Hospital?
220510 -
220511 -     [On 030109 the doctor could not find the date when radiation
220512 -     treatments ended to analyse and diagnose cancer relapse.
220513 -     ref SDS 38 GK51
220515 -  ..
220516 - Millie said that radiation treatments have already begun.  She got the
220517 - first treatment on 020723, this past Tuesday, ref SDS 34 0001,
220518 - following the meeting on 020708 to plan this phase of treatment.
220519 - ref SDS 33 TV4I  Millie commented they have a lot of trouble at her
220520 - law firm finding information when needed.  This was reported on
220521 - 960406, ref SDS 3 5922, and further relates that finding critical
220522 - details is hard for everyone. ref SDS 3 4249
220523 -
220524 -     [...below, the doctor could not find the Tumor Board report.
220525 -     ref SDS 0 WF42
220527 -      ..
220528 -     [On 021108 Microsoft project to improve ability to find critical
220529 -     details on the computer. ref SDS 36 EF5I
220530 -
220531 -
220532 -
2206 -

SUBJECTS
Lumps Discomfort Ended Under Left Arm after Switching Chemothrapy Tr
Radiation Examination No Side Effects
Sleep Problems Not Serious Enough for Medication

2505 -
250601 -  ..
250602 - Examination Breast and Under Arm Show Progress
250603 - Sleeping Difficulty Discussed, No Medication Prescribed
250604 - Radiation Side Effects None After 3 Initial Treatments
250605 - Side Effects Radiation Treatment None So Far After Just 3 Treatments
250606 -
250607 - Millie said that discomfort from the lump under the left arm, reported
250608 - during the meeting on 020603, has gone away, following the switch from
250609 - Adriaymcin Cytoxen to Taxotere treatments. ref SDS 28 0001
250610 -
250611 -        [On 021206 new swelling and discomfort under left arm occurs
250612 -        again. ref SDS 37 KW5F
250614 -  ..
250615 - The doctor examined the left breast for redness, rash, and
250616 - inflammation.  He explained these symptoms can occur as side effects
250617 - of radiation treatments.
250619 -  ..
250620 - Examination today shows that, so far, this has not occurred.  The
250621 - doctor noted that these side effects of ratiation may begin to show up
250622 - as radiation treatment continues.  He asked Millie if she has
250623 - experienced any side effects from radiation treatment like fatigue,
250624 - nausea or other symptoms?
250625 -
250626 -        [On 021206 examination finds stiff, thickened skin on left
250627 -        breast. ref SDS 37 SG7J
250629 -  ..
250630 - Millie said there have been no evident evident side affects.  Her
250631 - appetite is good.  There has been no nausea, or tiredness while
250632 - getting radiation, that has accompanied chemotherapy treatments.  She
250633 - still gets tired and feels sluggish, but not in the manner that
250634 - occurred with chemotherapy.
250636 -  ..
250637 - The doctor noted that Millie started treatment on 020723, just 3 days
250638 - ago, per Millie's report above. ref SDS 0 YI5F  He wants Millie to be
250639 - alert and report any side effects from radiation immediately over the
250640 - next 4 weeks of treatment by Doctor Moini at Mt Diablo.
250642 -  ..
250643 - Reviewed briefly Doctor Moini's plans on 020708 to give 6 weeks of
250644 - radiation, ref SDS 33 AN6I, rather than 4 weeks initially planned on
250645 - 020321, and ordered by the primary care physician on 020628.
250646 - ref SDS 32 QB5Q
250648 -  ..
250649 - The doctor then recalled planning with Doctor Moini increased
250650 - radiation because the cancer marker has not responded normally,
250651 - indicating Millie's cancer presents a more complex case, discussed
250652 - further below. ref SDS 0 MO37
250654 -  ..
250655 - Millie mentioned difficulty falling asleep at night.
250657 -  ..
250658 - The doctor did not associate this with radiation treatments.  He
250659 - discussed prescribing a sleeping agent, but Millie decided against
250660 - increasing the medications she is taking.
250661 -
250662 -
250663 -
2507 -

SUBJECTS
Doctor Vacation During Month of August Schedule Follow Up Meeting fo

2603 -
260401 -  ..
260402 - Meeting Doctor After Vacation at End of August
260403 - Vacation Doctor During August Next Meeting at End of August
260404 -
260405 - The doctor will be on vacation during August.  He said the way things
260406 - are going, he needs a break, so this will be a welcome time to get
260407 - away for awhile.  Being head of the oncology department, and also
260408 - caring for patients, is a lot of responsibility, noted on 020321.
260409 - ref SDS 13 MK4J
260410 -
260411 -    [...below, the doctor handles emergency. ref SDS 0 YT6L
260413 -  ..
260414 - The doctor wants to see Millie when he returns from vacation at the
260415 - end of August.  He prepared paperwork for the staff to schedule a
260416 - meeting.
260418 -  ..
260419 - After the meeting today, Millie submitted the doctor's request form,
260420 - to schedule a meeting, to the nurse in the common area.  The nurse
260421 - said Kaiser will send a notice by mail scheduling a meeting with
260422 - the doctor.
260423 -
260424 -
260425 -
260426 -
260427 -
2605 -

SUBJECTS
2nd Opinion Relies on Affiliated Doctors Performing Other Aspects of
Research Knowledge Base Professionals for Advice Guidance on Diagnos
CA 15-3 Erratic Research Knowledge Base Professionals for Advice Gui
2nd Opinion Backup for Primary Care Physician Not Aware of Reliance
2nd Opinion from Radiologist to Backup Analysis by Primary Care Phys
Collabortion with Colleagues Research Kaiser Knowledge Base and Inte

3508 -
350901 -  ..
350902 - Collaboration 2nd Opinion Research Evaluate Erratic CA 15-3
350903 - Doctor Moini Backup for Second Opinion to Support Doctor Johnson
350904 - Complex Patient History Evaluate Collaboration Kaiser Knowledge Base
350905 -
350906 - The doctor said Millie's patient profile is more complex than most
350907 - stage II breast cancer cases.  As a result, he ordered radiation
350908 - treatment at Mt Diablo increased from 4 to 6 weeks, per above
350909 - ref SDS 0 3B4O, and citing "out of capsule" cancer condition in left
350910 - axilla, reported on 020321, ref SDS 13 6Q4U, and persistant elevated
350911 - cancer marker reported today, also above. ref SDS 0 YN5K
350913 -  ..
350914 - To address increased complexity of case management, the doctor
350915 - explained he has further collaborated with colleagues through Kaiser's
350916 - Tumor Board (see below, ref SDS 0 WF42), and is using a Knowledge Base
350917 - maintained by Kaiser's computers to help diagnose implications of the
350918 - cancer marker CA 15-3, per concern on 020628 about erratic, unexpected
350919 - test results, ref SDS 32 QB7H, which he says again today are very
350920 - troubling. ref SDS 0 GF5K
350922 -         ..
350923 -        [...below, doctor cannot find Tumor Board report. ref SDS 0
350924 -        RQ5F
350926 -  ..
350927 - There was discussion of other factors or tests besides CA 15-3 that
350928 - should be considered for evaluating progress of cancer treatment in
350929 - light of the doctor's opinion that the record in Millie's case does
350930 - not follow an expected pattern?
350931 -
350932 -        [On 040517 lucky to find record of Tumor Board hearing, patient
350933 -        history complex. ref SDS 42 4Q65
350935 -         ..
350936 -        [On 061020 primary care physician feels that patient profile
350937 -        has too many issues for a 5-year medical case of secondary
350938 -        inflammatory breast cancer (IBC), cellulitus, lymphedema,
350939 -        pulmonary embolism, broken finger. ref SDS 48 MO4K
350941 -  ..
350942 - There was no discussion of doing another PET scan to follow up the
350943 - test results reported on 020603 showing new evidence of metastasis,
350944 - and causing a change in treatment. ref SDS 28 0001
350946 -  ..
350947 - The doctor asked who is treating Millie at Mt Diablo hospital, where
350948 - radiation treatment is being performed on referral from Kaiser?
350950 -  ..
350951 - Millie advised that...
350952 -
350953 -                          Doctor Moini
350954 -
350955 - ...is the radiologist assigned in Millie's case, reported on 020708,
350956 - when the radiologist examined Millie and gave an orientation on
350957 - radiation treatment protocol. ref SDS 33 0001
350959 -  ..
350960 - The doctor said he is using Kaiser's Team Care practice to consult
350961 - with the radiologist for a backup second opinion on Millie's progress
350962 - with support for diagnostic analysis, and treatment plans.  He feels
350963 - there have already been consultations with the radiologist, but could
350964 - not recall what has been discussed so far.  He looked through the
350965 - Medical Chart, and found no record of consultations with Doctor Moini.
350966 - He feel this is a good sign that nothing of importance was mentioned
350967 - in prior consultations.  The doctor plans to call or write to Doctor
350968 - Moini again to follow up.
350970 -  ..
350971 - Millie mentioned again Doctor Moini discussed on 020708 increasing the
350972 - number of radiation treatments from 4 to 6, per above. ref SDS 0 3B4O
350974 -  ..
350975 - The primary care phyisician noted this change in the medical chart for
350976 - future reference.
350977 -
350978 -     [On 040419 surgeon counting on Oncologist for notice to make
350979 -     examination for backup analysis to implement team care practice.
350980 -     ref SDS 40 XU83
350982 -      ..
350983 -     [On 041014 review of Medical Chart for distribution to obtain 2nd
350984 -     opinions, ref SDS 43 PF7I, showed no evident record of
350985 -     consultations with anyone, including the tumor board and
350986 -     radiologist. ref SDS 43 HT6N
350988 -      ..
350989 -     [On 050923 surgeon collaborating with oncology department to apply
350990 -     Kaiser's Team Care practice. ref SDS 46 TV6H
350992 -      ..
350993 -     [On 050923 study shows challenge of due diligence implementing
350994 -     team care practice for collaboration and conferring to support
350995 -     diagnosis and treatment of the patient. ref SDS 46 N45O
350997 -  ..
350998 - Getting a 2nd opinion aligns with Kaiser's Healthwise Handbook; review
350999 - on 990625 showed requirements for 2nd opinion to help verify accuracy
351000 - of analysis. ref SDS 4 455N
351001 -
351002 -        [On 040318 primary care physician in Oncology Department
351003 -        discusses advantage of 2nd opinion outside the department to
351004 -        cross check planning on treating relapse of cancer, based on
351005 -        new and advancing symptoms. ref SDS 39 AW6M
351007 -  ..
351008 - There is nothing in the medical chart nor in Kaiser's computer showing
351009 - consultations on background, tests, interpretations, analysis,
351010 - application of research, ideas, follow up planning.  This knowledge
351011 - seems, therefore, to be only in the mind of the physician and is
351012 - formed each time the patient is examined, as today, or discussed, as
351013 - when radiologist talked to the doctor before seeing Millie on 020708.
351014 - It is re-formulated days, weeks, months later when discussed again,
351015 - since there is no evident means of constructing a well ordered record
351016 - to manage chronology, context, and connections that convert
351017 - inforamtion into the power of knowledge.
351018 -
351019 -      [...below, discussed research to support knowledge management.
351020 -      ref SDS 0 ST6F
351022 -  ..
351023 - During the meeting on 020708 the radiologist was not familiar with CA
351024 - 15-3 blood tests for cancer and distant metastasis. ref SDS 33 TV4I
351025 - and ref SDS 33 WU3L  The radiologist mentioned having discussed the
351026 - case with the the primary care physician in Oncology at Kaiser for
351027 - input on designing radiation treatments and explained a detailed plan,
351028 - but there was no record showing how the design aligns with
351029 - consultations and research. ref SDS 33 TV4I
351030 -
351031 -    This record seems similar to events on reported on 921023
351032 -    concerning Broadwater Dam where the agencies lead counsel was
351033 -    counting on the manager of the engineering department for backup on
351034 -    an opinion that a design firm hired to engineer and manage
351035 -    construction of the project had failed to perform a legal duty, and
351036 -    this official view of reality was repeated so many times in
351037 -    meetings and documents that everyone believed the engineering firm
351038 -    had failed to perform, ref SDS 1 9054, until investigation showed
351039 -    that the engineering manager for the agency had not actually
351040 -    examined the evidence, reported on 920124. ref SDS 2 0001
351042 -  ..
351043 - Millie recalled today that the radiloogist was familiar with PET scan
351044 - results, based on comments during the meeting on 020708. ref SDS 33
351045 - ZO5N
351046 -
351047 -
351048 -
351049 -
351050 -
3511 -

SUBJECTS
Tumor Board Minutes Lost 1st Hearing Millie's Case Doctor Cannot Fin

4703 -
470401 -  ..
470402 - Tumor Board Referral Due to Rising CA 15-3 Results Pending
470403 -
470404 - The doctor said Millie's case was submitted to the Tumor Board some
470405 - weeks ago for an opinion and guidance, in light of concerns that CA
470406 - 15-3 has not dropped into the low 30s, as expected, reported on
470407 - 020628. ref SDS 32 QB7H
470409 -  ..
470410 - The Tumor Board's findings and recommendations were not presented nor
470411 - cited during the meeting today.  There was discussion of doctors
470412 - collaborating and using Kaiser's Knowledge base for research, per
470413 - above. ref SDS 0 MO37  The doctor could not find the Tumor Board
470414 - report in Millie's medical chart, nor in Kaiser's knowledge data base
470415 - using the computer in the exam room today.
470416 -
470417 -        [...above, doctor could not find the date when radiation
470418 -        treatments he ordered were scheduled to begin. ref SDS 0 4Y5I
470420 -         ..
470421 -        [On 030109 the doctor could not find the date when radiation
470422 -        treatments ended to analyse and diagnose cancer relapse.
470423 -        ref SDS 38 GK51
470425 -  ..
470426 - The doctor seemed to indicate that results from review by the Tumor
470427 - Board usually come back the same day.
470429 -  ..
470430 - The doctor will ask his assistant, Arlette, to find the results of the
470431 - Tumor Board review and submit to the patient.
470432 -
470433 -        [...never received the Tumor Board report.
470434 -
470435 -        [On 040517 results of 2nd Tumor Board review were difficult to
470436 -        find. ref SDS 42 4Q65
470438 -  ..
470439 - On 020708 the radiologist was asked, for a written opinion based on
470440 - her examination comments, but said there is not enough time to
470441 - communicate with the patient using email, because doctors get a lot of
470442 - email from other doctors. ref SDS 33 EY9N
470443 -
470444 -
470445 -
470446 -
470447 -
470448 -
470449 -
4705 -

SUBJECTS
Spine MRI No Evidence Distant Metastasis Shows Degenerative Conditions
Distant Metastasis No Evidence After MRI on Spine

5104 -
510501 -  ..
510502 - MRI on Spine Shows No Evidence Distant Metatasis
510503 - Distant Metastasis No Evidence Shown by MRI on Spine
510504 -
510505 - The doctor reviewed results of a recent MRI test on the Millie's
510506 - spine, performed on 020713.
510508 -  ..
510509 - He provided a printed report and said there is no evidence of distant
510510 - metatasis, ref SDS 0 I954, consistent with analysis on 020628 that
510511 - other tests so far indicate that metatasis found by the PET scan test
510512 - is localized to the under arm area now being treated with radiation.
510513 - ref SDS 32 0001
510515 -  ..
510516 - Test results show....
510517 -
510518 -    66/F Radiology Report
510519 -
510520 -    MRI of the lumbar spine
510528 -     ..
510529 -    DD:  020715          DT:  020717    ERW
510531 -     ..
510532 -    Through L5-S1.
510533 -
510534 -       Congenital schmorl's node involving the superior and inferior
510535 -       endplate at L1.  Minimal compression deformity of T12 vertebrail
510536 -       body.  No significant abnormal marrow signal to suggest
510537 -       metastatic disease.
510539 -     ..
510540 -    Impression
510541 -
510542 -       1.  No evidence of metastatic disease.
510543 -
510544 -       2.  Multilevel mild lumbar spondylosis, most affected at L4-5,
510545 -           as described.
510547 -     ..
510548 -    History
510549 -
510550 -       T12 compression deformity.  H/O breast cancer.  R/O Metatasis.
510552 -     ..
510553 -    Findings
510554 -
510555 -       Technique:  Standard lumbar spine screen MRI protocol.
510556 -
510557 -       There are presumed five lumbar vertebrae.  There is degenerative
510558 -       disc desiccaton at multiple levels.  The conus medullaris is at
510559 -       the L2 level.
510561 -        ..
510562 -       There is mild degenerative disc bulge at L4-5 causing minimal
510563 -       left neural forminal stenosis.  Mild facet joint arthropathy
510564 -       from L3-4
510565 -
510566 -
510567 -
510568 -
510569 -
5106 -

SUBJECTS
Arthritis Spine Avoid Jumping Exercise to Maintain Strength Flexibili
Ostopenia Diagnosed by Bone Density Tests Does Not Require Treatment
Johnson, Doctor Reports MRI on Spine Shows Mild Deterioration
Referral Not Made to Specialist for Treatment of Degeneration Spine A
Meeting Johnson, Doctor Reports MRI on Spine Shows Mild Deteri
Ostopenia Diagnosed by Bone Density Tests Does Not Require Treatment

5708 -
570901 -  ..
570902 - Arthritis from Aging for 66 Years Treat with Over Counter Medication
570903 - Spine Shows Normal Deterioration from Aging Requires No Referal
570904 - Glucosamine and Condroiten Suggested to Treat Mild Arthritis
570905 -
570906 - Millie asked about treatment for impressions, ref SDS 0 I954, and
570907 - findings in the report, ref SDS 0 F46G, which seem to align with
570908 - results of the bone scan test showing a condition described as...
570909 -
570911 -                          ..
570912 -                         osteopenia
570913 -
570914 -
570915 - ...discussed with Doctor Johnson on 020628? ref SDS 32 BX6G
570917 -  ..
570918 - The doctor characterized this as within the range of normally expected
570919 - conditions after 66 years of wear and tear leading to mild arthritis.
570920 - He compared the problem to an elderly person's hand curling.
570922 -  ..
570923 - Treatment is continued exercise to maintain strength and flexibility.
570924 - Avoid jumping activity that magnifies compression, like basketball,
570925 - football, tumbling, leaping off the house, that sort type of thing.
570926 - Bicycling and swimming are good forms of exercise that do not stress
570927 - the joints, as are most aerobics that people do in gym classes that
570928 - Millie is currently doing.
570930 -  ..
570931 - The doctor said patients take over-the-counter drugs like Glucosamine
570932 - and Condroiten to minimize degeneration of spinal tissue.
570933 -
570934 -      On 990925 these medicines were prescribed to treat knee problems.
570935 -      ref SDS 6 3120
570936 -
570937 -      On 991011 research Glucosamine and Condroiten. ref SDS 7 5933
570939 -       ..
570940 -      On 000124 Doctor Yamamoto at Kaiser uses Glucosamine and
570941 -      Condroiten with favorable results. ref SDS 9 1680
570943 -  ..
570944 - The doctor feels a referral to a specialist for evaluation and
570945 - treatment is not required, and noted a referral would likely result in
570946 - treatment discussed today.
570947 -
570948 -
570949 -
570950 -
570951 -
5710 -

SUBJECTS
Example Pressure Doctor's Experience from Constant Failure
Slippery Slope Cynicism Caused by Constant Failure Medical Practice
Emergency Illustrates Pressure of Failure Makes Pursuit of Excellence
Medical Management Improve Difficult Computers Considered Helpful for
Emergency Illustrates Pressure of Failure Makes Pursuit of Excellence

6407 -
640801 -  ..
640802 - Emergency Shows Challenge of Vigilance to Improve Medical Practice
640803 -
640804 - After about 20 minutes during the meeting with Doctor Johnson today,
640805 - the doctor excused himself and left the examination room, saying he
640806 - has to check on something.
640808 -  ..
640809 - He returned about 10 minutes later and apologized, saying there is an
640810 - emergency, per initial comment that today is hectic. ref SDS 0 0001
640812 -  ..
640813 - The doctor placed several calls to hospital staff requesting support
640814 - for a woman in the oncology waiting room area who is experiencing
640815 - elevated blood pressure.  The patient received medication to reduce
640816 - blood pressure, but instead blood pressure went up to about 240.  He
640817 - wants the hospital to admit her for observation and support to ensure
640818 - everything can be done to avoid further complications.  He is having
640819 - an orderly bring the patient to another location, rather than remain
640820 - in the oncology waiting area.
640822 -      ..
640823 -     This episode illustrates pressure doctors experience doing work
640824 -     that ultimately fails, reported on 020221. ref SDS 10 Y27F
640825 -
640826 -
640827 -
640828 -
640830 -  ..
640831 - IT Department Reviews Improvements to Management of Patient Care
640832 - Healthwise Handbook Calling for Doctor Patient Communication
640833 -
640834 - At the conclusion of the meeting today, we reviewed opportunities for
640835 - research to strengthen medical practice by implementing requirements
640836 - specified in Kaiser's Healthwise Handbook on communication between
640837 - doctors and patients.  For example Kaiser's letter on 991028 cited
640838 - research Kaiser performs to maintain and improve quality care.
640839 - ref SDS 8 0832
640840 -
640841 -        [On 040505 discussed adding intelligence to medical management
640842 -        with system of Communication Metrics. ref SDS 41 0001
640844 -  ..
640845 - The doctor seemed familiar with requirements in the Healthwise
640846 - Handbook saying communication between doctors and patients is central
640847 - to effective diagnosis and treatment, reviewed on 990625. ref SDS 4
640848 - 0806
640850 -  ..
640851 - The doctor recalled seeing the Handbook, even though copies are not in
640852 - examination rooms we have visited the past 6 months at Kaiser, either
640853 - here in Walnut Creek, or at Mt. Diablo Hospital (which is an
640854 - affiliated organization).
640856 -  ..
640857 - Research to implement requirements for good medical practice would
640858 - enable understanding to grow from continual refinement of knowledge
640859 - gathered through communications and analysis, which Doctor Johnson
640860 - noted above is missing from current capabilities. ref SDS 0 YO6K
640861 -
640862 -     [On 050520 the doctor began capturing a legible record on Kaiser's
640863 -     computer, and disclosed Kaiser's plans to equip patient
640864 -     examination rooms with ergonomic work stations for efficiently
640865 -     investing intellectual capital. ref SDS 45 HX6J
640867 -      ..
640868 -     [On 051121 Kaiser email support for doctor/patient partnership
640869 -     communication. ref SDS 47 V25O
640871 -  ..
640872 - The doctor indicated the best place for evaluating improvements to
640873 - medical management of doctor communication with patients is the
640874 - regional IT department in Oakland.  He related new systems Kaiser has
640875 - implemented, or is testing, that sends patients detailed instructions
640876 - from the doctor so that patients don't forget critical details.
640878 -  ..
640879 - Kaiser's Healthwise Handbook seems to set a requirement for doctor's
640880 - and patients to work together through partnership using a "ping pong"
640881 - methodology reported on 990625 to improve accuracy of understanding
640882 - about the context of instructions, ref SDS 4 3960, that is essential
640883 - to avoid medical mistakes, reported on 990912. ref SDS 5 0960
640885 -  ..
640886 - On 991028 the president of Kaiser notified patients that Kaiser was
640887 - implementing a new policy for doctors to drive decisions about patient
640888 - care, as called out in the Healthwise Handbook. ref SDS 8 2555  This
640889 - policy empowers doctors and patients to strengthen partnership so that
640890 - both the doctor and the patient remember critical details, as
640891 - discussed today. ref SDS 0 4Y5I and further at ref SDS 0 YO6K, as well
640892 - as remembering results from the Tumor Board. ref SDS 0 WF42
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640901 -
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