THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: April 9, 2004 11:06 AM Friday; Rod Welch

Millie confirmed scheduling at Kaiser; asks for 2nd opinion.

1...Summary/Objective
2...Schedule Treatment for Metastatic Cancer Commence on 040420
3...Treatment Scheduled to Commence Immediately Cleared by the Doctor
4...Port Installation Scheduled for End of April
5...Dual Port Not Supported Kaiser Relies on New Medicines Avoid Clogging
6...2nd Opinion Requested Verify Scope of Problem and Treatment Planning
7...Kaiser Offers 4 Choices to Patients for Obtaining 2nd Opinion
8...Meeting with the Doctor Scheduled for 040416
........Scheduling Clarification Requested on Meeting with the Doctor
........Error Discovered Need Clarification on Meeting with the Doctor
........Too Many Calls Meetings Emails People Confused Make Mistakes
........Mistakes When Too Many Calls Meetings Emails People Confused
........Project Manager Coordinate Details Avoid Confusion Errors

ACTION ITEMS.................. Click here to comment!

1...What publications guide performance by the Tumor Board.

CONTACTS 

SUBJECTS
Scheduled Treatment Commence Immediately Cleared by the Doctor Cance
Schedule Treatment for Metastatic Cancer Commence on 040420 Avastin
Millie Writes to Rosalie Submitting Record of Understandings Asking

0805 -
0805 -    ..
0806 - Summary/Objective
0807 -
080701 - Follow up ref SDS 3 0000. ref SDS 2 0000.
080702 -
080703 - Millie writes to Rosalie confirming that chemo treatments, including
080704 - the Avastin trial, will begin on 040420. ref SDS 0 K175  Rosalie is
080705 - asked to review the record of the meeting on 040402 and provide
080706 - feedback to verify accuracy of understandings. ref SDS 0 YC4Q  Confirm
080707 - Rosalie's explanation about Kaiser's improved methods to avoid
080708 - clogging of "port" technology used to administer chemotherapy
080709 - treatments. ref SDS 0 7J96  Further confirm surgery to install a port
080710 - may not occur prior to start of treatments on 040420, but hopefully
080711 - before the end of April. ref SDS 0 EH4I  Millie asks Kaiser to go
080712 - ahead and make arrangements for a second opinion. ref SDS 0 HS3O  The
080713 - doctor's nurse called Millie in the afternoon and explained four (4)
080714 - choices. ref SDS 0 7K4G  Millie asks Rosalie to clarify the date of
080715 - the next meeting with the doctor, either on 040415 or on 040416.
080716 - ref SDS 0 YD4R  In the afternoon, Kaiser called and confirmed the
080717 - meeting is on 040416. ref SDS 0 046B
080718 -
080719 -     [On 040410 Rosalie responds. ref SDS 5 0001
080720 -
080721 -
080722 -
080723 -
080724 -
080726 -  ..
0808 -
0809 -
0810 - Progress
0811 -
081101 - Schedule Treatment for Metastatic Cancer Commence on 040420
081102 - Treatment Scheduled to Commence Immediately Cleared by the Doctor
081103 -
081104 - Follow up ref SDS 3 HS63, ref SDS 2 9739.
081105 -
081106 - Millie submitted ref DIT 1 0001 to Rosalie on several pending issues,
081107 - saying...
081109 -         ..
081110 -    1.  Thanks very much for your call on Wednesday scheduling
081111 -        treatments to begin on April 20.  I feel better knowing we are
081112 -        going forward based on the doctor's plan to begin treatment
081113 -        immediately, and this lets me make firm arrangements at work.
081114 -        ref DIT 1 0001
081116 -  ..
081117 - On 040402 the doctor asked Rosalie to schedule Millie for treatment.
081118 - ref SDS 3 HS63
081120 -  ..
081121 - This confirms Millie's report on 040407. ref SDS 4 3S6L
081123 -  ..
081124 - Millie continues...
081125 -
081126 -    2.  When time permits, please review the record of our meeting on
081127 -        April 2, ref DIT 1 UQ6G, and let me know if I have missed
081128 -        anything important from our discussions. ref SDS 2 0001
081129 -
081130 -            [On 040410 Rosalie responds she is preparing to take a
081131 -            vacation, so time is too short for reviewing the record.
081132 -            ref SDS 5 OP48
081134 -             ..
081135 -            [On 040415 Millie responds noting common problem that
081136 -            everyone is busy these days, so there is never enough time
081137 -            to verify accuracy of communications. ref SDS 8 566S
081138 -            Millie commends Rosalie and Kaiser for progress on action
081139 -            items. ref SDS 8 VL6V
081140 -
081141 -
081142 -
081143 -
0812 -

SUBJECTS
Port Surgery Installation Scheduled by Rosalie
Port Installation Scheduled for End of April
Port Will Provide Partial Releif from Excessive Needle Insertions in

1405 -
140601 -  ..
140602 - Port Installation Scheduled for End of April
140603 - Dual Port Not Supported Kaiser Relies on New Medicines Avoid Clogging
140604 -
140605 - Follow up ref SDS 2 V750.
140606 -
140607 - Millie continues...
140609 -         ..
140610 -    3.  Thanks, also, for explaining, during our call on Wednesday,
140611 -        Kaiser's policy on using a "dual" port system, ref DIT 1 6U6L,
140612 -        following up the doctor's recommendations on March 18,
140613 -        ref SDS 1 CO3G, and planning you presented when we met at
140614 -        Kaiser last week. ref SDS 2 V750
140616 -         ..
140617 -        I asked about this because friends, who have had cancer or have
140618 -        worked with loved ones who have been treated for cancer, have
140619 -        said that "ports" can become clogged, causing delay or other
140620 -        adverse impacts to treatment.  Apparently one solution is a
140621 -        "dual" port procedure that provides a backup system, so that if
140622 -        a problem occurs, then the backup is used while the problem is
140623 -        cleared, and this avoids delays and discomfort to the patient.
140624 -        Your explanation today makes sense and is a big relief hearing
140625 -        that Kaiser uses new procedures and medications, including
140626 -        heparin, that minimize the risk of clogging. ref DIT 1 AS7J
140628 -  ..
140629 - This reflects Millie's report on 040407 that she talked to Rosalie
140630 - about getting a "dual port," ref SDS 4 XR6O, which is a pending issue
140631 - from the meeting on 040402. ref SDS 2 6C6I
140633 -  ..
140634 - Millie continues...
140635 -
140636 -    4.  I hope the work can be done in time to start treatments on the
140637 -        20th, and understand from your call that surgery may be backed
140638 -        up, so there could be a slight delay on port installation, but
140639 -        this will not delay starting chemo treatments on the 20th.
140640 -        Thanks for clarifying this. ref DIT 1 FG8K
140641 -
140642 -            [On 040414 Kaiser scheduled surgery to install the port on
140643 -            040419, ref SDS 6 194J, a day before treatments begin on
140644 -            040420. ref SDS 0 K175
140646 -  ..
140647 - This addresses action item on 040402 to schedule surgery for
140648 - installing a port. ref SDS 2 V750  It reflects Millie's report on
140649 - 040407 saying she talked to Rosalie and understands the port will not
140650 - be installed by the time treatments begin on 040420, but probably will
140651 - get done before the end of April. ref SDS 4 3S6L
140652 -
140653 -
140654 -
140655 -
140656 -
1407 -

SUBJECTS
2nd Opinion Metastatic Cancer Treatment Chemotherapy New Trial Drug
2nd Opinion Requested Millie Writes Letter to Rosalie Asking Doctor
Millie Talked to Marilyn and Feels Better Now about Getting a 2nd Op

1905 -
190601 -  ..
190602 - 2nd Opinion Requested Verify Scope of Problem and Treatment Planning
190603 -
190604 - Follow up ref SDS 1 AW6M.
190605 -
190606 - Millie continues...
190607 -
190608 -    5.  On March 18, the doctor discussed the advantage of getting more
190609 -        input at this stage of treatment, ref DIT 1 JB9G, where
190610 -        metastatic cancer has been diagnosed. ref SDS 1 AW6M
190612 -         ..
190613 -    6.  Could you please visit with the doctor and mention that I would
190614 -        like him to go ahead and make the arrangements for a 2nd
190615 -        opinion.  Please keep me posted on options for keeping costs
190616 -        down, ref DIT 1 4C9M, with the understanding that some
190617 -        additional payment may be needed, based on the doctor's
190618 -        comments a few weeks ago. ref SDS 1 HC6O
190619 -
190621 -  ..
1907 -
1908 -
1909 - 1646
1910 -
191001 - Kaiser Offers 4 Choices to Patients for Obtaining 2nd Opinion
191002 -
191003 - Millie received a call from the doctor's admin nurse, Debra.
191005 -  ..
191006 - Debra responded to Millie's letter asking for a 2nd opinion.
191007 - ref SDS 0 YC6X
191009 -  ..
191010 - The nurse advised patients that have four (4) options....
191011 -
191012 -    1.  Review by another oncologist in the department.
191013 -
191014 -    2.  Review by another onoclogist in another Kaiser hospital.
191015 -
191016 -    3.  Review by the Kaiser Tumor Board.
191018 -         ..
191019 -    4.  Review by another physician in another organization.
191021 -  ..
191022 - Kaiser can facilitate the 1st three choices.
191024 -  ..
191025 - Patients must make arrangements independently for option 4, getting an
191026 - opinon from another hospital.
191028 -  ..
191029 - Millie initially requested review by the Tumor Board.
191030 -
191031 -       [On 040414 Debra called and advised the Tumor Board hearing is
191032 -       scheduled for 040416, ref SDS 6 HS3O, and Millie will have a
191033 -       bone scan performed to support review by the Board. ref SDS 6
191034 -       XY5K
191036 -        ..
191037 -       [On 040429 bone scan test performed at Kaiser in Walnut Creek.
191038 -       ref SDS 9 0001
191040 -        ..
191041 -       [On 040517 results of test were not submitted nor reviewed.
191042 -       ref SDS 10 GN6G
191044 -     ..
191045 -    What publications guide performance by the Tumor Board.
191047 -     ..
191048 -    What circumstances influence a decision about which of the 4
191049 -    options to select, i.e., what kinds of common scenarios make one
191050 -    choice or another favorable?
191051 -
191052 -
191053 -
191054 -
191055 -
1911 -

SUBJECTS
Schedule Meeting with the Doctor in Two Weeks, Rosalie to Schedule

2003 -
200401 -  ..
200402 - Meeting with the Doctor Scheduled for 040416
200403 -
200404 - Follow up ref SDS 3 9M6O.
200405 -
200406 - Millie continues....
200407 -
200408 -    5.  During the meeting at Kaiser on April 2, I understood that the
200409 -        doctor wanted to meet again in two weeks, ref DIT 1 4E4J, and
200410 -        that he indicated you would schedule the visit. ref SDS 3 9M6O
200412 -         ..
200413 -    6.  This is good timing for me to discuss a couple of issues, and
200414 -        so I wrote to you on Wednesday asking about progress on setting
200415 -        up the meeting.  Yesterday, the staff called and left a message
200416 -        at my office saying the meeting with the doctor is scheduled
200417 -        for April 15 at 0215p.  The message further indicated something
200418 -        is scheduled for April 16 and the 20th, but was unclear about
200419 -        specifics. ref DIT 1 0N5H
200421 -  ..
200422 - Below, Millie got a clarifiction on this matter that the meeting with
200423 - the doctor is on 040416. ref SDS 0 046B
200424 -
200425 -
200426 -
200427 -
200428 -
2005 -

SUBJECTS
Rosalie Lead Contact Coordination Expediter Case Manager Project Man
Schedule Clarification Requested on Meeting the Doctor Millie Writes

2904 -
290501 -         ..
290502 -        Scheduling Clarification Requested on Meeting with the Doctor
290503 -        Error Discovered Need Clarification on Meeting with the Doctor
290504 -
290506 -         ..
290507 -    7.  I really appreciate your promptness attending to these details.
290508 -        It's wonderful to work with someone who is careful, thorough
290509 -        and timely.  When there is a lot going on, with activity moving
290510 -        in many directions, it's easy to get confused and things fall
290511 -        through the cracks.  That happens a lot where I work.
290512 -        ref DIT 1 QN6F
290514 -         ..
290515 -    8.  A small case in point -- when I got home from work last night,
290516 -        there was another message from Kaiser saying the meeting with
290517 -        the doctor is on April 16 at 0215p. ref DIT 1 FS6M
290519 -         ..
290520 -    9.  Could you please check into this and let me know when the
290521 -        meeting with the doctor is scheduled?  Is it the 15th or the
290522 -        16th?  Is there another event scheduled on the 16th apart from
290523 -        meeting with the doctor; and, is there another event scheduled
290524 -        on the 20th other than the start of treatments? ref DIT 1 LT3H
290526 -  ..
290527 - This is following up request for scheduling the meeting, per above.
290528 - ref SDS 0 YD4R
290529 -
290531 -         ..
290532 -        Too Many Calls Meetings Emails People Confused Make Mistakes
290533 -        Mistakes When Too Many Calls Meetings Emails People Confused
290534 -        Project Manager Coordinate Details Avoid Confusion Errors
290535 -
290536 -
290537 - Millie continues...
290539 -         ..
290540 -   10.  I know you are very busy, so I will call Kaiser on Monday, if I
290541 -        don't hear from you by then, to check on meeting with the
290542 -        doctor.  My feeling is that when there is a lot going on, we
290543 -        need a top project manager to ensure everything is properly
290544 -        coordinated.  When there are too many calls and too many
290545 -        emails, everybody gets more confused and mistakes escalate.  It
290546 -        is better for one person to be pointing all the rest of us in
290547 -        the right direction.  I'm grateful we have you for this task.
290548 -        ref DIT 1 OU3O
290550 -  ..
290551 - Rosalie seemed to be the project manager in the meeting with the
290552 - doctor on 040402. ref SDS 3 WW7I
290554 -  ..
290555 - Millie continues...
290556 -
290557 -   11.  Thanks again for all your help. ref DIT 1 KZ4N
290558 -
290559 -
290561 -  ..
2906 -
2907 -
2908 - 2121
2909 -
290901 - Millie reported this evening, that she went ahead and called Kaiser
290902 - back this afternoon, and left a message for Rosalie.  Some time after
290903 - leaving the message for Rosalie, Kaiser called Millie at work, and
290904 - confirmed that the meeting with the doctor is on 040416 1415, clearing
290905 - the action item from the letter to Rosalie this morning, per above.
290906 - ref SDS 0 YD7P
290907 -
290908 -     [On 040410 Rosalie confirmed date and time for meeting with the
290909 -     doctor on 040416 1045. ref SDS 5 KV5H
290911 -  ..
290912 - The woman who called said that there was a mixup in the previous
290913 - calls, because she was given a range of dates to offer the patient,
290914 - and in her prior messages this point was not explained.  Eventually,
290915 - she became confused and so tried to call back and left conflicting
290916 - messages, which explains the three calls yesterday.
290917 -
290918 -
290919 -
290920 -
290921 -
290922 -
290923 -
290924 -
290925 -
2910 -