CONTACTS 

SUBJECTS
Lesson Learned Innovation Stifled by Bureacracy Denial Anything SDS
Tumor Board Procedures Casual Informal Conversation Not Hearing No T
Meeting Doctor Moini Radiation Follow Up Consultation at Mt Diablo H

2305 -
2305 -    ..
2306 - Summary/Objective
2307 -
230701 - Follow up ref SDS 8 0000. ref SDS 7 0000.
230702 -
230703 - This was a regularly scheduled follow up visit by the doctor.
230705 -  ..
230706 - The doctor said there is nothing further she can do to treat Millie,
230707 - unless there were to be surgery and further complications occurred.
230709 -  ..
230710 - This seems to align with planning for radiation following further
230711 - surgery after chemotherapy, as set out in the Tumor Board report
230712 - received in the record on 040517. ref SDS 2 F77M
230714 -  ..
230715 - The doctor did not discuss Doctor Guardino's 2nd opinion issued by
230716 - Stanford Medical Center, reported on 041209 that indicated further
230717 - radiation may be a treatment strategy following any surgery that may
230718 - be performed. ref SDS 4 O29W
230719 -
230720 -     [On 041230 primary care physician discusses plans for surgery, and
230721 -     considers Stanford's 2nd opinion. ref SDS 9 2R7G
230723 -      ..
230724 -     [On 050907 surgeon in Kaiser's Oakland office discusses reviewing
230725 -     the record to determine if the patient has room for further
230726 -     raditation treatment. ref SDS 10 AF4W
230728 -  ..
230729 - The doctor described tumor board procedures at Mt Diablo Hospital,
230730 - which she feels are typical for industry practice...
230731 -
230732 -    1.  Doctors in related fields attend a meeting to comprise a
230733 -        "tumor board".
230734 -
230735 -        This addresses in part the question on 040517 about tumor board
230736 -        procedures. ref SDS 2 F751
230738 -         ..
230739 -    2.  Primary care physician or lead oncologist "presents" the case
230740 -        by explaining patient history.
230742 -         ..
230743 -    3.  The board of doctors discuss treatment options similar to
230744 -        discussions people have in the hall, or at the water cooler.
230745 -        Nobody examines the patient's medical chart, tests, nor reviews
230746 -        test reports, i.e., no writings are examined by the board,
230747 -        except as remembered, and voiced verbally by the presenting
230748 -        doctor.
230749 -
230750 -            [On 061218 research indicates Tumor Boards are intended to
230751 -            improve patient care through continual learning, pooling
230752 -            expertise, and focusing limited time for accurate
230753 -            understanding of complex patient history. ref SDS 11 6W3F
230755 -             ..
230756 -            [On 061218 case study illustrates limitations of Tumor
230757 -            Board process. ref SDS 11 6W3X
230759 -         ..
230760 -    4.  Patients do not attend in order to clarify and correct the
230761 -        record.
230763 -         ..
230764 -    5.  A transcript of proceedings is not prepared to assist the
230765 -        doctor presenting the case in understanding what transpired
230766 -        during the tumor board hearing.
230768 -         ..
230769 -    6.  No member of the tumor board, including the presenting doctor
230770 -        prepares written reports nor any analysis of the presentation,
230771 -        including case history and recommendations to aid the doctor
230772 -        and patient partnership in making treatment decisions based on
230773 -        review of case history.
230775 -         ..
230776 -        On 040517 the doctor submitted "minutes" for a tumor board
230777 -        hearing at Kaiser on 040416, which indicates Kaiser is more
230778 -        professional and thorough than is common for tumor board
230779 -        hearings for industry practice. ref SDS 2 MB7F
230781 -         ..
230782 -        The doctor advised today that careful, thorough written
230783 -        analysis of a patient's case is only prepared when a 2nd
230784 -        opinion is requested from an outside authority, illustrated by
230785 -        reports from Doctor Benz at UCSF, received on 041114,
230786 -        ref SDS 3 EK6F, and from Doctor Guardino at Stanford, received
230787 -        on 041209. ref SDS 4 LO5L
230789 -         ..
230790 -        The explanation of tumor board procedures today aligns with the
230791 -        report showing cursory analysis was performed by the tumor
230792 -        board in "minutes" of a hearing on 040416 which was submitted
230793 -        to the patient a month later on 040517. ref SDS 2 VH7H
230795 -         ..
230796 -        Reliance on conversation and dialog aligns with report on
230797 -        010908 of overwhelming tendency to use bad management, because
230798 -        management training teaches top executives to rely on dialog
230799 -        for expediting the work, reported at Axiom on 950426.
230800 -        ref SDS 1 4392
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2309 -