CONTACTS 

SUBJECTS
Meeting Doctor Examine Response to Chemotherapy Treatments Taxol Xel

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 93 0000, ref SDS 82 0000.
040502 -
040503 - Progress recovering from IBC.  CA-15-3 drops from near highest ever to
040504 - 67. ref SDS 0 GJ5M  Inflammation dramatically reduced; healing of
040505 - cancer sores in left breast. ref SDS 0 025H  Doctor ordered another CT
040506 - test to assess growth of lymph nodes under right arm. ref SDS 0 B58M
040507 - Improvement recovering from IBC attributed to Taxotere capecitabine
040508 - (Xeloda), so treatment continued, ref SDS 0 AW5G, with dosage of
040509 - capecitabine reduced by 25% to reduce side effects, ref SDS 0 NT3I,
040510 - based on diary of patient medical history. ref SDS 0 VP3N  New drug
040511 - trial being started at UCSF. ref SDS 0 L27G  Bladder infection and
040512 - temperature elevated to 101.4; doctor prescribed Keflex. ref SDS 0
040513 - VT3O  Doctor approved dental cleaning to avoid infection. ref SDS 0
040514 - YU8N  Kaiser's new computer system helped the doctor capture patient
040515 - history with contemporaneous record of organizational memory.  The
040516 - doctor patient partnership model of team care was supported with
040517 - reliance on an agenda to conduct a productive meeting. ref SDS 0 HX6J
040518 -
040519 -
040520 -
040522 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Agenda for Work Plan After Switching to Taxotere and Capecitabine
040902 -
040903 - Follow up ref SDS 93 SM6M, ref SDS 82 SM6M.
040904 -
040905 - This is the first review after a complete cycle following change in
040906 - treatment from AC to Taxotere and capecitabine (Xeloda) initiated on
040907 - 050329, ref SDS 82 T58M, and starting on 050415. ref SDS 86 0001
040909 -  ..
040910 - Millie created an agenda on the marking board...
040911 -
040912 -        CA 15-3 dramatic fall...................... ref SDS 0 GJ5M
040913 -        CT testing................................. ref SDS 0 NL4N
040914 -        Breast exam recovering IBC................. ref SDS 0 025H
040915 -        Surgeon examination review report.......... ref SDS 0 XQ41
040916 -        Treatment plan............................. ref SDS 0 AW5G
040917 -        Side Effects adjust dosage................. ref SDS 0 NT3I
040918 -        Drug Trial UCSF............................ ref SDS 0 L27G
040919 -        Bladder infection.......................... ref SDS 0 VT3O
040920 -        Dental cleaning............................ ref SDS 0 YU8N
040921 -
040922 -            [...see below doctor checked the agenda. ref SDS 0 HX5I
040923 -
040924 -
040925 -
040926 -
040927 -
0410 -

SUBJECTS
CA 15-3 67 Dramatic Fall from 105 Shows Favorable Response to Treatm

1203 -
120401 -  ..
120402 - CA 15-3 Cancer Marker 67 Dramatic Fall from 105
120403 -
120404 - Follow up ref SDS 93 087J, ref SDS 82 087J.
120405 -
120406 - Blood test on 050506 shows CA 15-3 dropped to 80 from 105 for the
120407 - prior test on 050415 reported during the meeting on 050422.
120408 - ref SDS 93 087J  Another test a week later on 050512 shows CA 15-3
120409 - dropped further down to 67.
120411 -           ..
120412 -          050512......... 67 H............. 050520, ref SDS 0 087J
120413 -          050506......... 80 H............. 050520, ref SDS 0 087J
120414 -          050415.........105 H............. 050422, ref SDS 93 087J
120415 -          050325.........100 H............. 050329, ref SDS 82 087J
120416 -          050318.........101 H............. 050325, ref SDS 80 2N5J
120417 -          050304......... 88 H............. 050311, ref SDS 74 087J
120418 -          050225......... 95 H............. 050308, ref SDS 73 0001
120419 -          050211......... 78 H............. 050214, ref SDS 71 02BB
120420 -          050128......... 67 H............. 050204, ref SDS 69 087J
120421 -          041228......... 56 H............. 041230, ref SDS 64 087J
120422 -          041204......... 43 H............. 041210, ref SDS 61 087J
120423 -          041007......... 39............... 041104, ref SDS 52 087J
120424 -          040923......... 49 H............. 041005, ref SDS 48 087J
120425 -          040908......... 44 H............. 040909, ref SDS 47 087J
120426 -          040825......... 47 H............. 040812, ref SDS 47 087J
120427 -          040811......... 42 H............. 040812, ref SDS 46 087J
120428 -          040728......... 43 H............. 040729, ref SDS 44 2N5J
120429 -          040712......... 47 H............. 040713, ref SDS 43 087J
120430 -          040614......... 55 H............. 040615, ref SDS 42 PX6X
120431 -          040517......... 78 H............. 040601, ref SDS 41 2N5J
120432 -          040311......... 70 H............. 040318, ref SDS 37 SM6M
120433 -          040205......... 60 H............. 040211, ref SDS 36 SM6M
120434 -          031201......... 62 H............. 031205, ref SDS 35 SM6M
120435 -          030912......... 66 H............. 030915, ref SDS 34 SM6M
120436 -          030708......... 68 H............. 030710, ref SDS 33 SM6M
120437 -          030503......... 54 H............. 030508, ref SDS 31 SM6M
120438 -          030403......... 45 H............. 030508, ref SDS 31 SM6M
120439 -          030215......... 46 H............. 030220, ref SDS 30 5E6L
120440 -          030106......... 37 H............. 030109, ref SDS 29 SM6M
120441 -          021202......... 41 H?............ 021204, ref SDS 28 SP5G
120442 -          021111......... 36 H?............ 021113, ref SDS 27 Y65I
120443 -          021023......... 33 H?............ 021023, ref SDS 26 SQ5I
120444 -          020930......... 33 H?..29........ 021002, ref SDS 25 SQ5I
120445 -          020917......... 36 H?............ 020924, ref SDS 24 SQ5I
120446 -          020717......... 59 H?............ 020726, ref SDS 23 YN5K
120447 -          020629......... 75 H ............ 020705, ref SDS 21 UX6I
120448 -          020608........  67 H ............ 020614, ref SDS 20 0001
120449 -          020603........ 108 H ............ 020607, ref SDS 19 X67F
120450 -          020511........ 117 H ............ 020603, ref SDS 18 PJ4J
120451 -          020419......... 81 H ............ 020430, ref SDS 17 7N5H
120452 -          020321......... 85 H ............ 020405, ref SDS 16 6T8K
120453 -
120454 -
120456 -  ..
1205 -
1206 -
1207 - Analysis
1208 -
120801 - CA 15-3 67 Cancer Marker Dramatic Decline Under New Treatment
120802 -
120803 - Follow up ref SDS 93 GJ5M, ref SDS 82 GJ5M.
120804 -
120805 - Since the last meeting, CA 15-3 has dropped twice, reflecting
120806 - significant clinical improvement in the left breast. ref SDS 0 025H
120807 - There was an interim drop from 105 on 050422, ref SDS 94 554O, to 87
120808 - several weeks ago, and another drop to 67 shown in the test last week.
120809 - ref SDS 0 087J
120811 -  ..
120812 - This demonstrates favorable response to treatment for the first time,
120813 - since 041104, ref SDS 51 GJ5M, and was achieved despite stopping
120814 - treatment temporarily due to severe side effects, reported on 050514.
120815 - ref SDS 97 QC8M
120816 -
120817 -
120818 -
120819 -
120820 -
120821 -
120822 -
1209 -

SUBJECTS
CT Test Ordered to Assess Progress of Recovery Based on Reduced CA 1

1303 -
130401 -  ..
130402 - CT Test Ordered Evaluate Progress New Protocol Taxotere Xeloda
130403 -
130404 - Follow up ref SDS 93 NL4N, ref SDS 82 NL4N.
130405 -
130406 - The doctor ordered another CT test for the week between the end of the
130407 - 3rd cycle, and beginning the 4th cycle.
130408 -
130409 -
130410 -
130411 -
130412 -
130413 -
1305 -

SUBJECTS
100% Growth Lymph Nodes Right Auxillary CT Test Ordered Review

1903 -
190401 -  ..
190402 - 100% Growth Lymph Nodes Right Auxillary CT Test Ordered Review
190403 -
190404 - Follow up ref SDS 93 B58M, ref SDS 64 B58M.
190405 -
190406 - Next CT test ordered today can check on indications of growth in lymph
190407 - nodes under right arm, reported on 050422, ref SDS 93 B58M, reviewing
190408 - the last CT test on 050325.
190409 -
190410 -     [On 050610 CT test on 050530 shows growth on righ axillary has
190411 -     stopped; swelled lymph nodes have subsided to less than 1 cm;
190412 -     findings this issue is almost totally resolved. ref SDS A5 B58M
190413 -
190414 -
190415 -
1905 -

SUBJECTS
Tingling Along Left Arm for Several Days Beginning before 050415 Not
Arm Lumps Lymph Nodes Left Axillary No Swelling Observed from Examin
Arm Swelled Lymph Nodes Under Right Arm Getting Bigger Testing with

2805 -
280601 -  ..
280602 - Lumps Under Arms No Clinical Examination No Problems Reported
280603 -
280604 - Follow up ref SDS 93 MW8J, ref SDS 82 MW8J.
280606 -  ..
280607 - Tingling sensations have not been repeated, since the meeting on
280608 - 050422. ref SDS 93 NM6J
280610 -  ..
280611 - There was no examination of left and right axillary.
280612 -
280613 -
280614 -
280615 -
2807 -

SUBJECTS
Neck Lumps No Evidence Left and Right Side Doctor Clinical Examinati
Neck Lumps Lymph Nodes Left Side No Examination Patient Reports Favo

3404 -
340501 -  ..
340502 - Lumps in Neck No Evidence of Swelling Indicating Cancer Receded
340503 -
340504 - Follow up ref SDS 93 8R6M, ref SDS 82 8R6M.
340505 -
340506 - No examination of the neck.
340507 -
340508 -
340509 -
340510 -
340511 -
3406 -

SUBJECTS
Wound Biopsy Left Breast Healing well after 2 Treatment Taxotere Cap

4203 -
420401 -  ..
420402 - Wound Biopsy Continues Healing with Treatment Taxotere Capecitabine
420403 -
420404 - Follow up ref SDS 93 6T5G, ref SDS 82 6T5G.
420405 -
420406 - The doctor examined the left breast and observed nearly healed biopsy
420407 - wound following the 2nd cycle treatment of chemotherapy for IBC with
420408 - Taxotere and capecitabine (Xeloda) beginning on 050415. ref SDS 86
420409 - 0001
420410 -
420411 -
420412 -
420413 -
420414 -
4205 -

SUBJECTS
Breast Examination Dramatic Recovery Inflammation Greatly Reduced Si

4703 -
470401 -  ..
470402 - IBC Improvement Reducing Inflammation Dramatically Using Xeloda
470403 - Redness IBC Dramatic Improvement IBC Major Change for Better
470404 - Blistering Sores Cancer Left Breast IBC Fully Subsided and Healed
470405 - Taxotere Capecitabine Xeloda Significant Improvement Treating IBC
470406 -
470407 - Follow up ref SDS 93 025H, ref SDS 82 025H.
470408 -
470409 - The doctor examined the left breast and concurred there has been
470410 - dramatic improvement with Taxotere and capecitabine (Xeloda) after
470411 - just 2 cycles of treatment beginning on 050415. ref SDS 86 407N
470412 - Improving IBC conditions supports the decision to change treatment on
470413 - 050329, ref SDS 82 T58M, and further supports continued efforts to
470414 - find a treatment level for Xeloda that the patient can tolerate.
470416 -  ..
470417 - The expanding area of inflammation observed by the surgeon on 050324,
470418 - ref SDS 78 YY7F, and earlier during the examination by the doctor on
470419 - 050311, ref SDS 74 UA8N, has now receded significantly in severity
470420 - and scope.  The red rash covers less area, and is much less intense.
470421 -
470422 -    [On 060806 IBC progressing rapidly after 1st cycle Taxotere
470423 -    capecitabine treating recurrence. ref SDS B8 7Q95
470425 -     ..
470426 -    [On 060922 case study indicates slower response to same treatment
470427 -    may be incorrect, and recovery may be the same or faster.
470428 -    ref SDS C0 0D4T
470430 -  ..
470431 - Cancerous bumps and sores that began appearing two (2) months ago, and
470432 - reported beginning in the meeting on 050311, ref SDS 76 UA8N, and
470433 - continuing through the last meeting on 050422, ref SDS 93 025H, have
470434 - now fully "dried up."
470436 -  ..
470437 - These observations reflect a big decline in CA 15-3 cancer marker, per
470438 - above, ref SDS 0 GJ5M, and continued improvement reported beginning on
470439 - 050502, ref SDS 95 EO5J, and again on 050510. ref SDS 96 EO5J  This
470440 - demonstrates favorable response to treatment for the first time, since
470441 - 041104, ref SDS 52 GJ5M, and was achieved despite stopping treatment
470442 - temporarily due to severe side effects, reported on 050514.
470443 - ref SDS 97 QC8M
470444 -
470445 -
470446 -
470447 -
4705 -

SUBJECTS
Management Standards Healthwise Handbook Communication Collaboration
Hectec Busy Being Busy Not Enough Time to Think Continual Bumbling I
Patient Organize Medical Record Organizational Memory Critical Facto
Surgery Examination on 050324 to Evaluate Readiness for Masectomy Pr

7406 -
740701 -  ..
740702 - Examination by Surgeon on Criteria for Masectomy
740703 -
740704 - Follow up ref SDS 93 XQ41, ref SDS 82 XQ41.
740705 -
740706 - The doctor noted improved prospects for surgery based on examination
740707 - showing improvement treating IBC, per above. ref SDS 0 025H  There was
740708 - no discussion of the surgeon's examination on 050324 to evaluate
740709 - performing a masectomy as treatment for "pockets of resistance" to
740710 - chemotherapy, ref SDS 78 GK9M, which was requested by the doctor on
740711 - 050311, ref SDS 74 XQ41, and deferred during the previous meeting on
740712 - 050329, ref SDS 82 X76G, and deferred again due a hectic schedule
740713 - during the meeting on 050422. ref SDS 93 XQ41
740715 -  ..
740716 - There was no discussion today of follow up examination on 050401 by
740717 - Doctor Choi, who recommended against surgery at that time. ref SDS 84
740718 - PPSU
740720 -  ..
740721 - Criteria for masectomy requested by the doctor on 050311, ref SDS 74
740722 - PA4N, is pending review of issues the patient discussed with surgery
740723 - on 050324. ref SDS 78 OV5H
740724 -
740725 -
740726 -
740727 -
740728 -
740729 -
7408 -

SUBJECTS
Taxotere Capeticabine (Xeloda) Chemotherapy Effectiveness Treatment

7803 -
780401 -  ..
780402 - Treatment Plan Chemotherapy Taxotere Capecitabine Continued
780403 - Taxotere Capecitabine (Xeloda) Chemotherapy Treatment Plan Continued
780404 -
780405 - Follow up ref SDS 93 AW5G, ref SDS 82 AW5G.
780406 -
780407 - After two (2) cycles of new treatments, and showing dramatic
780408 - improvement in patient recovery from IBC symptoms, per above,
780409 - ref SDS 0 025H, the doctor proposed continuing...
780411 -         ..
780412 -    a.  Taxotere and capecitabine (Xeloda) couplet to implement the
780413 -        work plan on 041230, ref SDS 64 D49F, and modified on 050329 to
780414 -        schedule four (4) cycles of treatment, ref SDS 82 FP57, based
780415 -        on the 2nd opinion received from Doctor Benz on 041117.
780416 -        ref SDS 53 OU6S
780418 -             ..
780419 -            [On 050617 completed 4th treatment. ref SDS A7
780420 -            407N
780421 -
780422 -
780423 -
7805 -

SUBJECTS
Diary Health Care Doctor Patient Partnership Medical Chart Patient H
Side Effects Minimal So Far Shown by Diary Patient History
Side Effects Increase Tolerance Exceeded Dose Capecitabine (Xeloda)

8805 -
880601 -         ..
880602 -    b.  Side Effects Rise So Reduce Dose Xeloda (Capecitabine)
880603 -        Dose Treatments Reduced to Reduce Side Effects Xeloda
880604 -
880605 -        Follow up ref SDS 93 NT3I, ref SDS 82 NT3I.
880606 -
880607 -        The doctor originally explained side effects of Taxotere and
880608 -        capecitabine (Xeloda) on 050329, ref SDS 82 NT3I; on 050415 the
880609 -        pharmacist submitted documents detailing side effects.
880610 -        ref SDS 86 7F8Q
880612 -         ..
880613 -        The doctor examined Millie's right foot, and observed evidence
880614 -        of blistering, which has significantly receded after treatment
880615 -        with capecitabine (Xeloda) treatment was stopped on 050514.
880616 -        ref SDS 97 QC8M
880618 -         ..
880619 -        The doctor discussed patient history from Millie's diary
880620 -        listing side effects in the record on 050422, ref SDS 93 JY3N,
880621 -        following Kaiser's instructions on 050415. ref SDS 86 XT5F  The
880622 -        doctor recognized Millie was only joking on 050516 when she
880623 -        told Kaiser's Advice nurse that death would be better than
880624 -        chemotherapy treatments with capecitabine, ref SDS 99 AQ6G,
880625 -        however, he recalled discussions on 030606 that chemotherapy
880626 -        eventually becomes intolerable for everybody, including those
880627 -        who are initially vital and strong, like Millie, ref SDS 32
880628 -        ED8H, which is why cancer is treated by switching patients to
880629 -        different treatments, reported on 041130.
880631 -         ..
880632 -        The doctor considered options to adjust the dose of
880633 -        capecitabine (Xeloda) planned in the record on 050516.
880634 -        ref SDS 99 BD4G
880636 -         ..
880637 -        The doctor changed the dose of capecitabine originally
880638 -        prescribed by Zan in the pharmacy on 050415. ref SDS 86 PP8L
880639 -        Treatment is reduced for capecitabine (Xeloda) by 25% to
880640 -        experiment for a level of treatment the patient can tolerate
880641 -        and will continue positive benefits reported today. ref SDS 0
880642 -        025H  Previously, 2-500 mg tablets were taken twice a day.  Now
880643 -        the patient will take 1 and 1/2  tablets twice a day.  Reducing
880644 -        from 4 to 3 tablets per day, is a 25% reduction.
880645 -
880646 -            [On 050527 side effects increase with peeling of hands for
880647 -            the first time. ref SDS A4 0001
880649 -             ..
880650 -            [On 050610 recovery from IBC continues with reduced dose of
880651 -            capecitabine (Xeloda). ref SDS A5 025H
880653 -             ..
880654 -            [On 050729 side effects escalate, very difficult to
880655 -            tolerate again, even with 25% reduced dose on 050520,
880656 -            ref SDS A8 DS5J, doctor maintains strength of capecitabine
880657 -            (Xeldoa) for two (2) more treatments to guard against
880658 -            another relapse. ref SDS A8 VP4N
880660 -             ..
880661 -            [On 050729 Vivian, the pharmacist, explained strategy to
880662 -            start patients with maximum strength of capecitabine
880663 -            (Xeloda), then experiment to reduce the dose down to a
880664 -            level patients can tolerate. ref SDS A9 407N
880666 -             ..
880667 -            [On 060721 Millie getting treatment with capecitabine again
880668 -            for 3rd relapse of IBC; dosage 1.5 pills per day specified
880669 -            again. ref SDS B7 FQ9M
880670 -
880671 -
880672 -
8807 -

SUBJECTS
Trial Chemotherapy New Drug Treatment UCSF Millie Asks Primary Care

9103 -
910401 -         ..
910402 -    c.  Trial Chemotherapy New Drug Treatment UCSF
910403 -        New Drug Trial Chemotherapy Treatment UCSF
910404 -
910405 -        Millie asked about a new breast cancer treatment trial recently
910406 -        announced at UCSF in the Summer edition of the...
910407 -
910408 -               Carol Franc Buck
910409 -               Breast Care Center
910410 -               Newsletter
910411 -
910412 -        ...which says in part on page 7...
910414 -             ..
910415 -            AG 013736 in Combination with Codetaxel versus
910416 -            Docetaxel Alone in Patients wtih Metastatic Breast
910417 -            Cancer
910419 -             ..
910420 -            Doctor Hope Rugo and her team are conducting a
910421 -            research study to evaluate the safety and
910422 -            effectiveness of an oxperimental drug called AG
910423 -            013736, which is manufactured by Pfizer, together
910424 -            with an approved cancer drug, docetaxel (Taxotere),
910425 -            as a therapy to treat metastatic breast cancer.  The
910426 -            main purpose of this part of the study is to
910427 -            determine if giving docetaxel and AG 013736 is better
910428 -            than giving docetaxol by itself, and to see whether
910429 -            this combination controls metastatic cancer for
910430 -            longer than the chemotherapy alone.
910432 -             ..
910433 -            For more information..., please contact Mary O'Rouke
910434 -            at 415 353 9612
910436 -         ..
910437 -        The doctor today indicated Millie may not qualify for this
910438 -        trial because of already being treated with Taxol, or for some
910439 -        other reason that was not clear during the meeting.
910440 -
910441 -            [On 050909 Doctor Lisa Bailey plans to discuss Millie's
910442 -            case for participating in a drug trial sponsored by Doctor
910443 -            Parks at UCSF. ref SDS B1 UQ5F
910445 -         ..
910446 -        There was discussion of contacting Doctor Benz who examined
910447 -        Millie at UCSF on 041018, ref SDS 50 0001, and a month later on
910448 -        041117 submitted an opinion, ref SDS 53 6L9O, which recommended
910449 -        treatment with capecitabine, ref SDS 53 OU5V, including the
910450 -        current treatment of couplets capecitabene-Taxotere, begun on
910451 -        050415. ref SDS 86 407N  Doctor Benz further said in his 2nd
910452 -        opinion letter that UCSF could be contacted on future drug
910453 -        trials. ref SDS 53 OV3T
910455 -         ..
910456 -        No other options for treatment were discussed today.
910457 -
910458 -            [On 050823 Millie asks UCSF about new treatment trial at
910459 -            UCSF. ref SDS B0 7I5Y
910460 -
910461 -            [On 060711 Millie relapses; primary care physician
910462 -            coordinating with protocol nurse to find drug trials that
910463 -            may arrest progression of disease. ref SDS B6 ED4K
910464 -
910465 -
910466 -
9105 -

SUBJECTS
Bladder Infection Urinary System Temperature 100.4 Compounds Cancer

9403 -
940401 -  ..
940402 - Urinary Tract Infection Temperature 100.4 Keflex Prescribed
940403 - Bladder Infection Compounds Cancer Treatments and Recovery
940404 -
940405 - Millie reported a new problem of bladder infection, beginning
940406 - yesterday.  Today, seems improved, but still discomfort urniating.
940408 -  ..
940409 - Temperature was elevated to 100.4 today, when the nurse took vitals to
940410 - begin the meeting.  This was startling because guidance for
940411 - chemotherapy patients is to visit the emergency room when the
940412 - temperature reaches 100.5, based on prior experience with the cat bite
940413 - problem, reported on 041202. ref SDS 58 IX9N
940415 -  ..
940416 - Millie is planning a trip tomorrow taking a train to Grand Junction,
940417 - Colorado visiting her sister's family.
940419 -  ..
940420 - Doctor ordered urnialysis which requires a lab sample after the
940421 - meeting.
940422 -
940423 -        [...see below visited lab. ref SDS 0 JP9F
940425 -  ..
940426 - Doctor prescribed Keflex for 10 days, and advised that if the
940427 - temperature comes down by tomorrow, there is no problem for Millie to
940428 - take the train ride for a 4 day vactaion to Colorado.
940429 -
940430 -        [...see below purchase Keflex at pharmacy. ref SDS 0 PRPW
940431 -
940432 -        [On 050521 after taking prescribed Keflex, temperature drops to
940433 -        98.9; so, Millie left on the trip to Colorado. ref SDS A3 6H6O
940434 -
940435 -
940436 -
940437 -
9405 -

SUBJECTS
Dental Cleaning Important for Chemotherapy Patients to Detect Infect

9703 -
970401 -  ..
970402 - Dental Cleaning Important for Chemotherapy Patients
970403 -
970404 - Reviewed discussions on 050518 with the dentist noting that regular
970405 - dental cleaning is recommended for cancer patients to reduce the
970406 - chance of infection. ref SDS A0 F779  The dentist advised Millie this
970407 - past October that she needs work to repair a bridge.
970409 -  ..
970410 - The doctor indicated today that routine dental cleaning is a good idea
970411 - for prevention and early detection of infection that avoids problems
970412 - like infection from the cat bite Millie suffered on 050212 that placed
970413 - her in "fairly dangerous" peril. ref SDS 70 OV5I
970414 -
970415 -     [On 050610 dental examination for infection scheduled on 050616.
970416 -     ref SDS A5 YU8N
970418 -  ..
970419 - He further indicated that undergoing more extensive "surgical" dental
970420 - work to eliminate infection, also, reported on 050518, ref SDS A0
970421 - FB7Y, is not a common practice for chemotherapy patients, because the
970422 - bigger risk is dental care causing infection due to reduced immune
970423 - strength.  Routine cleaning often includes examination with xray
970424 - imaging, which will disclose whether there is a pre-existing problem
970425 - of infection that needs attention.  The current regimine of
970426 - chemotherapy treatments will be ending in about 6 weeks.  That may
970427 - provide a window of opportunity for dental work, if needed.
970428 -
970429 -
970430 -
970431 -
970432 -
970433 -
9705 -

SUBJECTS
Medical Chart Legible Meeting Minutes Contemporaneous Record Meeting

BY03 -
BY0401 -  ..
BY0402 - Continual Exposure Good Management Drives Transformation
BY0403 - Medical Chart Contemporaneous Legible Record Improves Practice
BY0404 - Doctor Patient Partnership Leverages Medical Training Rely on Agenda
BY0405 - Contemporaneous Patient History Improves Diagnosis Treatment Planning
BY0406 -
BY0407 - During the meeting today, the doctor used Kaiser's new computer system
BY0408 - to invest time entering a record of discussion with the patient, the
BY0409 - examination, diagnosis and treatment planning.  He did considerable
BY0410 - cross checking of sources, and editing to refine understandings, which
BY0411 - fits the model of quality control discussed in POIMS for thinking
BY0412 - through writing. ref OF 7 3742  This editing led to further discussion
BY0413 - and examination that clarified understandings to correct initial error
BY0414 - from spontaneous first impressions, similar to Morris' first
BY0415 - experience using SDS on 910520. ref SDS 1 655O
BY0417 -  ..
BY0418 - Kaiser begins a new era advancing medical practice with transformation
BY0419 - toward a "paperless office," Knowledge Management model using computer
BY0420 - networks to construct, store, and retrieve contemporaneous record on
BY0421 - patient history for organizatgional memory in the medical chart.
BY0422 - Using computers for fast, accurate patient history strives to
BY0423 - implement the Bush vision in 1945 to use computers for records
BY0424 - managment, reported on 960304. ref SDS 4 BE6L  Faster access to
BY0425 - legible records on patient history in the medical chart helps reduce
BY0426 - communication problems that cause mistakes, reported in a national
BY0427 - study reviewed on 990912. ref SDS 8 0960  Better communication and
BY0428 - records management improves analysis for diagnosis and treatment
BY0429 - planning.  On 041230 the doctor noted benefits of planning for
BY0430 - effective treatment, ref SDS 64 LU6K, discussed previously on 041130.
BY0431 - ref SDS 54 YR8F
BY0432 -
BY0433 -     [On 051121 Kaiser email support for doctor/patient partnership
BY0434 -     communication. ref SDS B2 V25O
BY0436 -      ..
BY0437 -     [On 060106 doctor progress toward working inteligently using new
BY0438 -     email system for submitting work plan to patient drawn from
BY0439 -     electronic medical chart stored on Kaiser's computer. ref SDS B3
BY0440 -     FE4I
BY0442 -      ..
BY0443 -     [On 060317 Knowledge Management goals for network centric
BY0444 -     organization explained at Boeing. ref SDS B4 KR5G
BY0446 -      ..
BY0447 -     [On 060428 doctor begins making electronic distribution of
BY0448 -     computer medical chart for collaboration with the patient that
BY0449 -     enables feedback to refine accuracy. ref SDS B5 FE4I
BY0451 -      ..
BY0452 -     [On 060821 Doctor Benz at UCSF 2nd opinion consultation relied on
BY0453 -     Kaiser's false and misleading report in the medical chart that the
BY0454 -     patient was being treated with warfarin (Coumadin) for pulmonary
BY0455 -     embolism; reliance was induced by improved legibility enabled by
BY0456 -     computer technology. ref SDS B9 PM4N
BY0458 -  ..
BY0459 - Capturing personal and organizational memory invests intellectual
BY0460 - capital (see POIMS, ref OF 5 1101) that pays off by reducing mistakes
BY0461 - (see NWO, ref OF 11 0742), which is especially common in the complex
BY0462 - practice of health care, reported on 990912, ref SDS 7 0001, and
BY0463 - illustrated by work on 041230 when the doctor asked why chemotherapy
BY0464 - treatments with Adriamycin and Cytoxin had been stopped two (2) years
BY0465 - earlier, ref SDS 61 XQ84, which was critical to prescribing this
BY0466 - treatment, as recommended a few weeks earlier in a 2nd opinion by the
BY0467 - Stanford Cancer Center in a letter received on 041209. ref SDS A4 SN88
BY0468 -
BY0469 -     [On 061024 case study medical practice computer access limited
BY0470 -     even with everything on the computer, people can't find details
BY0471 -     stored in parts of the computer (software modules) that are not
BY0472 -     frequently used. ref SDS C1 JD9L
BY0474 -      ..
BY0475 -     [On 061110 review of medical chart shows numerous errors and
BY0476 -     omissions. ref SDS C2 FE4I
BY0478 -      ..
BY0479 -     [On 061208 mistakes, errors, and omissions compound in electronic
BY0480 -     medical chart stored on the computer network cannot be corrected
BY0481 -     because Kaiser "locks down" the record after the doctor meets with
BY0482 -     the patient; prevents feedback loops called out in Healthwise
BY0483 -     Handbook from correcting the medical chart. ref SDS C3 N54K
BY0485 -      ..
BY0486 -     [On 070126 case study everybody giving up on 3 goals for Knowledge
BY0487 -     Management. ref SDS C4 QH8L
BY0489 -      ..
BY0490 -     [On 070307 feedback resisted to avoid stress of correcting
BY0491 -     mistakes; high stress prevents refining accuracy of record,
BY0492 -     causing errors and omissions to compound. ref SDS C5 G56L
BY0494 -  ..
BY0495 - The doctor commented on a recent demonstration of a new work station
BY0496 - which Kaiser plans to deploy that will give doctors more efficient use
BY0497 - of technology with an ergonomic design.  The current configuration of
BY0498 - the doctor's computer in the examination room is awkward, which slows
BY0499 - productivity and discourages use, reflecting the report on 000307 that
BY0500 - good management using traditional methods is a lot of hard work.
BY0501 - ref SDS 94 5182  Therefore, effort today capturing a greater share of
BY0502 - the record in real-time took considerable motivation.  The record on
BY0503 - 910520 illustrates how ergonomics play a big role in software design
BY0504 - to increase productivity. ref SDS A3 JE6M
BY0506 -  ..
BY0507 - Additionally, the doctor was careful to check the agenda listed by the
BY0508 - patient on the marking board to ensure comprehensive consideration of
BY0509 - all pending and new matters. ref SDS 0 NO6O  At one point, the doctor
BY0510 - looked up at the marking board, and said...
BY0511 -
BY0512 -      Okay, what's next!
BY0514 -  ..
BY0515 - This application of the intelligence cycle set out in POIMS,
BY0516 - ref OF 6 6649, shows marked progress toward an effective doctor
BY0517 - patient partnership by performing current work based on an agenda
BY0518 - drawn from an accurate record of organizational memory for patient
BY0519 - history, rather than reliance on hazy personal memory and illegible
BY0520 - scribbles in a conventional medical chart that barely reveal the gist
BY0521 - of the story, reported on 041014. ref SDS 49 W78K
BY0523 -  ..
BY0524 - Progress today demonstrates attitudes change with relentless pressure
BY0525 - from continual exposure to good management the past several years,
BY0526 - beginning on 020321. ref SDS 95 0001  It may reflect experience at the
BY0527 - last meeting on 050422, ref SDS 93 9V8M, when another patient asked
BY0528 - the doctor about a record she found on the Internet with patient
BY0529 - history. ref SDS 90 VQ3O  Seeing how comprehensive work history and
BY0530 - analysis aids understanding for diagnosis and treatment planning may
BY0531 - have contributed to the doctor's effort today.
BY0532 -
BY0533 -     [On 051121 Kaiser email support for doctor/patient partnership
BY0534 -     communication. ref SDS B2 V25O
BY0536 -  ..
BY0537 - After the meeting, Millie remarked that today seemed to demonstrate a
BY0538 - marked change in performance using good management to capture a
BY0539 - contemporaneous record, and to edit the record while talking to the
BY0540 - patient in order refine accuracy understanding events, correlations,
BY0541 - implications and nuance.  This change in conduct reflects how
BY0542 - attitudes change.  People care about accuracy when improvement is
BY0543 - within reach.
BY0545 -  ..
BY0546 - Kaiser deserves credit for one of the few comprehensive efforts to
BY0547 - implement a paperless office model, as a component of Knowledge
BY0548 - Management.
BY0549 -
BY0550 -        [On 070126 case study shows 3 primary goals of Knowledge
BY0551 -        Management have all failed, ref SDS C4 IQ5L; and most every
BY0552 -        organization that has tried to develop tools and practices that
BY0553 -        improve management have failed, e.g., research at SRI on
BY0554 -        000324, ref SDS 98 4877; CRTI project reported on 000420,
BY0555 -        ref SDS 12 4911; IBM could not transform Lotus Notes into KM,
BY0556 -        001130. ref SDS 13 F26K
BY0557 -
BY0558 -
BY0559 -
BY06 -

SUBJECTS
Bladder Infection Urinary System Temperature 100.4 Compounds Cancer

C003 -
C004 - 1120
C00501 -  ..
C00502 - Purchase Medications at Kaiser Pharmacy
C00503 -
C00504 - Visited Pharmacy on 2nd Floor after meeting with the doctor.
C00505 -
C00506 - Received prescription for Keflex....
C00507 -
C00508 -    Cephalexin 250 MG capsules
C00510 -     ..
C00511 -    Rx #512 988685
C00513 -     ..
C00514 -    Take 1 capsule only 3 times a day.
C00515 -
C00516 -
C00518 -  ..
C006 -
C007 -
C008 - 1139
C00901 -  ..
C00902 - Lab Tests to Evaluate Urinary Infection
C00903 -
C00904 - Visited the Lab on the 1st Floor.
C00905 -
C00906 - Millie gave a urine sample for the urinalysis ordered by the doctor to
C00907 - assess new report today of a bladder problem. ref SDS 0 YQ6K
C00908 -
C00909 -
C00911 -  ..
C010 -
C011 -
C012 - 1523
C01301 -  ..
C01302 - Bladder Infection Sick Temperature 100.4
C01303 - This afternoon, Millie said
C01304 - she is not feeling well.
C01306 -  ..
C01307 - At 1500 she took a Keslex pill for the bladder infection.
C01309 -  ..
C01310 - She reported feeling chilled, and so put on a robe over her clothing,
C01311 - even though the temperature in the house is about 73 degrees, because
C01312 - the weather has warmed up to about 78 outside today.
C01314 -  ..
C01315 - Her temperature is still 100.4.
C01316 -
C01318 -  ..
C014 -
C015 -
C016 - 1817
C017 -
C01701 - This evening, Millie did not eat much dinner.  We had spagetti, which
C01702 - she likes, so loss of appetitie is a concern.
C01703 -
C01704 -
C01706 -  ..
C018 -
C019 -
C020 - 2200
C021 -
C02101 - Millie took another Keflex pill for the bladder infection problem.
C02102 - ref SDS 0 JJ5J
C02103 -
C02104 -
C02105 -
C02106 -
C02107 -
C02108 -
C02109 -
C02110 -
C02111 -
C02112 -
C02113 -
C02114 -
C02115 -
C02116 -
C02117 -
C02118 -
C02119 -
C022 -