CONTACTS
SUBJECTS
Magnesium Replacement Treatment Ordered Blood Counts Magnesium 1.5 B
1603 -
1603 - ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 69 0000. ref SDS 67 0000.
160502 -
160503 -
160504 -
160506 - ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - Brigid received the copy of Millie's letter yesterday to Kaiser,
160902 - ref SDS 70 TR5O, confirming understandings about getting treatment
160903 - with Neupogen for low blood counts. ref SDS 70 TS5U
160904 -
160906 - ..
160907 - Magnesium 1.5 Low Millie Treated with Magnesium Replacement
160908 -
160909 - Follow up ref SDS 68 XQ6L, ref SDS 48 4F9G,.
160910 -
160911 - Brigid advised that Jackie added magnisum to the blood test yesterday.
160912 - Results reported today show Magnesium 1.5, which is below the target
160913 - range of 1.8. ref SDS 69 CP6J
160915 - ..
160916 - This corrects the problem reported yesterday that Magnesium was
160917 - missing from the blood test report, ref SDS 68 XQ6L, which occurred
160918 - previously on 080110, ref SDS 45 JH6F, and was then corrected, as
160919 - reported a week later on 080117. ref SDS 48 4F9G Protocol for
160920 - cetuximab and Carboplatin clinical trial specifies blood tests for
160921 - Magnesium every 4 weeks, shown on 080313. ref SDS 65 2N6N
160923 - ..
160924 - The doctor wants Millie to get...
160925 -
160926 - magnesium replacement
160927 -
160928 - ...medication in addition to Neupogen prescribed yesterday during the
160929 - meeting at UCSF, ref SDS 68 XV4G, and reported to Kaiser by Millie's
160930 - letter latter in the afternoon. ref SDS 70 TS5U This can be an oral
160931 - or an IV treatment at Millie's preference. Brigid indicated in the
160932 - call that "magnesium replacement" is the full extent of the
160933 - prescription.
160935 - ..
160936 - [On 080405 Pharmacist discloses Kaiser does not sell products
160937 - for Magnesium Replacement; customers must buy Calcium and
160938 - Magnesium dietary supplement tablets taken 3 times a day for
160939 - multiple days. ref SDS 71 J23S
160941 - ..
160942 - [On 080409 notify primary care physician of discrepancies
160943 - in the work performed by Kaiser pharmacy. ref SDS 72 OP4O
160945 - ..
160946 - [On 080410 blood test shows Magnesium 1.9 which is within
160947 - the target range, and indicates effective treatment ordered
160948 - by UCSF on 080404. ref SDS 75 RW6F
160949 -
160950 -
160951 -
160952 -
1610 -
SUBJECTS
Referral Coordination Failure UCSF Resists Notify Kaiser Medication
4503 -
450401 - ..
450402 - Referral Coordination UCSF Resists Notifying Kaiser Medication Change
450403 - Collaboration Coordination UCSF Notify Kaiser Prescription Magnesium
450404 -
450405 - Discussed Brigid contacting Arlette at Kaiser to coordinate additional
450406 - treatment, as Jackie did for the CT test ordered yesterday at UCSF,
450407 - ref SDS 68 669L, shown by Millie's letter confirming understandings,
450408 - also, reported yesterday. ref SDS 70 TS4Q
450410 - ..
450411 - Previously on 071213, Brigid coordinated with Catherine to prescribe
450412 - adding Magnesium treatment at UCSF in the Infusion Clinic. ref SDS 37
450413 - S24K Brigid advised today, that she does not want to coordinate the
450414 - work because referral coordination with Kaiser takes more time than
450415 - internal coordination at UCSF.
450417 - ..
450418 - Brigid explained that she does not know Arlette, and has no experience
450419 - working with Kaiser. Brigid does not want to contact Jackie to
450420 - coordinate with Arlette, and she does want to coordinate with Jackie
450421 - to get Arlette's telephone number, nor does she want Arlette's
450422 - telephone number from the patient. Brigid does not want
450423 - responsibility for contacting Kaiser, because this takes a lot of
450424 - time. She said that for many patients she can call the pharmacy
450425 - directly for a referring agency, like Kaiser in this case, and order
450426 - treatments, but Kaiser does not provide this level of customer
450427 - support.
450429 - ..
450430 - [...below in this record today on 080404 1440 Brigid notes
450431 - coordination is difficult for comprehensive medical care,
450432 - and is even harder for complex case management between
450433 - hospitals treating referral patients. ref SDS 0 SE5L
450435 - ..
450436 - Brigid's report today that coordinating referral work with Kaiser to
450437 - order Magnesium medication for Millie from Kaiser takes too much time
450438 - aligns with Doctor Rugo discussing difficulties yesterday on 080403
450439 - ordering Neupogen from Kaiser. ref SDS 68 IM87 This record conflicts
450440 - with the report from Kaiser on 070710 that communication with UCSF on
450441 - Millie's referral treatment was effective. ref SDS 26 OG7F
450443 - ..
450444 - [On 080410 UCSF refused to respond to written request for
450445 - medical status to disability entitlement; proposed patient
450446 - use telephone for conversation to perform case management,
450447 - ref SDS 74 PT4M, contrary to UCSF report on 080403 that
450448 - reliance on conversation using the telephone phone tag does
450449 - not support effective case management. ref SDS 68 IM87
450451 - ..
450452 - Brigid advised the best solution to recover from the blood test
450453 - mistake is for Millie to go to UCSF and get supplemental IV treatment
450454 - for Magnesium Replacement in the Infusion Clinic for clincial trial
450455 - standard of care, as occurred previously on 071213. ref SDS 38 HH5I
450456 - This is effective, because she can write a prescription in a few
450457 - seconds someone; she can call the Infusion Clinic and can coordinate
450458 - the work in seconds, rather than minutes and hours. It is fast and
450459 - easy, requiring essentially zero cognitive overhead, explained in NWO.
450460 - ref OF 15 LH6K
450462 - ..
450463 - Of course this solution that takes the health care professional
450464 - seconds and zero diligence, may take 3 - 6 hours for the patient to
450465 - drive to San Francisco, get the treatment, and return to Concord in
450466 - the middle of commute traffic, with attendant frustrations and risks.
450468 - ..
450469 - Brigid suggested that since Millie needs Neupogen, possibly Kaiser can
450470 - give both Neupogen, and the Megnesium replacement at the same time.
450471 - This would save time, since accurate work by a professional only takes
450472 - a few seconds. She asked that since Millie coordinated with Kaiser on
450473 - prescribing Neupogen, as requested by Doctor Rugo yesterday,
450474 - ref SDS 68 SG7I, the patient can perform additional referral
450475 - coordination with Kaiser today to add Magnesium treatments.
450476 -
450477 - [...below Arlette at Kaiser coordinating with the doctor to
450478 - schedule IV treatment at the Kaiser Infusion Clinic for Neupogen
450479 - and Magneseum medications prescribed by UCSF. ref SDS 0 JV97
450481 - ..
450482 - [...below Arlette reports doctor ordered Neupogen treatment; wants
450483 - Millie to get the medication from the Kaiser Pharmacy at Park
450484 - Shadelands. ref SDS 0 JW6J
450486 - ..
450487 - [On 080423 UCSF applies doctor patient partnership again
450488 - requests scope of blood draw from patient that is prescribed in
450489 - the Chemotherapy Orders issued by the doctor. ref SDS 76 1P6M
450491 - ..
450492 - The patient agreed to support referral coordination, and needs the
450493 - exact prescription UCSF orders in order to accurately perform the
450494 - work.
450495 -
450497 - ..
450498 - Accuracy Give Up Not Enough Time Writing Verify Conversation
450499 - Literacy Declines Reliance on Conversation without Authentication
450500 - Writing Feedback Loops Resisted for Accuracy Medical Prescriptions
450501 -
450502 - Follow up ref SDS 68 4U9O.
450503 -
450504 - Requested that Brigid respond to the letter yesterday coordinating
450505 - Neupogen, ref SDS 70 TS5U, and confirm the explanation in this telecon
450506 - that the doctor at UCSF has ordered further treatment for "Magnesium
450507 - replacement." She can clarify any details of the prescription Millie
450508 - needs so there is less chance for misunderstanding by Kaiser that
450509 - occurs in verbal conversation.
450511 - ..
450512 - Brigid feels feedback loops writing a letter for comprehensive care to
450513 - confirm discussion conveying prescriptions written in the medical
450514 - chart for medications takes extra time that is unnecessary
450515 - duplication, since she writes down the record of this telecon in the
450516 - UCSF medical chart to make sure everything is understood correctly.
450517 - She noted that relying on assumptions from memory of conversation in
450518 - meetings and calls is effective for other patients in her practice at
450519 - UCSF. Brigid asked why invest time writing a prescription for
450520 - patients to take to the pharmacy, when talking in meetings and on the
450521 - telephone, like today, seems so fast and easy?
450522 -
450523 - [On 080405 Kaiser pharmacy has no products for "Magnesium
450524 - Replacement; Kaiser sells the patient Calcium Magnesium
450525 - supplement pills. ref SDS 71 J24F
450527 - ..
450528 - The patient needs precisely what is written in the medical chart in
450529 - order to avoid mistakes coordinating verbal guidance ordering
450530 - medications. Traceability to original sources is an ISO industry
450531 - standard for accuracy to reduce mistakes by authenticating verbal
450532 - communications, reported on 950721. ref SDS 3 1740
450534 - ..
450535 - Written communication was requested yesterday on 080403 by Doctor Rugo
450536 - at UCSF, and in order to verify accuracy of coordinating work with
450537 - Kaiser. ref SDS 68 4U9O For the same reason, the patient needs
450538 - written confirmation of new instructions today that expand prior
450539 - understandings.
450540 -
450541 - [On 080410 UCSF wants patient to call so that someone can
450542 - document a call rather than respond to documentation submitted
450543 - by the patient. ref SDS 74 U59F
450545 - ..
450546 - Verbal communication causes errors when not confirmed in writing due
450547 - to variables in biology of speaking and hearing, commonly called the
450548 - "telephone game," cited in NWO. ref OF 11 XF5H UCSF explains
450549 - treatments in meetings, then writes a prescription, rather than rely
450550 - on people to remember what was said, shown by the record on 080313.
450551 - ref SDS 65 4E9N The report on 990912 shows communication is the
450552 - biggest cause of medical mistakes. ref SDS 6 0001 Andy Grove at Intel
450553 - notes mental maps are awfully forgiving of ambiguity, reviewed on
450554 - 980307. ref SDS 4 3668 People pay a price for relying on assumptions
450555 - to fill in the gaps from ambiguity in conversation that is not
450556 - authenticated by writing to verify accuracy, shown by research on
450557 - 900303. ref SDS 1 F999
450559 - ..
450560 - An example is the communication snafu at UCSF on 080306 that delayed
450561 - treatment delivering the order to the wrong place, reported by Jackie.
450562 - ref SDS 63 EX4I
450564 - ..
450565 - Writing things down increases accuracy by orders of magnitude that
450566 - makes people "superhuman," compared to reliance on assumption from
450567 - memory, reported on 010622. ref SDS 8 N668 Standards for medical
450568 - practice require writing things down rather than rely on memory, shown
450569 - by Kaiser's Healthwise Handbook, reviedwed on 990625. ref SDS 5 3960
450571 - ..
450572 - Drucker notes people have given up on improving management because
450573 - communication is too complex, reported on 931130. ref SDS 2 3851
450575 - ..
450576 - Review on 991108 shows cultural pressures that cause reliance on
450577 - literacy to decline on the job. ref SDS 7 1092 Knowledge Management
450578 - professionals and educators object to accuracy because avoiding
450579 - mistakes takes extra time that slows conversation, reported on 020820.
450580 - ref SDS 10 V66I Similarly, NASA reported on 030826 that loss of the
450581 - Columbia Space Shuttle costing billions of dollars reflects skills of
450582 - engineering professionals interpret good management practices to
450583 - verify accuracy as suggestions that take extra time, rather than
450584 - requirements for investing time to save lives, time, and money.
450585 - ref SDS 11 8K4G Case study on 020504 show people feel enormous
450586 - pressure to ignore requirements for good management in law,
450587 - regulations, contracts, and professional standards. ref SDS 9 NS6F
450589 - ..
450590 - [On 080409 UCSF reliance on verbal communication for treatment
450591 - medication prescriptions aligns with Kaiser practices in the
450592 - Emergency Room, because doctor does know how to use computer to
450593 - write things down. ref SDS 73 F194
450595 - ..
450596 - [On 080410 UCSF wants patient to call so that someone can
450597 - document a call rather than respond to documentation submitted
450598 - by the patient. ref SDS 74 U59F
450600 - ..
450601 - Of course in an emergency time is compressed. People are forced to
450602 - work by conversation. Telling someone to turn down the heat when the
450603 - pot boils over is effective because timely action is needed and
450604 - context is clear. For more complex activity, like ordering
450605 - medication, especially for the first time, as here ordering Magnesium
450606 - for oral treatment, ref SDS 0 O142, introduces ambiguity about what
450607 - precisely should be done, not for the experienced, expert health care
450608 - professional, but for the patient who is nervous about past mistakes.
450610 - ..
450611 - The oral treatment option seems to have a great many variables. How
450612 - many milligrams in a pill? How many pills to take in day, how often,
450613 - for how long? What precisely does the over-the-counter box say?
450614 - Will anything with "Magnesium" on the box be okay?
450616 - ..
450617 - Accordingly, if there is enough time, submitting written confirmation
450618 - by email, as Brigid did for the Cellulitis matter last month on
450619 - 080304, ref SDS 62 B18J, is the best prescription for effective case
450620 - management.
450622 - ..
450623 - The challenge is to avoid the slippery slope of sloppy work relying
450624 - solely on conversation that seems fast and easy, like fools gold, even
450625 - when there is time for good management. Since the consequences of
450626 - poor communciation are usually delayed, people get accustom to working
450627 - by converstation, and soon nothing is verified. Requests for good
450628 - practice cause anger and resentment as intrusive, unncessary overkill,
450629 - duplicating what everybody knows. An example is the record on 041130
450630 - asking the doctor for a written explanation of treatments available to
450631 - care for Millie. ref SDS 13 YR8F
450633 - ..
450634 - This challenge can be met with good will through the doctor-patient
450635 - partnership that saves time for the medical professional while
450636 - creating a written record that increases accuracy to reduce mistakes.
450638 - ..
450639 - Brigid feels that coordination is difficult for comprehensive care,
450640 - and that coordinating medical care for referral patients increases
450641 - complexities of case management. She said that sometimes things "slip
450642 - through the cracks" due to a hectic schedule, like today, because
450643 - there is not enough time to very accuracy, per above. ref SDS 0 O166
450645 - ..
450646 - Previously on 070517, Brigid cited difficulties coordinating between
450647 - hospitals for accurate test reports. ref SDS 24 CV6K
450649 - ..
450650 - Today, Brigid proposed that instead of UCSF writing a letter to Millie
450651 - with accurate presentation of complex verbal instructions, which she
450652 - has written in the UCSF medical chart, per above, ref SDS 0 BH6G,
450653 - Millie can write a letter to UCSF with recollections from memory of
450654 - what has been said in the call and which Brigid indicates is also
450655 - written in the medical chart. This will save time for Brigid, and if
450656 - there is a mistake in the letter, Brigid will submit clarifications to
450657 - correct the record, following the procedure requested by Doctor Rugo
450658 - at UCSF yesterday. ref SDS 68 4U9O
450660 - ..
450661 - Explained the patient is pleased to support UCSF case management by
450662 - writing a letter to Kaiser. Would like to get precisely what is being
450663 - prescribed by UCSF in order to prepare the letter to Kaiser which
450664 - Brigid requests be submitted by the patient.
450666 - ..
450667 - Brigid feels there is not enough time to support the patient with a
450668 - letter showing what is proposed.
450669 -
450670 -
450671 -
450672 -
4507 -
SUBJECTS
Magnesium Replacement Treatment Prescribed b UCSF Ordered from Kais
6303 -
6304 - 1447
630501 - ..
630502 - Patient Performs Case Management Referral Coordination Magnesium
630503 -
630504 - Millie submitted ref DIT 1 0001 to the primary care physician at
630505 - Kaiser with copy to Arlette, and to the medical team at UCSF...
630506 -
630507 - 1. Brigid called this afternoon and advised that after my
630508 - treatment yesterday at UCSF, Magnesium was added to the scope
630509 - of the blood test. Results today show Magnesium 1.5, which is
630510 - below the 1.8 target range, ref SDS 0 O059, as shown in the
630511 - revised test report. ref SDS 69 CP6J, ref DIT 1 0001
630513 - ..
630514 - 2. Doctor Rugo has ordered "Magnesium Replacement" to increase my
630515 - blood counts. ref SDS 0 OP6U, ref DIT 1 US6G
630517 - ..
630518 - 3. This supplements the order yesterday for Neupogen. ref SDS 70
630519 - TS5U, ref DIT 1 OL6J
630521 - ..
630522 - 4. Can you please arrange for me to come in later today, tomorrow,
630523 - or at the latest on Monday to get both Neupogen and Magnesium
630524 - Replacement treatments. ref DIT 1 US6M
630526 - ..
630527 - 5. Arlette called this morning, and indicated she would coordinate
630528 - the Neupogen matter. I will call and follow up to incorporate
630529 - magnesium. ref DIT 1 US7I
630530 -
630531 - [...below, Arlette calls back with instructions
630532 - implementing doctor's orders on Neupogen treatment in the
630533 - Infusion Clinic. ref SDS 0 JW6J
630534 - ..
630535 - Millie's letter to Kaiser continues...
630536 -
630537 - 6. Thanks to Brigid for timely notice. Please correct or clarify
630538 - these understandings as needed. ref DIT 1 US7N
630540 - ..
630541 - 7. Just a heads up -- I was able to go hiking 3+ miles today,
630542 - which is the steroids working from yesterday. Hoping to go to
630543 - the gym tomorrow, but we'll see. ref DIT 1 US7S
630544 -
630545 -
630546 -
630548 - ..
6306 -
6307 -
6308 - 1555
6309 -
630901 - Called Arlette, per planning in Millie's letter to Kaiser, earlier
630902 - today for Millie to get treatment in the Infusion Clinic for Neupogen
630903 - and Magnesium, per above. ref SDS 0 V39U
630905 - ..
630906 - Explained new request from UCSF today for treatment with Magnesium
630907 - Replacement, per above. ref SDS 0 O059, in addition to Neupogen
630908 - prescribed yesterday by UCSF.
630910 - ..
630911 - Arlette let the doctor know that UCSF has prescribed Neupogen and
630912 - Magnesium Replacement, per above. ref SDS 0 O152
630913 -
630914 -
630916 - ..
6310 -
6311 -
6312 - 1733
6313 -
631301 - Called Arlette back.
631302 -
631303 - No one answers the telephone to coordinate the work. Got a message
631304 - everyone has gone home.
631305 -
631307 - ..
6314 -
6315 -
6316 - 1807
6317 -
631701 - Arlette called.
631702 -
631703 - The doctor has ordered a single Neupogen treatment, as prescribed by
631704 - UCSF yesterday. Arlette said the doctor wants Millie to get Neupogen
631705 - at the Park Shadelands Pharmacy tomorrow, and go to the Infusion
631706 - Clinic. A nurse will do the treatment injection, as discussed by
631707 - Brigid in her call from UCSF this morning, per above, ref SDS 0 O152,
631708 - and further related in Millie's letter to Kaiser, also above.
631709 - ref SDS 0 V39U
631710 -
631711 - [On 080607 UCSF provides Neupogen treatments to patients in the
631712 - Infusion Clinic that avoids confusion, problems, and mistakes.
631713 - ref SDS 77 4154
631715 - ..
631716 - Arlette's work plan seems to address issues presented in the letter to
631717 - Kaiser yesterday on 080403. ref SDS 70 TS8Y On 061031 there was no
631718 - charge for Neupogen treatment in the hospital. ref SDS 15 9U65
631719 - Arelette advises today the doctor has ordered Neupogen at the Pharmacy
631720 - for Millie to take to the Infusion Clinic across the hall, and get
631721 - injection in the hospital by professionals, as Kaiser did on 061031.
631722 - ref SDS 15 9U65 This should solve problems getting Neupogen at Kaiser
631723 - on 061101. ref SDS 16 JS4U
631725 - ..
631726 - [On 080405 Park Shadelands Kaiser Pharmacy closed; Millie gets
631727 - Neupogen from Kaiser Pharmacy in Walnut Creek, after 2 hours
631728 - long, complex transaction, ref SDS 71 H656, charged $12 for 1
631729 - self-injection treatment, because Infusion Clinic was closed,
631730 - ref SDS 71 XQ6O; Millie finally takes medication prescribed by
631731 - UCSF in order to get chemotherapy treatment next Thursday.
631732 - ref SDS 71 RU6I
631733 -
631734 -
631736 - ..
631737 - Arlette explained that Magnesium replacement is an over-the-counter
631738 - oral treatment that requires Millie to take pills for a number of
631739 - days. Millie may be able to get this at the Park Shadelands Pharmacy.
631740 - Arletted seemed to say look for anything that says...
631741 -
631742 - "Magnesium"
631744 - ..
631745 - Alternatively, Mil can go to any drug store, e.g., Longs Drugs, and
631746 - ask for "Magnesium" tablets.
631748 - ..
631749 - This seems potentially problematic. Typically, instructions say to
631750 - take a specific number of pills (e.g., 1, 1.5, 2), containing a
631751 - specific amount of agent, so many times a day and for a specified
631752 - number of days. If treatment was with an IV some specific amount of
631753 - agent would be given. Why no similar instructions for oral treatment?
631755 - ..
631756 - [On 080405 Pharmacist discloses Kaiser does not sell products
631757 - for Magnesium Replacement; customers must buy Calcium and
631758 - Magnesium dietary supplement tablets. ref SDS 71 J23S
631760 - ..
631761 - [On 080409 notify primary care physician of confusion and
631762 - problems getting Neupogen treatments from Kaiser. ref SDS 72
631763 - OP4O
631765 - ..
631766 - [On 080409 commend Arlette for good coordination in letter to
631767 - Kaiser primary care physician. ref SDS 72 OP4O
631768 -
631769 -
631770 -
631771 -
631772 -
631773 -
631774 -
631775 -
631776 -
631777 -
631778 -
6318 -