CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie met with Doctor Johnson at Kaiser this morning.  Millie's
040902 - daughter Pam attended the meeting to learn about the treatment plan.
040904 -  ..
040905 - On 090725 2017 Millie sent a letter this evening to the medical team
040906 - confirming understandings on the work plan for Millie to recover from
040907 - the 8th relapse of cancer...
040908 -
040909 -    1.  Subject: Gemzar Scheduled Jul 28 0900 at Kaiser Recover 8th Relapse Cancer
040910 -        Date: Sat, 25 Jul 2009 22:03:34 -0700
040925 -         ..
040926 -    2.  This confirms planning in the meeting yesterday at Kaiser to
040927 -        fill the gap caused by UCSF suddenly announcing on 090716 that
040928 -        they have no treatments for me at this time.
040930 -         ..
040931 -    3.  Your examination thankfully showed no signs of difficult
040932 -        breathing and constant cough, observed at UCSF on 090716, and
040933 -        in the Emergency Department on 090720.  You further observed
040934 -        IBC on my left arm outside the zone treated with radiation at
040935 -        UCSF during February and March, and also on my left chest and
040936 -        abdomen, and spreading toward my back, also outside zones
040937 -        treated with radiation and hyperthermia by Doctor Hsu at UCSF.
040938 -        I pointed out a few darkening spots on my left arm that may
040939 -        suggest progression of IBC.  You commented the left arm looked
040940 -        less swollen with lymphedema than you remembered from
040941 -        examination on 090626.  There is also concern that IBC will
040942 -        cause Cellulitis on the left arm which has occurred many times
040943 -        in the past.
040945 -         ..
040946 -    4.  You said it was unnecessary to remove the bandage to examine
040947 -        the worsening wound on my breastbone area from IBC untreated
040948 -        since 090122 due to a mistake performing radiation treatment at
040949 -        UCSF in February and March.  Understandably, Kaiser feels this
040950 -        is a UCSF issue.
040952 -         ..
040953 -    5.  Following discovery of this problem by Doctor Hsu during
040954 -        examination at UCSF on 090609, UCSF proposed correcting the
040955 -        problem with MPA treatment, shown by Doctor Hsu's letter the
040956 -        next day on 090610.  Doctor Rugo advised on 090616 that
040957 -        "everybody is on board" for giving me the treatment necessary
040958 -        to recover from the radiation treatment mistake, beginning with
040959 -        MPA. ref SDS 26 D647 [...and reported that Kaiser and UCSF had
040960 -        agreed in a letter to treat Millie's next relapse with PARP,
040961 -        ref SDS 26 KD6L, and this was confirmed in a letter to the
040962 -        medical team the next day on 090617 0112. ref SDS 27 VS9P...].
040963 -        So, I was shocked [a month later] in the evening on 090716 when
040964 -        Tara called and said Doctor Rugo has no more treatments for me
040965 -        at UCSF, and wants me to get Gemzar at Kaiser.
040966 -
040967 -            [On 090727 2012 sent letter to Paula explaining Millie's
040968 -            entitlement to recover damages including expanded treatment
040969 -            to recover from UCSF's medical mistake. ref SDS 31 3S4I
040971 -             ..
040972 -            [On 090730 1129 Paula in Kaiser Claims Resolution
040973 -            Department corridinating to get relief at Kaiser for
040974 -            Millie's injuries caused by UCSF medical mistakes providing
040975 -            radiation treatment on referral from Kaiser. ref SDS 32
040976 -            BD5I
040978 -         ..
040979 -    6.  To recover from loss of treatment on 090716 at UCSF, you
040980 -        ordered Gemzar recommended by Doctor Rugo following examination
040981 -        at UCSF on 090716 by Tara, who determined MPA treatment started
040982 -        on 090616 was affecting my breathing, and leading to treatment
040983 -        in the ER at Kaiser this past Monday on 090720 for rising pain
040984 -        and difficultly breathing.
040986 -         ..
040987 -    7.  You further reduced the dose of Gemzar to reduce difficult side
040988 -        effects of chemotherapy, and indicated this reduced strength of
040989 -        medication would not reduce my ability to recover from IBC.
040991 -         ..
040992 -    8.  My daughter, Pamela, attended the meeting yesterday and asked
040993 -        why reduce the dose, since my cancer marker is at an all time
040994 -        high at UCSF, CA 15-3 193 for the test last week on 090716?
040995 -        Based on the differential evident in patient history, CA 15-3
040996 -        at Kaiser is likely 400 or more, and will be checked on Monday
040997 -        when I get a lab to start Gemzar, as explained further below.
040999 -         ..
041000 -    9.  You explained during the meeting yesterday that beginning
041001 -        chemotherapy with a low dose gives me a better chance of
041002 -        maintaining treatments essential to recover from cancer by
041003 -        suffering less debilitating side effects.  You cited my history
041004 -        of low blood counts due to bone marrow depleted by numerous
041005 -        chemotherapy regimens, noting similar impact to hair,
041006 -        fingernails, toenails, and other human systems that "grow,"
041007 -        becoming less robust.  In the case of blood, you ordered
041008 -        Neupogen treatments in the Infusion clinic to maintain counts,
041009 -        continuing the prior order you issued on 080609. ref SDS 9
041010 -        IL6I
041012 -         ..
041013 -   10.  At that time, in June 2008, Neupogen was prescribed by Doctor
041014 -        Rugo to maintain my blood counts, when she added Carboplatin
041015 -        chemotherapy to my treatment after a year getting only
041016 -        cetuximab "targeted" agent for my care on referral to UCSF
041017 -        recovering from the 4th relapse.  Yesterday, you ordered the
041018 -        same Neupogen treatment to continue in the Infusion Clinic for
041019 -        the Gemzar protocol Doctor Rugo prescribed on 090716 as a
041020 -        stop-gap measure, while Kaiser and UCSF develop a treatment
041021 -        plan.
041023 -         ..
041024 -   11.  You further confirmed plans yesterday to give me blood
041025 -        transfusions to maintain blood counts, discussing specifically
041026 -        platelets.
041028 -         ..
041029 -   12.  Pam asked about prospects for success of Gemzar treatment.
041031 -         ..
041032 -   13.  You repeated prior guidance on 090515 that likelihood of my
041033 -        responding to Gemzar is low, because my cancer has mutated into
041034 -        very aggressive cells that have "outsmarted" all of my many
041035 -        prior treatments, including modern "targeted" agents I have
041036 -        received, and so will likely quickly "outsmart" older
041037 -        chemotherapy technology like Gemzar.
041039 -         ..
041040 -   14.  I asked yesterday about arrangements to begin the Hospice
041041 -        process, which you discussed on 090213. ref SDS 13 IW8N
041043 -         ..
041044 -   15.  You explained that Hospice provides palliative care, and seemed
041045 -        further to say that, since I am getting Gemzar treatment to
041046 -        recover from cancer, Kaiser cannot start Hospice arrangements,
041047 -        because Hospice is a federally assisted program of some kind.
041048 -        Recall that on 090325 you recommended I contact Hospice at that
041049 -        time to "get acquainted," while I was in treatment at UCSF, and
041050 -        in advance of actually getting Hospice services. ref SDS 14
041051 -        JS5I
041053 -         ..
041054 -   16.  Does advice yesterday on deferring a "get acquainted" meeting
041055 -        with Hospice reflect a change in prior guidance?
041057 -         ..
041058 -   17.  Pamela was concerned yesterday about me getting comprehensive
041059 -        care, including the role of the patient assistant.  She worried
041060 -        Rod was distracting the medical team improperly wasting time
041061 -        talking about the past.  She wanted to know, when I would start
041062 -        treatment?
041063 -
041064 -            [On 100124 0527 Millie's lifelong friend suffering deep
041065 -            emotional depression and physicial distress recovering at
041066 -            home from knee surgery, ref SDS 41 PPVV, Pam asks why
041067 -            patient assistance is needed for routine recovery at home.
041068 -            ref SDS 41 VG66
041070 -         ..
041071 -   18.  Thanks for taking time to explain that my care has become [...
041072 -        "yeomen's work to manage...] very complicated requireing
041073 -        multiple resources at Kaiser and UCSF to treat expanding
041074 -        [...patient profile - see below, ref SDS 0 T58R...] and
041075 -        difficult medical maladies [...listed in the record on 090213,
041076 -        ref SDS 13 ES7I...].
041078 -             ..
041079 -            [On 100730 2146 Millie dies 100729; Pam's letter notes
041080 -            patient assistance leveraged professional medical care to
041081 -            provide good case management that extended her mom's life.
041082 -            ref SDS 51 ZH7N
041084 -             ..
041085 -            [On 100731 0239 letter thanks Pam for appreciation of
041086 -            caring for her mom (Millie) afflicted with cancer the past
041087 -            10 years. ref SDS 52 S88Q
041089 -         ..
041090 -   19.  You gave an example yesterday that increase in breathing
041091 -        problems can be caused by several factors from my patient
041092 -        history.  [...as a result of UCSF medical mistakes providing
041093 -        radiation services on referral from Kaiser...]  There could be
041094 -        cancer in the lining of my lungs, there could be progressive
041095 -        radiation injury [...explained by Doctor Hsu at UCSF on
041096 -        090609,6ref SDS 25 EK8J...], there could be recurrence of
041097 -        pulmonary embolism.  You noted that merely because the CT test
041098 -        on 090720 made affirmative findings that PE was not observed in
041099 -        the scans, it could have been missed, as occurred with 2 prior
041100 -        CT scans in 2004, then was identified in a 3rd test on 041103
041101 -        [...reported during the meeting the next day at Kaiser on
041102 -        041104 1030. ref SDS 5 4Y9G...].
041104 -         ..
041105 -   20.  You further noted yesterday that sudden rise of symptoms after
041106 -        starting MPA on 090616, and evident recovery yesterday after
041107 -        ending treatment with MPA a week ago on 090716, correlates with
041108 -        the MPA protocol that says blood clots in the lungs are a rare
041109 -        side effect MPA, reviewed on 090616 [actually reported on
041110 -        090514, ref SDS 16 KW3P].
041112 -         ..
041113 -   21.  Since I have had 2 prior PE episodes, reported on 061002,
041114 -        ref SDS 6 MI5I, and since I have family history of related
041115 -        incidents, there is strong likelihood MPA caused PE, which
041116 -        caused my breathing problems that landed me in the ER on
041117 -        Monday.  You therefore approved Doctor Rugo ending my treatment
041118 -        with MPA, because of deep concern about my breathing problems
041119 -        observed during the meeting at UCSF last week on 090716.
041120 -
041121 -
0412 -

SUBJECTS
Evidence-based Medicine Understanding Article Published Kaiser Medic

3103 -
310401 -  ..
310402 - Evidence-based Medical Management Kaiser Practice
310403 - Care Delivered Before 100% Certainty in Time to be Effective
310404 -
310405 -
310406 -   22.  Of course none of these causal links are 100% certain.  You
310407 -        explained yesterday that since corrections must be made in time
310408 -        to be effective, people cannot wait for 100% certainty.
310410 -         ..
310411 -   23.  Kaiser relies on "evidence-based" management to make sense of
310412 -        complex problems in time to be effective [reported by Paula
310413 -        McPhail in Kaiser's Member Services Claims Resolution
310414 -        Department, in a telecon on 090520 1153. ref SDS 18 HX3O].  See
310415 -        for example...
310417 -         ..
310418 -        Understanding Evidenced Based Medicine
310419 -
310420 -
310421 -           http://www.nclnet.org/health/ebm2.htm
310423 -         ..
310424 -        Evidence-Based Education: Developing Kaiser Permanente Faculty
310425 -        For the New Millennium
310426 -
310427 -           http://xnet.kp.org/permanentejournal/winter99pj/education.html
310429 -         ..
310430 -   24.  Evidence-based management requires a timely, well-ordered
310431 -        record of work history for reliance on accurate "evidence." You
310432 -        noted that evidence in my case points to MPA treatment causing
310433 -        pulmonary embolism, which in turn caused my breathing
310434 -        problems.  Similarly, yesterday you ordered Neupogen treatments
310435 -        in the Infusion Clinic, because senior patients with breathing
310436 -        problems, and enfeebled by harsh chemotherapy side effects
310437 -        which I will begin suffering next week, cannot self-administer
310438 -        Neupogen injections, shown by evidence in my case on 080609,
310439 -        where this was tried and failed. ref SDS 9 IL6I
310440 -
310441 -            [On 091002 0900 VA medical chart on 091002 example of
310442 -            evidence based medical practice. ref SDS 34 7S8M
310444 -         ..
310445 -   25.  Additionally, Kaiser protocol requires me to have two
310446 -        injections to provide dose levels prescribed for my patient
310447 -        profile.  Self-injection does not support divided injections.
310448 -        Evidence from patient history on 080628 shows Neupogen
310449 -        treatment in the Infusion Clinic was effective. ref SDS 10 PR5F
310451 -         ..
310452 -   26.  You noted yesterday that since evidence supports continuing
310453 -        prior practice giving me Neupogen in the Infusion Clinic,
310454 -        Kaiser policy to rely on evidence-based management requires
310455 -        continuing what works, and avoiding what failed.
310456 -
310457 -
3105 -

SUBJECTS
Yeomen's Work Evidence-based Medical Practice Health Care Well Order

6303 -
630401 -  ..
630402 - Complementarity Doctor Patient Partnership Effective Case Management
630403 - Yeomen's Work Well Ordered Record Save Lives Time Money
630404 - Good Management Looks Like Yeomen's Work Unnecessary Overkill
630405 - Evidenced Based Management Yeoman's Work Maintain Well Ordered Record
630406 -
630407 -
630408 -   27.  You also explained that creating a "well-ordered record" to
630409 -        find critical details for "evidence-based" management to make
630410 -        sense of complex problems is "yeoman's work" [illustrated by
630411 -        case study of treatment history on 090213, ref SDS 13 ES7I].
630412 -        Most of the details required for comprehensive care are not
630413 -        needed in the moment, and so look like "unnecessary overkill."
630414 -        Chronology, context, and connections are needed days, weeks,
630415 -        months, even years later; but, if the story is not written at
630416 -        the time events occur, then there is no "evidence" when needed
630417 -        to save lives, time, and money. [...on 090213 Doctor Johnson
630418 -        explained that comprehensive case management to extend survival
630419 -        and quality of life takes a lot of "will power" to maintain a
630420 -        well ordered record, because it is faster and easier to ignore
630421 -        evidence and rely on data in the computer, rather than keep the
630422 -        computer up-todate. ref SDS 13 JL5I...]
630424 -  ..
630425 - Knowledge Management is defined with this construction of writing down
630426 - details of daily work that occur but don't seem needed in the moment,
630427 - and so seem like unnecessary overkill to write them down, and spend
630428 - time organizing the record with connections of cause and effect, but
630429 - will be needed later to understand cause and effect, and which cannot
630430 - be found, recognized, nor understoon without initial investment of
630431 - intellectual capital to maintain a well ordered record showing cause
630432 - and effect.
630434 -  ..
630435 - The "dilema" of knowledge management is balancing time writing the
630436 - record on details needed in the future that reduces time for taking
630437 - immediate action, explained in POIMS. ref OF 3 QP4F  Better tools
630438 - enable capturing a larger share of daily work in a well ordered
630439 - record, as related on 890523. ref SDS 1 TP8O
630441 -             ..
630442 -            [...below on 090725 2017 using computers for evidence-based
630443 -            case management has proven very difficult. ref SDS 0 MP8O
630445 -             ..
630446 -            [On 100730 2146 Millie dies 100729; Pam's letter notes good
630447 -            case management extended her mom's life. ref SDS 51 ZH7N
630449 -             ..
630450 -            [On 101209 1418 NVIDIA customer support log technology
630451 -            tracks actual communications for evidence-based case
630452 -            management. ref SDS 53 NL8P
630454 -             ..
630455 -            [On 101220 1555 HP reports same problem of people relying
630456 -            on evidence in the computer because access is fast and
630457 -            easy, and ignoring evidence from the customer because
630458 -            entering communication into the computer takes diligence
630459 -            and will power. ref SDS 54 AQ6G
630460 -
630461 -
630462 -
6305 -

SUBJECTS
Evidence-based Practice Manual Research and Outcome Measures in Heal

AA03 -
AA0401 -  ..
AA0402 - Best Evidence Compare Treatment Trade-offs Doctor Fiduciary Duty
AA0403 - Fiduciary Duty Doctor's Prescribe Care Based on Best Evidence
AA0404 - Trade-offs Compare Treatments Standard of Care for Medical Practice
AA0405 -
AA0406 -
AA0407 -   28.  Your reference to "yeoman's work" investing time setting up the
AA0408 -        record "today" that empowers people to succeed "tomorrow" was
AA0409 -        not idle chatter.  [Doctor Rugo noted last month on 090616,
AA0410 -        that comprehensive communication with a "well ordered record"
AA0411 -        makes collaboration and cooperation effective, so that
AA0412 -        everybody at Kaiser and UCSF is "on board" for treating my
AA0413 -        cancer as a chronic disease. ref SDS 26 D647]  Albert Roberts
AA0414 -        and Kenneth Yeager say on page 3 of their book "Evidence-based
AA0415 -        Practice Manual:  Research and Outcome Measures in Health and
AA0416 -        Human Services," Oxford University Press, 2004, that...
AA0417 -
AA0418 -            [On 100302 0830 Doctor Johnson notes Millie's survival 3 -
AA0419 -            4 times longer than expected for her disease is a unique
AA0420 -            case achieved through "yeoman's work" performing medical
AA0421 -            management. ref SDS 43 FC67,
AA0423 -         ..
AA0424 -        "...few individuals have the ability to sift through the
AA0425 -        available data and make informed decisions.  Rather, many of
AA0426 -        those seeking and requiring treatment...[expect] health care
AA0427 -        professionals... will...determine which treatment methodology
AA0428 -        is going to result in the most positive outcome with the least
AA0429 -        cost in terms of suffering, time, and money.  As a result of
AA0430 -        the trust placed in them, health care professionals have a
AA0431 -        fiduciary duty to answer the question "What do you recommend?"
AA0432 -        based on the best available scientific information [evidence]."
AA0434 -  ..
AA0435 - Doctor's duty to compare trade-offs on treatments based on best
AA0436 - evidence for positive outcomes that minimize costs of suffering, time,
AA0437 - and money reflects classic requirements for quality management to
AA0438 - perform cost and benefit analysis.  Evidence-based management,
AA0439 - including medical practice, requires yeoman's work writing a record so
AA0440 - evidence is available, when needed to make analysis.  Collaboration
AA0441 - through doctor patient partnership can invest time to transform
AA0442 - quickly scribbled ad hoc and first impressions into a well ordered
AA0443 - record that enables finding critical details connection cause and
AA0444 - effect in time to be effective, per above. ref SDS 0 T58R
AA0445 -
AA0446 -            [On 090727 2012 letter to Paula in Kaiser Claims Resolution
AA0447 -            Department presents Millie's entitlement to recover damages
AA0448 -            including expanded treatment to recover from UCSF's medical
AA0449 -            mistake. ref SDS 31 3S4I
AA0451 -             ..
AA0452 -            [On 090730 1129 Paula in Kaiser Claims Resolution
AA0453 -            Department corridinating to get relief at Kaiser for
AA0454 -            Millie's injuries caused by UCSF medical mistakes providing
AA0455 -            radiation treatment on referral from Kaiser. ref SDS 32
AA0456 -            BD5I
AA0458 -             ..
AA0459 -            [On 091112 0752 Millie asks medical team to investigate
AA0460 -            available treatments and submit analysis comparing
AA0461 -            trade-offs based on best evidence. ref SDS 36 L66S
AA0463 -             ..
AA0464 -            [On 100730 2146 Millie dies 100729; Pam's letter notes good
AA0465 -            case management extended her mom's life. ref SDS 51 ZH7N
AA0466 -
AA0467 -
AA0468 -
AA05 -

SUBJECTS
Case Study Millie Asks Medical Team Compare Trade-offs on Treatments

BA03 -
BA0401 -  ..
BA0402 - Case Study Millie Asks Medical Team to Compare Trade-offs on Treatments
BA0403 -
BA0404 - Published guidance on standard of care calling for doctors to compare
BA0405 - trade-offs on treatment effectiveness, side effects ("suffering") and
BA0406 - cost, aligns with Millie's requests to the medical team...
BA0407 -
BA0408 -        1.  Millie requests list of treatments
BA0409 -            with pros and cons................ 081015 1643, ref SDS 11 K45V
BA0411 -             ..
BA0412 -        2.  Millie requests medical team submit
BA0413 -            comparison on trade-offs to evaluate
BA0414 -            next treatment based on patient history
BA0415 -            listing approximately 20 possible
BA0416 -            treatments........................ 090520 1137, ref SDS 17 SS3W
BA0418 -             ..
BA0419 -        3.  Expedited claim demands Kaiser perform
BA0420 -            requirements of EOC Section 2 to prescribe
BA0421 -            care based on best evidence comparing
BA0422 -            trade-offs on treatments appropriate
BA0423 -            for Millie's patient
BA0424 -            profile........................... 090520 1203, ref SDS 19 9595
BA0426 -             ..
BA0427 -        4.  Millie notifies medical team to prescribe
BA0428 -            treatment for recovering from 8th relapse
BA0429 -            of cancer based on best evidence comparing
BA0430 -            trade-offs on treatments appropriate
BA0431 -            for Millie's patient
BA0432 -            profile............................ 090522 0813, ref SDS 20 7Z7R
BA0434 -             ..
BA0435 -        5.  Millie asks again for Kaiser to explain
BA0436 -            CPT-11 and trade-offs with other treatments
BA0437 -            for Millie's patient profile to recover
BA0438 -            from 8th relapse of
BA0439 -            cancer............................ 090522 1351, ref SDS 21 2T9W
BA0441 -             ..
BA0442 -        6.  Millie asks medical team to compare
BA0443 -            trade-offs gemcitabine proposed by Doctor
BA0444 -            Rugo with other treatments appropriate
BA0445 -            for Millie's patient
BA0446 -            profile........................... 090528 1652, ref SDS 22 B24S
BA0448 -             ..
BA0449 -        7.  Standard of care evidenced-based medical
BA0450 -            practice - doctors have a fidicuary responsibility
BA0451 -            to help patients compare treatments to get
BA0452 -            best results, minimize suffering side
BA0453 -            effects, and reduce costs based
BA0454 -            on the best available
BA0455 -            evidence........................... 090725 0817, ref SDS 0 T58U
BA0457 -             ..
BA0458 -        8.  Doctor Johnson reports having sufficient
BA0459 -            time to plan Millie's next treatment from
BA0460 -            list submitted on 090326, and compare
BA0461 -            trade-offs to identify treatment with
BA0462 -            best chance for Millie to recover
BA0463 -            from 9th relapse of cancer
BA0464 -            based on the best
BA0465 -            evidence........................... 090909 1344, ref SDS 33 VF60
BA0467 -             ..
BA0468 -        9.  Millie reports progression of cancer
BA0469 -            requests meeting to review trade-offs
BA0470 -            to select treatment with best
BA0471 -            chance of recovering from
BA0472 -            9the relapse....................... 091019 0007, ref SDS 35 0Z4P
BA0474 -             ..
BA0475 -       10.  Millie submits agenda for meeting at Kaiser
BA0476 -            on 091112, and asking which asking Doctor
BA0477 -            Johnson to present results from medical team
BA0478 -            investigating for treatments "targeted" to
BA0479 -            Millie's patient profile for recovering from
BA0480 -            9th relapse of cancer, and submit analysis
BA0481 -            comparing trade-offs for determining
BA0482 -            the best chance of rcovering
BA0483 -            based on best evidence
BA0484 -            possible for this
BA0485 -            case............................... 091112 0752, ref SDS 36 L66S
BA0486 -            from among 20 alternative oncologic
BA0487 -            treatments submitted to the
BA0488 -            medical team....................... 091112 0752, ref SDS 36 LE3R
BA0490 -             ..
BA0491 -       11.  Trade-offs for alternative oncologic
BA0492 -            treatments is reported in Kaiser's Medical
BA0493 -            Chart as having been explained during
BA0494 -            a meeting at Kaiser, and that the patient
BA0495 -            agreed to the doctor's recommended
BA0496 -            treatment, though there is no
BA0497 -            work product listing treatments
BA0498 -            and trade-offs..................... 091112
BA0500 -             ..
BA0501 -       12.  Millie requests trade-offs between Abraxane
BA0502 -            discussed by Doctor Johnson for Millie's
BA0503 -            next treatment, and other treatment modalities
BA0504 -            presented to the medical team, and
BA0505 -            proposed by Doctor Rugo at
BA0506 -            UCSF............................... 091203 1017, ref SDS 37 A44Q
BA0508 -             ..
BA0509 -       13.  Millie requests list of treatments
BA0510 -            comparing trade-offs for effectiveness,
BA0511 -            side effects and
BA0512 -            cost.............................. 100103 1147 ref SDS 38 FZ6P
BA0514 -             ..
BA0515 -       14.  Millie asks medical team to assess
BA0516 -            trade-offs for available targeted
BA0517 -            treatments........................ 100120 0217, ref SDS 40 HL7V
BA0519 -             ..
BA0520 -       15.  Written explanation requested of
BA0521 -            trade-offs comparing effectivenss,
BA0522 -            side effects, and cost of treatments
BA0523 -            targeted to Millie's patient
BA0524 -            profile........................... 100120 0217, ref SDS 40 PSWT
BA0526 -             ..
BA0527 -       16.  Millie's letter notifies the medical team
BA0528 -            that Kaiser's medical chart for the meeting
BA0529 -            on 091112, incorrectly reports that alternative
BA0530 -            oncologic treatments were presented and
BA0531 -            trade-offs on effectivenss, side effects,
BA0532 -            and costs were explained to the
BA0533 -            patient............................ 100301 0005, ref SDS 42 OO9S
BA0534 -            Millie asks Kaiser to submit any work
BA0535 -            product listing treatments and trade-offs
BA0536 -            in writing to avoid confusion
BA0537 -            about what was "said" in
BA0538 -            meetings........................... 100301 0005, ref SDS 42 OO4S
BA0540 -             ..
BA0541 -       17.  Millie's letter to medical team requests
BA0542 -            again explanation in writing from Kaiser on
BA0543 -            trade-offs with respect to effectiveness,
BA0544 -            side effects, and cost on treatments
BA0545 -            targeted to patient
BA0546 -            profile............................ 100301 0005, ref SDS 42 OO7T
BA0548 -             ..
BA0549 -       18.  Doctor did not have time to prepare report
BA0550 -            on trade-offs for alternative oncology
BA0551 -            treatments comparing effectiveness
BA0552 -            tolerance for side effects
BA0553 -            and cost........................... 100302 0830, ref SDS 43 ZV4N
BA0555 -             ..
BA0556 -       19.  Trade-offs of alternative "targeted"
BA0557 -            treatments was requested again in Millie's
BA0558 -            letter to the medical
BA0559 -            team............................... 100304 2251, ref SDS 44 OQ5T
BA0561 -             ..
BA0562 -       20.  Trade-offs requested again for treatments
BA0563 -            "targeted" to Millie's patient profile that
BA0564 -            do not degrade bone marrow, and so reduce
BA0565 -            risk of shingles recurrence, and in any
BA0566 -            event can be given concurrently with
BA0567 -            treatment for shingles if this
BA0568 -            disease does recur................. 100305 0822, ref SDS 45 0W3W
BA0570 -             ..
BA0571 -       21.  Millie notifies medical team that some recovery
BA0572 -            has occurred from 10th relapse of cancer after
BA0573 -            2 treatments with Abraxane; asks medical team
BA0574 -            to compare alternate oncology treatments for
BA0575 -            trade-offs to be prepared for prescribing
BA0576 -            treatment in time to recover from
BA0577 -            the 11th relapse of
BA0578 -            her cancer......................... 100319 0843, ref SDS 46 1T5V
BA0580 -             ..
BA0581 -       22.  Medical team asked to perform critical issue
BA0582 -            identifying trade-offs comparing alternate
BA0583 -            oncology treatments for Millie to
BA0584 -            recover from next
BA0585 -            relapse............................ 100329 2322, ref SDS 47 WA9U
BA0587 -             ..
BA0588 -       23.  Millie reports 11th relapse cancer marker
BA0589 -            suddenly soars highest in patient history
BA0590 -            CA 15-3 424], asks medical team to compare
BA0591 -            trade-offs on effectiveness, side effects,
BA0592 -            and costs to determine best course of
BA0593 -            care, including radiation and
BA0594 -            hyperthermia....................... 100501 1037, ref SDS 48 U45R
BA0595 -            since Doctor Johnson determined
BA0596 -            progression of Millie's cancer
BA0597 -            is primarily in the skin........... 100501 1037, ref SDS 48 PQYW
BA0599 -             ..
BA0600 -       24.  Millie asks medical team again for written
BA0601 -            explanation of work plan to recover from
BA0602 -            11th relapse comparing trade-offs on treatment
BA0603 -            options, including ending treatment, in order
BA0604 -            to be prepared for discussions
BA0605 -            meeting with doctor in 4
BA0606 -            weeks.............................. 100503 2338, ref SDS 49 6X9P
BA0607 -
BA0608 -
BA0609 -
BA0610 -
BA07 -

SUBJECTS
Default Null Subject Account for Blank Record

CJ03 -
CJ0401 -  ..
CJ0402 - Millie's letter to medical team continues...
CJ0404 -  ..
CJ0405 - Technology Fails Support Evidence-based Knowledge Management
CJ0406 - Well Ordered Record Essential Effective Care Yoeman's Work
CJ0407 - Yoeman's Work Medical Practice Maintain Well Ordered Record
CJ0408 - Knowledge Management Technology Limited Evidence-based Intelligence
CJ0409 -
CJ0410 -   28.  The authors continue on page 44...
CJ0411 -
CJ0412 -           http://books.google.com/books?id=cgjj1WVL1dMC&pg=PA44&lpg=PA44&dq=%22automate+much+of+the+yeoman%27s+work+of+health+care%22&source=bl&ots=alGRUUCf2R&sig=W9NWIv85uvzdFEMzEC0avpfG63E&hl=en&ei=WGVrStnILZOGsgOT_a2WBQ&sa=X&oi=book_result&ct=result&resnum=1
CJ0414 -         ..
CJ0415 -        "Sophisticated software has been produced to automate much of
CJ0416 -        the yeoman's work of health care document indexing.  However,
CJ0417 -        these systems still fail for lack of proven methods for
CJ0418 -        identifying patients, practitioners, and events.  The simple
CJ0419 -        act of identifying patients, provider, time, and place has
CJ0420 -        proved surprisingly difficult, yet this is essential for
CJ0421 -        dredging information from data."  [...doctors ignore evidence
CJ0422 -        because relying on data in the computer is fast and easy, and
CJ0423 -        entering communication into the computer requires "will power,"
CJ0424 -        per above. ref SDS 0 T58R...]
CJ0426 -  ..
CJ0427 - Aligns with case study showing manufacturers, developers, engineers,
CJ0428 - and computer scientists have given up trying to build technology for
CJ0429 - Knowledge Management, reported on 070126 0736. ref SDS 7 QH8L
CJ0430 -
CJ0431 -            [On 101209 1418 NVIDIA customer support shows technology
CJ0432 -            tracks communications for evidence-based case management.
CJ0433 -            ref SDS 53 NL8P
CJ0435 -             ..
CJ0436 -            [On 101220 1555 HP reports same problem of people relying
CJ0437 -            on evidence in the computer because access is fast and
CJ0438 -            easy, and ignoring evidence from the customer because
CJ0439 -            entering communication into the computer takes diligence
CJ0440 -            and will power. ref SDS 54 AQ6G
CJ0442 -         ..
CJ0443 -   29.  Interestingly, Roberts and Yeager present in figure 44 a
CJ0444 -        structure of cognition required for evidenced-based medicine...
CJ0445 -
CJ0446 -               data
CJ0447 -               information
CJ0448 -               knowledge
CJ0449 -               wisdom
CJ0450 -
CJ0451 -        ...which they note is not yet supported by mainstream
CJ0452 -        technology; however, it aptly summarizes the complex structure
CJ0453 -        of "intelligence" in NWO, which has guided my care using
CJ0454 -        evidenced-based management the past 8-years. ref OF 12 XF6F
CJ0456 -         ..
CJ0457 -   30.  The question is where to find "yeoman" to perform the work, and
CJ0458 -        can technology leverage intelligence that converts information
CJ0459 -        into the power of knowledge to control the future?  You
CJ0460 -        thankfully have Arlette; but, more Arlette's are needed to
CJ0461 -        leverage training, skills, and experience of a practicing
CJ0462 -        physician.
CJ0464 -         ..
CJ0465 -   31.  Longevity drives an inherent dilemma compounding complexity of
CJ0466 -        the record.  Kaiser's success treating me for 8 years sows the
CJ0467 -        seeds of collapse and failure, as people become tired and
CJ0468 -        overwhelmed by the magnitude of my medical problems [see case
CJ0469 -        study listed on 090213 1140. ref SDS 13 ES7I].
CJ0471 -         ..
CJ0472 -   32.  You explained on 090213 that "yeoman's work" has been done
CJ0473 -        using Kaiser's doctor/patient partnership model to manage
CJ0474 -        complex clinical, logistical, and financial dimensions of my
CJ0475 -        care. ref SDS 13 FZ4H [...as discussed above, ref SDS 0 T53T
CJ0476 -        and ref SDS 0 T58R, citing meeting on 090213 that noted
CJ0477 -        doctors feel it is faster and easier to ignore evidence than
CJ0478 -        to enter communication into the computer for fast and easy
CJ0479 -        access. ref SDS 13 JL5I...]
CJ0480 -
CJ0481 -            [On 100107 1327 Doctor Johnson sending copies of Kaiser
CJ0482 -            correspondence with UCSF on Millie's health care to comply
CJ0483 -            with HIPAA, and to support doctor/patient partnership that
CJ0484 -            leverages time of health care professionals to provide care
CJ0485 -            in time to be effective. ref SDS 39 KN66
CJ0487 -         ..
CJ0488 -   33.  The following month on 090325 you handed me a graph which you
CJ0489 -        had plotted showing my good luck getting excellent care with
CJ0490 -        Kaiser and UCSF that has extended my quality of life 2 - 3
CJ0491 -        times longer than normal for my disease trajectory. ref SDS 14
CJ0492 -        P39M
CJ0494 -         ..
CJ0495 -   34.  What is "yeoman's work" for evidenced based management that
CJ0496 -        brings good luck?
CJ0497 -
CJ0498 -            [On 100124 0527 Millie's lifelong friend suffering deep
CJ0499 -            emotional depression and physicial distress recovering at
CJ0500 -            home from knee surgery, ref SDS 41 PPVV, Pamela asks why
CJ0501 -            patient assistance is needed for routine recovery at home.
CJ0502 -            ref SDS 41 VG66
CJ0504 -         ..
CJ0505 -   35.  After the meeting yesterday, you and Rod left the room for me
CJ0506 -        to dress.  As Pam and I walked down the hall a few minutes
CJ0507 -        later, I overheard you asking Rod if he had seen the television
CJ0508 -        broadcast of President Obama's discussion this past Tuesday on
CJ0509 -        health care?  I could have answered that question.  I watched
CJ0510 -        it, but Rod was doing "yeoman's work" writing up the record of
CJ0511 -        my visit to the ER the day before. ref SDS 29 GE5H
CJ0513 -         ..
CJ0514 -   36.  He was also coordinating with UCSF for the letter which Tara
CJ0515 -        said Doctor Rugo submitted to you on 090716 planning my follow
CJ0516 -        on treatment [...with PARP...]  Precise evidence on breathing
CJ0517 -        problems treated in the ER on 090720, and on Doctor Rugo's
CJ0518 -        decision to end my treatment with MPA due to rising breathing
CJ0519 -        problems on 090716, together with proposals for follow on work
CJ0520 -        [...starting PARP in September at UCSF to recover from UCSF
CJ0521 -        medical mistakes...] were needed for meeting with you to decide
CJ0522 -        my future applying Kaiser's evidence based management policy
CJ0523 -        [explained above. ref SDS 0 MP8O].
CJ0525 -         ..
CJ0526 -   37.  I further heard you mention approval of Obama's proposal on
CJ0527 -        Tuesday to strengthen collaboration among providers for better
CJ0528 -        coordination of care.
CJ0530 -         ..
CJ0531 -   38.  I was disappointed during the meeting yesterday, when you
CJ0532 -        advised that you have not received Doctor Rugo's letter, and so
CJ0533 -        have not called and discussed coordinating my care with Doctor
CJ0534 -        Rugo [...for me to start with PARP "targeted" to cancer in
CJ0535 -        September...], as I was told by Tara on 090716 would occur.
CJ0536 -        ref SDS 28 EE5W  Understandably, you have just returned from
CJ0537 -        vacation and so are working your way through 500 emails,
CJ0538 -        mentioned during the meeting yesterday.  Doctor Rugo could call
CJ0539 -        you, but she explained on 080403 that calling doctors to
CJ0540 -        collaborate on patient care is really yeoman's work.
CJ0541 -        ref SDS 8 SG7I
CJ0543 -         ..
CJ0544 -   39.  Doctor Rugo mentioned on 090514 that she receives 500 email a
CJ0545 -        day and so does not have time to read the record in my case.
CJ0546 -        ref SDS 16 LS6I  Rod asked Doctor Rugo a month later on 090616,
CJ0547 -        if she wanted to be dropped from distribution on this list, and
CJ0548 -        she seemed adamant to continue getting the record coordinating
CJ0549 -        my care. ref SDS 26 HL6I
CJ0551 -         ..
CJ0552 -   40.  So, as things stand today, now that we have treatment with
CJ0553 -        something on the books (see telecon with Bella below,
CJ0554 -        ref SDS 0 T65T). the next step is to implement Doctor Rugo's
CJ0555 -        work plan for collaboration with you to coordinate my care.  We
CJ0556 -        also have on the books Doctor Rugo's report on 090514 [actually
CJ0557 -        on 090616] that "everybody" at Kaiser and UCSF is "on board"
CJ0558 -        for treating my cancer going forward, ref SDS 26 D647, [...and
CJ0559 -        this requires evaluating trade-offs to select treatment from
CJ0560 -        the list of alternate agents submitted to the medical team on
CJ0561 -        090326, ref SDS 15 QM3V, with the best chance to recover from
CJ0562 -        9th relapse, requested previously, shown in case study per
CJ0563 -        above, ref SDS 0 X66O].
CJ0564 -
CJ0565 -            [On 090727 2012 letter to Paula in Kaiser Claims Resolution
CJ0566 -            Department presents Millie's entitlement to recover damages
CJ0567 -            including expanded treatment to recover from UCSF's medical
CJ0568 -            mistake. ref SDS 31 3S4I
CJ0570 -             ..
CJ0571 -            [On 090730 1129 Paula in Kaiser Claims Resolution
CJ0572 -            Department corridinating to get relief at Kaiser for
CJ0573 -            Millie's injuries caused by UCSF medical mistakes providing
CJ0574 -            radiation treatment on referral from Kaiser. ref SDS 32
CJ0575 -            BD5I
CJ0577 -         ..
CJ0578 -   41.  As I listened to President Obama's presentation this past
CJ0579 -        Tuesday, he seemed adamant that better health care requires
CJ0580 -        collaboration among providers through email, calls, and
CJ0581 -        meetings to prevent patients from "slipping through the
CJ0582 -        cracks."  Your letter on 090205 made the same point.
CJ0583 -        ref SDS 12 278T  A meeting seems a stretch, but calls and
CJ0584 -        email, while "yeoman's work," can be facilitated by yeoman.
CJ0585 -        Accordingly, please let me know what is being done to make use
CJ0586 -        of the time we are buying with Gemzar to accomplish Doctor
CJ0587 -        Rugo's work plan for a telephone call to coordinate my care
CJ0588 -        recovering from the medical mistakes that has placed me in
CJ0589 -        severe distress.  I want to have a conference call, and submit
CJ0590 -        an agenda to make communication productive, as called out by
CJ0591 -        President Obama.  This is the time to turn rhetoric into
CJ0592 -        reality.
CJ0593 -
CJ0594 -            [On 100601 0830 Doctor Johnson reports that for the past
CJ0595 -            month, and continuing pattern and practice the past year,
CJ0596 -            he has been unable to collaborate with Doctor Rugo on
CJ0597 -            arranging Millie's treatment with PARP to implement UCSF's
CJ0598 -            work plan for Millie to recover from UCSF medical mistakes,
CJ0599 -            and because UCSF and Kaiser cannot communicate with email
CJ0600 -            nor the telephone. ref SDS 50 4F6I
CJ0602 -         ..
CJ0603 -   42.  Late yesterday afternoon about 1700 Bella called with the
CJ0604 -        Kaiser Infusion Clinic in Walnut Creek.  She scheduled me to
CJ0605 -        start treatment with Gemzar next Tuesday on 090728 0900.  This
CJ0606 -        implements my request during the meeting yesterday for timely
CJ0607 -        treatment, including an earlier request last month for
CJ0608 -        treatment in the beginning of the week, so I have a few days to
CJ0609 -        recover from side effects, to possibly have energy for weekend
CJ0610 -        events with family and friends.  Thanks very much for patient
CJ0611 -        consideration.
CJ0613 -         ..
CJ0614 -   43.  Bella said the Infusion Clinic in Walnut Creek does not have
CJ0615 -        enough time to squeeze me in for 10 or 20 minutes to draw blood
CJ0616 -        for a lab on Monday the day before I start treatment.  She
CJ0617 -        asked  me to call 372 1824 on Monday 090727 to schedule same
CJ0618 -        day blood draw at the Kaiser Infusion Clinic in Martinez.  I
CJ0619 -        assume the lab is already set up in the computer, so I don't
CJ0620 -        have to explain authorization and scope, as occurred in the
CJ0621 -        past.
CJ0623 -         ..
CJ0624 -   44.  Previously, on 090601 Sheree planned for me to get a blood draw
CJ0625 -        the same day as treatment. ref SDS 24 PQ5Q
CJ0627 -         ..
CJ0628 -   45.  Accordingly, I assume that if the Infusion Clinic in Martinez
CJ0629 -        cannot perform the lab on same day notice, then the Walnut
CJ0630 -        Creek  team will do the blood draw the next day before I get
CJ0631 -        treatment on 090728.  Alternatively, I could go to Kaiser in
CJ0632 -        Antiock, or Pleasant Hill on Monday , if there is a conflict
CJ0633 -        scheduling a blood draw in Martinez.  Just let me know.
CJ0635 -         ..
CJ0636 -   46.  Thanks again for fitting me in on Friday for an unscheduled
CJ0637 -        meeting to order treatment, after the shock of ending treatment
CJ0638 -        at UCSF the week before.
CJ0639 -
CJ0646 -
CJ0647 -
CJ0648 -
CJ0649 -
CJ0650 -
CJ0651 -
CJ0652 -
CJ0653 -
CJ0654 -
CJ0655 -
CJ07 -