San Francisco, CA
S U M M A R Y
DIARY: July 25, 2009 08:17 PM Saturday;
Millie letter to medical team on meeting at Kaiser start treatment.
2...Evidence-based Medical Management Kaiser Practice
3...Care Delivered Before 100% Certainty in Time to be Effective
........Understanding Evidenced Based Medicine
4...Complementarity Doctor Patient Partnership Effective Case Management
5...Yeomen's Work Well Ordered Record Save Lives Time Money
6...Good Management Looks Like Yeomen's Work Unnecessary Overkill
7...Evidenced Based Management Yeoman's Work Maintain Well Ordered Record
8...Best Evidence Compare Treatment Trade-offs Doctor Fiduciary Duty
9...Fiduciary Duty Doctor's Prescribe Care Based on Best Evidence
10...Trade-offs Compare Treatments Standard of Care for Medical Practice
11...Case Study Millie Asks Medical Team to Compare Trade-offs on Treatments
12...Technology Fails Support Evidence-based Knowledge Management
13...Well Ordered Record Essential Effective Care Yoeman's Work
14...Yoeman's Work Medical Practice Maintain Well Ordered Record
15...Knowledge Management Technology Limited Evidence-based Intelligence
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up
040506 - ..
0408 - Progress
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...
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.
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?
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.
Evidence-based Medicine Understanding Article Published Kaiser Medic
310401 - ..
310402 - Evidence-based Medical Management Kaiser Practice
310403 - Care Delivered Before 100% Certainty in Time to be Effective
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
310421 - http://www.nclnet.org/health/ebm2.htm
310423 - ..
310424 - Evidence-Based Education: Developing Kaiser Permanente Faculty
310425 - For the New Millennium
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
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.
Yeomen's Work Evidence-based Medical Practice Health Care Well Order
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
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
Evidence-based Practice Manual Research and Outcome Measures in Heal
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
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...
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
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
Case Study Millie Asks Medical Team Compare Trade-offs on Treatments
BA0401 - ..
BA0402 - Case Study Millie Asks Medical Team to Compare Trade-offs on Treatments
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...
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
Default Null Subject Account for Blank Record
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
CJ0410 - 28. The authors continue on page 44...
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
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...
CJ0446 - data
CJ0447 - information
CJ0448 - knowledge
CJ0449 - wisdom
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...]
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?
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].
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.
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.