CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Dr. Syed E. Naqvi, M.D.; Physician
020103 - Primary Care =925 206 2040

SUBJECTS
Medical, Kaiser
Knee Examination Shows Problem on 990625
Knee Examination Shows Problem on 990816
Exam 990816 Knee Treatments
Policy Procedures on Communication
Syed Doesn't Like Email
Primary Care Physician
Change Physician

1010 -    ..
1011 - Summary/Objective
1012 -
101201 - Follow up ref SDS 51 0000, ref SDS 49 0000.
101202 -
101203 - Received message from Kaiser that was unclear and incomplete.  Sent
101204 - letter on preparing for meeting with orthopedist, but turned out
101205 - message was about meeting on physical therapy.  Syed sent letter
101206 - saying he wants regular email and printed correspondence.  It is
101207 - unclear whether he reviewed the record, and is taking requested
101208 - action.  Went to Kaiser and got xrays of knees for meeting with
101209 - orthopedist.  Discovered meeting on 990816 is for pysical therapy;
101210 - made plans to attend the meeting.
101211 -
101212 -     [On 990816 meeting with physical therapist. ref SDS 53 0879]
101213 -
101214 -     [On 990816 medical chart seems to be missing medical history.
101215 -     ref SDS 53 2601]
101216 -
101217 -     [On 990829 meeting with orthopedist set for 990910. ref SDS 54
101218 -     0001]
101219 -
101220 -
101221 -
101222 -
1013 -
1014 -
1015 - Progress
1016 -
101601 -  ..
101602 - Meeting at Kaiser Scheduled for 990816
101603 -
101604 - Millie said she got a phone message that Kaiser has scheduled a
101605 - meeting for me on Monday, 990816.
101606 -
101607 - This must be the meeting with the orthopedist, which Syed planned to
101608 - schedule, when we talked on Wednesday. ref SDS 51 5152
101609 -
101610 -      [Below, this meeting is for physical therapy. ref SDS 0 4346]
101611 -
101612 - Sent ref DIT 1 to Syed linked to record on 990811. ref SDS 51 0001
101613 -
101614 - Ask him to submit the background on medical history to orthopedic
101615 - people, including xray I am having done today, per below. ref SDS 0
101616 - 5518
101617 -
101618 -      [On 990829 meeting scheduled with orthopedic doctor on 990910.
101619 -      ref SDS 54 0001]
101620 -
101621 - Asked Syed to help the message department by recommending that they
101622 - leave details on meetings. ref SDS 36 4176
101623 -
101624 -     [On 990813 sent copy to Morris as example of how to use
101625 -     "intelligence" constructively. ref SDS 52 0001]
101626 -
101627 -
101628 -  ..
1017 -
1018 -
1019 - 1659 received letter from Syed
1020 -
102001 - Syed sent a letter in the afternoon, ref DRT 1, citing his previous
102002 - letter, ref DRP 7 4550, sent on 990802, ref SDS 49 9108, that reported
102003 - a preference to use conventional email, and the Kaiser Message Center,
102004 - ref DRP 7 2058, rather than clear, concise, complete commmunication
102005 - that delivers medical "intelligence" via Internet.
102006 -
102007 - Syed does not say that he reviewed ref DIT 1 0001, not-with-standing a
102008 - preference to avoid the patient's method of communication.
102009 -
102010 - As a result, it is not clear that needed action will result to support
102011 - the patient.  This state of the record conflicts with Kaiser's
102012 - guidelines on communication, which calls for feedback from the doctor
102013 - to confirm understandings, as reported on 990625. ref SDS 36 4752
102014 -
102015 -       [On 990910 Kaiser communication failed. ref SDS 56 3038]
102016 - ..
102017 - There are a couple solutions.
102018 -
102019 -    1.  We can try to get support for Syed, who undoubtedly is very
102020 -        busy, and so may feel that clicking on a link to obtain medical
102021 -        "intelligence" takes time away from patient care.  Kaiser's
102022 -        Healthwise Handbook seems to suggest a larger role for a nurse
102023 -        can be an effective way to maintain good communication with a
102024 -        personal care provider. ref OF 1 1160
102025 -
102026 -        Possibly Nannett or another nurse/admin person can help Syed
102027 -        with the burden of reviewing medical history.
102028 -
102029 -          [On 990924 Patient Assistance reported that some doctors are
102030 -          not comfortable with procedures to click on links.
102031 -          ref SDS 59 8137]
102032 -
102033 -          [On 990927 asked Patient Assistance for help. ref SDS 60 3966]
102034 -        ..
102035 -    2.  We can change to a doctor who is comfortable with
102036 -        communication that makes partnership effective, as recommended
102037 -        by Kaiser's guidelines on 990625. ref SDS 36 2924
102038 -
102039 -        This may be difficult, since Sylvia indicated that Syed is one
102040 -        of the best doctors at Kaiser on using new methods to
102041 -        communicate with the patient.
102042 -
102043 - On 990625 Kaiser's guidelines on communiation indicated there is a
102044 -
102045 -
102046 -                         Patient Assistance
102047 -
102048 -
102049 - ... role at Kaiser. ref SDS 36 1456
102050 -
102051 - Kaiser's guidelines recommend changing doctors if communication is not
102052 - effective, reviewed on 990625. ref SDS 36 4928
102053 -
102054 -       [On 990910 Kaiser communication failed. ref SDS 56 3038]
102055 -
102056 -       [On 990913 Patient Assistance reported failure to support
102057 -       communication due to exigent personal problems. ref SDS 57 0001]
102058 -
102059 -       [On 990923 Syed confirmed unwillingness to use web mail to
102060 -       improve communication. ref SDS 58 0001]
102061 -
102062 -       [On 990927 asked Patient Assistance to inquire about changing
102063 -       Primary Care Physicians. ref SDS 60 3776]
102064 -
102065 -
102066 -
102067 -
102068 -
102069 -
1021 -

SUBJECTS
Xrays on Knees, 990813

1204 - 1550 visited Kaiser
1205 -
1206 -
120601 -  ..
120602 -  ..
120603 - Xrays on Knees for Meeting with Orthopedic Surgeon
120604 -
120605 - Went to Section C, per instructions from Syed on 990811, and obtained
120606 - a requesition for xrays. ref SDS 51 6901  Had to correct the
120607 - requisition, which was for only one knee.  It was changed to have both
120608 - knees xrayed per meeting on 990625 that showed both knees need
120609 - examination. ref SDS 36 4420
120610 -
120611 - Went over and got 4 xrays of both the knees.
120612 -
120613 - The xray technician, a woman named Gaye, said the xrays will be
120614 - available in about a week.  Analysis will be prepared by the Radiology
120615 - Department.  The xrays and report will be sent to the orothpedic
120616 - surgeon for the examination on my knees, scheduled by Doctor Naqvi.
120617 -
120618 -     [Sent confirming letter per above. ref SDS 0 1457]
120619 -
120620 -     [On 990829 sent reminder on med history and xrays. ref SDS 54 7387
120621 -
120622 -     [On 990907 requested confirmation the information sent to support
120623 -     meeting with orthopedic surgeon. ref SDS 55 1080]
120624 -
120625 -     [On 990910 xrays were not delivered. ref SDS 56 3038]
120626 -
120627 -     [On 991006 report Team Care policy was not followed to submit
120628 -     medical history to team members because doctor doesn't like web
120629 -     mail. ref SDS 61 0002]
120630 -
120631 -
120632 -
120633 -
1207 -

SUBJECTS
Knee Examination Shows Problem on 990816

1304 -
130401 -  ..
130402 - Physical Therapy Scheduled for Monday, Not Meeting with Doctor
130403 -
130404 - I asked Gaye to see if we can get some details on the meeting
130405 - scheduled for Monday, 990816.
130406 -
130407 - She looked this up on Kaiser's system, and found the meeting is for
130408 - physical therapy, and not with the orthopedic surgeon.
130409 -
130410 - Gaye explained how to find the physical therapy office.
130411 -
130412 -    [On 990816 meeting with physical therapy. ref SDS 53 0001]
130413 -
130414 -
130415 -
130416 -
130417 -
130418 -
1305 -