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Meeting Productivity Communication Failed Not Enough Time Team Care
2nd Opinions on Surgery from UCSF and Stanford Not Reviewed by Surge
Productivity Paralyzed Information Overload Buries Everyone Going Da
Collaboration Improved by Multiple SDS Users Experience SDS Aids Col
Productivity Meetings Collaboration Standard Intelligence Applicatio
Meeting Surgery Department Doctor Examin Wound Biopsy on 040419 Refe
Communication Failed Not Enough Time Team Care Collaboration Surgery

3209 -
3209 -    ..
3210 - Summary/Objective
3211 -
321101 - Follow up ref SDS 10 0000, ref SDS 6 0000.
321102 -
321103 -
321104 -
321105 -
321107 -  ..
3212 -
3213 -
3214 - Progress
3215 -
321501 - Met with the surgeon, Doctor Riley-Paull, to schedule mastectomy on
321502 - referral from Doctor Johnson in Oncology, and ordered during the
321503 - meeting at Kaiser on 041230. ref SDS 9 CW6J  Background on planning in
321504 - the Oncology Department for Millie to have mastectomy surgery is shown
321505 - in case study on 041210. ref SDS 8 657F
321507 -  ..
321508 - The surgeon examined the wound from the biopsy taken on 040419,
321509 - ref SDS 1 XU52, as requested on 041202 by referral from Doctor Parsley
321510 - when he examined Millie in the emergency department. ref SDS 6 AH9H
321512 -  ..
321513 - The surgeon commented that the red rash, and thickened, stiff skin
321514 - expanding beyond the left breast toward the neck, together with a
321515 - biopsy wound, which does not heal for eight (8) months signal severe
321516 - problems of IBC relapse that prevents performing surgery at this time.
321517 - She asked about the opinion of the primary care physician (PCP) in
321518 - Oncology on advisabilty of surgery for local control?
321520 -  ..
321521 - Millie asked if the surgeon has talked to the primary care physician
321522 - (PCP) in Oncology, or possibly received correspondence (email)
321523 - explaining objectives of the visit today?
321524 -
321525 -     [On 050204 primary care physician had not seen surgon's report in
321526 -     time to prepare for meeting with patient. ref SDS 12 UH3O
321528 -  ..
321529 - The surgeon advised there has been no contact with PCP.  She will call
321530 - the doctor with results of the meeting today.  This will expedite
321531 - collaboration planned by the doctor on 041230. ref SDS 9 UJ5M
321533 -  ..
321534 - Millie explained understandings from meeting on 041230 that the
321535 - primary care physician wants to schedule surgery that will contain the
321536 - spread of cancer for local control, ref SDS 9 6T5G, so that IBC in the
321537 - left breast does not compound into distant metastasis, and cascade out
321538 - of control, as shown in a study, also, on 041230. ref SDS 9 XV7M
321540 -  ..
321541 - Surgery considerations from patient history are shown in a case study
321542 - reported in the record on 041210. ref SDS 8 ZV5J
321544 -  ..
321545 - The surgeon asked if the biopsy wound has been continuously "messy,"
321546 - like today?
321547 -
321548 -     [On 050324 surgeon observes improved healing of biopsy wound after
321549 -     3 treatments with AC. ref SDS 14 906K
321550 -
321551 -     [On 050727 followed up examination by surgeon shows biopsy wound
321552 -     fully healed after 4 treatments with Taxotere and capecitabine.
321553 -     ref SDS 15 WI6K
321555 -  ..
321556 - Millie said no.  Case history shows healing has tracked improvement
321557 - from treating IBC.  After the biopsy was taken on 040419, the sore
321558 - healed slowly during six (6) months of treatment on the Avastin Taxol
321559 - chemotherapy trial.  Examination at UCSF for a 2nd opinion on 041018
321560 - and again the next day at Stanford on 041019 observed improvement in
321561 - both IBC and the biopsy wound.  Millie asked if the surgeon has
321562 - reviewed 2nd opinions; from UCSF saying the wound is "incompletely
321563 - healed," received on 041117, ref SDS 4 OU5T, and from Stanford
321564 - describing a "poorly healing" wound, received on 041209. ref SDS 7
321565 - O23X
321567 -  ..
321568 - The surgeon said she has not yet had time for review.
321570 -  ..
321571 - Millie further explained healing continued following examinations at
321572 - UCSF and Stanford.  On 041021 there was another chemotherapy treatment
321573 - with the Avastin-Taxol trial.  Examination at Kaiser on 041104 to
321574 - prepare for another cycle of chemotherapy found that the wound was
321575 - nearly healed. ref SDS 3 GL4K  However, treatment was ended because a
321576 - CT test showed pulmonary emboli, which is a side effect of Avastin.
321577 - ref SDS 3 N438  Treatment was also halted with Taxol alone (i.e.,
321578 - without Avastin that causes pulmonary emboli). ref SDS 3 Q59K  The
321579 - doctor recommended that treatment start again as soon as possible to
321580 - prevent IBC from flaring up again. ref SDS 3 WT60
321582 -  ..
321583 - On 041130 Millie was examined by the primary care physician in order
321584 - to get back on chemotherapy, as recommended on 041104.  The
321585 - examination found that the biopsy wound had changed course and
321586 - worsened during six (6) weeks without regular treatments for IBC, and
321587 - so the doctor in Oncology prescribed antibiotics to treat the wound.
321588 - ref SDS 5 6T5G
321590 -  ..
321591 - Two (2) days later on 041202, the rash on the left breast suddenly
321592 - spread dramatically, and temperature was elevated above the bench mark
321593 - for cancer patients to get treatment in the Emergency room.  During
321594 - treatment, the attending physician determined that symptoms of rising
321595 - IBC were expected side effects from treatment with antibiotics
321596 - prescribed to treat the biopsy wound.  During this examination, the
321597 - doctor observed the wound, and asked about backgound. ref SDS 6 AH9H
321598 - He notified PCP that a referral was made for examination by the
321599 - surgeon. ref SDS 6 BI4Y
321601 -  ..
321602 - On 041210 the primary care physician saw the patient.  Examination
321603 - showed the biopsy wound was healing slowly, and so the prescription
321604 - for antibiotics was extended, to run concurrent with chemotherapy
321605 - treatments scheduled to begin soon. ref SDS 8 6T5G
321607 -  ..
321608 - On 041230, the primary care physician supported examination today in
321609 - the surgery department after seeing the wound has worsened into the
321610 - "messy" condition observed today.  Antibiotic treatments were ended,
321611 - and new plans were made to begin chemotherapy treatments. ref SDS 9
321612 - 6T5G
321614 -  ..
321615 - The surgeon commented that in preparing for the meeting today she
321616 - noticed from Kaiser's computer that Millie started chemo a few days
321617 - ago on 050104.  Millie confirmed she got treatment in the Chemotherapy
321618 - Clinic on Tuesday. ref SDS 11 0001
321620 -  ..
321621 - The surgeon feels that patient history in this case shows chemotherapy
321622 - is the best treatment.  She said that spread of disease "fingering out
321623 - in patches" toward the neck seen today, does not provide enough
321624 - healthy skin to stitch the surgical wound together, and there is no
321625 - basis for determining boundaries of surgery until IBC rash subsides
321626 - enough to establish the maximum area for removing diseased tissue.
321627 - The surgeon will report to the primary care physician in Oncology on
321628 - her opinion, and explain that surgery for a masectomy on the left
321629 - breast will require successful treatment of worsening IBC, per
321630 - examination above, ref SDS 0 IS5N, for reasons discussed in the
321631 - meeting on 040429. ref SDS 2 SD7F
321632 -
321633 -     [On 050204 primary care physician had not seen surgon's report in
321634 -     time to prepare for meeting with patient. ref SDS 12 RD3M
321636 -      ..
321637 -     [On 050311 the doctor in oncology had not seen the surgeon's
321638 -     report on the examination today, nor discussed the case with the
321639 -     surgeon. ref SDS 13 RD3M
321641 -      ..
321642 -     [On 050311 the doctor requested another examination by the surgeon
321643 -     to evaluate criteria for surgery, ref SDS 13 XQ41, to eliminate
321644 -     "pockets" of resistance to chemotherapy. ref SDS 13 PA4N
321646 -      ..
321647 -     [On 050324 the surgeon examined the left breast and found
321648 -     improvement healing the biopsy wound, ref SDS 14 WI6K; the surgeon
321649 -     further found that IBC is worsening, which prevents surgery until
321650 -     recovery from IBC using chemotherapy. ref SDS 14 YY7F
321651 -
321652 -
321653 -
321654 -
321655 -
321656 -
321657 -
321658 -
321659 -
321660 -
3217 -