CONTACTS 

SUBJECTS
Kaiser Planning Issues Notify 5 Year Case Review

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 44 0000, ref SDS 42 0000.
050502 -
050503 - Millie wrote several letters today on pending issues, including
050504 - commending Kaiser and the doctor for good care the past 5 years.
050505 - ref SDS 0 K36G  Millie submitted the location of UCSF 2nd opinion that
050506 - proposes 2 drug trials Millie qualifies for participation. ref SDS 0
050507 - 086H   The doctor reported that results of CA 15-3 blood tests for
050508 - 0601214, and for today have not been posted yet. ref SDS 0 XT4K  Good
050509 - news hearing that heart disorder enlarged right ventricle takes many
050510 - years to become life threatening.  This is a good point to check with
050511 - heart specialist. ref SDS 0 VC4M
050512 -
050513 -
050514 -
050515 -
050517 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Scope Letter to Kaiser on Progress Review Diagnosis Treatment
050902 -
050903 - Follow up ref SDS 44 5S84.
050904 -
050905 - Planning in the record on 061217 developed background on a number of
050906 - pending issues. ref SDS 44 5S84
050907 -
050908 -
050909 -
050910 -
050911 -
050912 -
0510 -

SUBJECTS
INR 6.4 Hemmoraging Risk Medication Mistakes Diflucan Conflicts with

3903 -
390401 -  ..
390402 - Diflucan Fluconazole Increased Risk Hemorraging INR Rises 6.4
390403 - INR 6.4 Coumadin Change Treatment Protocol Reduce Risk Hemorraging
390404 -
390405 - Follow up ref SDS 43 4O5H.
390406 -
390407 - Submitted ref DIT 1 0001 to the doctor saying...
390408 -
390409 -    1.  As we transition to a new treatment, possibly for
390410 -        expanding IBC to the right breast, there are a number of
390411 -        issues that need review. Kaiser's correspondence system
390412 -        limits clear, concise, and complete communications, so
390413 -        each issue will be submitted in a separate letter.
390414 -
390415 -           [On 061227 notified Kaiser technical folks about limitations
390416 -           of email system. ref SDS 48 OX5J
390418 -            ..
390419 -           [On 061227 Kaiser cited NWO analysis of Communication
390420 -           Metrics. ref SDS 48 OX5J
390422 -            ..
390423 -           [On 070115 Kaiser submitted issues with email productivity
390424 -           to technical and management teams. ref SDS 52 OX5J
390426 -  ..
390427 - This addresses issues listed on 061217. ref SDS 44 5S84
390429 -  ..
390430 - Problems with Kaiser's electronic communication system were reviewed
390431 - on 060106. ref SDS 24 1O8F
390433 -  ..
390434 - Letter to primary care physician continues...
390435 -
390436 -    2.  Last Thursday, on 061214 my INR jumped to 6.4 with Diflucan
390437 -        (fluconazole) beginning on 061208, ref DIT 1 L26F; conflict
390438 -        occurred which required changing Coumadin regimen. ref SDS 43
390439 -        4O5H
390441 -  ..
390442 - Citing issue in the list on 061217. ref SDS 44 MM6L
390443 -
390444 -            [...below, Doctor responds saying to stop taking Diflucan
390445 -            however, prescription has already expired. ref SDS 0 6P9F
390446 -
390447 -            [On 100202 0301 Millie's INR 5.8 2nd highest in patient
390448 -            history risks hemoraging and death, ref SDS 53 K069,
390449 -            slipped through the cracks again due to conflicts in
390450 -            medications that were overlooked. ref SDS 53 LH6T
390452 -  ..
390453 - Letter to primary care physician continues...
390454 -
390455 -    3.  This morning I went for another blood draw to check on the INR.
390456 -        ref DIT 1 L36N
390458 -  ..
390459 - Results of the blood draw reported later this morning show
390460 - significant improvement dropping from 6.4 to 3.3.
390461 -
390462 -            [On 061227 letter to doctor reports improvement INR test.
390463 -            ref SDS 47 4Q84
390465 -  ..
390466 - Treatments with Coumadin resumed at reduced level to bring INR within
390467 - 2.0 - 3.0.
390468 -
390469 -
390470 -
390471 -
390472 -
3905 -

SUBJECTS
Rash Seems Improved May Be Wax Wane Scenario #2 Infection May Respon

4503 -
450401 -         ..
450402 -        CA 15-3 Blood Test Request Submit Results
450403 -        Rash Seems Improved May Be Wax Wane Scenario #2
450404 -        2 Scenarios IBC Rash Wax Wane Infection May Respond Treatment
450405 -
450406 -        Follow up ref SDS 44 QT5K, ref SDS 42 KW45.
450407 -
450408 -    4.  Not sure if Diflucan has helped.  Patient history this morning
450409 -        indicates that rash seems improved, ref SDS 44 QT5K, however,
450410 -        this rash seems to wax and wane, ref DIT 1 L37H, as noted in
450411 -        Benz 2nd opinion received on 041117. ref SDS 14 OS6W
450412 -
450413 -            [On 061227 report rash seems worse. ref SDS 47 4Q73
450415 -             ..
450416 -            [On 070112 Millie notified doctor that improvement in CA
450417 -            15-3 aligns with IBC rash intensity subsiding. ref SDS 51
450418 -            1G3K
450420 -         ..
450421 -    5.  Please submit CA 15-3 for tests today, and on 061214.
450422 -        ref DIT 1 ON7K
450424 -  ..
450425 - This follows up work on 061214 when Millie had a blood test for
450426 - Coumadin (warfarin) treatment, and requested CA 15-3, following up the
450427 - meeting on 061208 when no blood test was reported. ref SDS 42 087J,
450428 - but results of the test on 061214 was not reported at that time.
450429 - ref SDS 43 4O5H
450430 -
450431 -            [On 061227 CA 15-3 74 significant rise aligns with rash
450432 -            getting worse, after small decline when rash improved
450433 -            slightly. ref SDS 47 UF3I
450435 -             ..
450436 -            [On 070110 CA 15-3 56 cancer marker drops dramatically
450437 -            significant improvement aligns with IBC rash intensity
450438 -            subsiding; continuing erratic changes. ref SDS 50 087J
450440 -             ..
450441 -            [On 070112 Millie notified doctor that improvement in CA
450442 -            15-3 aligns with IBC rash intensity subsiding. ref SDS 51
450443 -            1G3K
450444 -
450445 -
450446 -
4505 -

SUBJECTS
Diflucan Fluconazole INR 6.4 Medication Mistakes Conflicts with Coum

5703 -
5704 - 1231
570501 -  ..
570502 - Doctor Advises Stop Taking Diflucan CA 15-3 Test Results Not Available
570503 -
570504 - Millie received ref DRT 1 0001 from the doctor responding to the
570505 - letter earlier this morning, ref DIT 1 0001, reporting conflict with
570506 - Diflucan (fluconazole) and Coumadin (warfarin), and asking for
570507 - submission of results on CA 15-3 cancer marker tests, per above.
570508 - ref SDS 0 8U5L
570510 -  ..
570511 - Primary care physician says...
570512 -
570513 -        Labs still pending. OK to stop Diflucan if there has been no
570514 -        response by now.
570516 -  ..
570517 - The doctor's report that labs for CA 15-3 blood tests on 061214 are
570518 - still pending 4 days later on 061218, ref SDS 43 4O5H, conflicts with
570519 - patient history since often CA 15-3 is available the same day and most
570520 - often by the next day, shown by patient history on 061201. ref SDS 39
570521 - 2N5J
570523 -  ..
570524 - The doctor prescribed Diflucan (fluconazole) on 061208 for 10 days.
570525 - ref SDS 42 KW45  Since today is the 10th day the doctor proposes
570526 - stopping treatment on the date treatment was prescribed to end.
570527 -
570528 -
570529 -
570530 -
570531 -
570532 -
5706 -

SUBJECTS
Drug Trials Millie Submits Letter Notifying Kaiser Location in UCSF

6903 -
690401 -  ..
690402 - Drug Trials UCSF 2 Proposals Kaiser Review Pending Needs Support
690403 - UCSF 2 Drug Trial Proposals Kaiser Needs Support to Complete Review
690404 -
690405 - Follow up ref SDS 42 P256.
690406 -
690407 - Millie submitted ref DIT 2 0001 another letter to the primary care
690408 - physician, this one on drug trials, per note in the first letter
690409 - explaining limitations of Kaiser's correspondence system, per above.
690410 - ref SDS 0 8U5L
690412 -  ..
690413 - This letter implements planning yesterday on 061217. ref SDS 44 FP6G
690415 -  ..
690416 - Millie says to the primary care physician...
690417 -
690418 -    1.  During the meeting at Kaiser on 061208 you requested notice,
690419 -        ref SDS 42 D58F, of the location in the Benz 2nd opinion
690420 -        received from Kaiser on 060929, ref SDS 35 6L9O, and
690421 -        documenting an earlier consultation on 060821, that says UCSF
690422 -        has 2 studies which can help me. ref DIT 2 0001  Here is a link
690423 -        to the record reviewing the Benz opinion proposing the 2
690424 -        trials, and further links to the actual document. ref SDS 35
690425 -        UI9K
690427 -         ..
690428 -    2.  Please let me know if you need further support accessing the
690429 -        Benz report, and submit comments to assess the UCSF proposal.
690430 -        ref DIT 2 V86H
690431 -
690432 -           [On 061226 Kaiser performing due diligence collaborating
690433 -           with UCSF to consider drug trial potocols for Millie's
690434 -           patient profile. ref SDS 46 086H
690435 -
690436 -
690437 -
690438 -
690439 -
6905 -

SUBJECTS
Navelbine Vinorelbine Tartrate Side Effects Compatibility Protocol P

7303 -
730401 -  ..
730402 - Navelbine Compatibility Single Agent or Combined Taxotere Capecitabine
730403 -
730404 - Follow up ref SDS 42 3B4N.
730405 -
730406 - Millie submitted ref DIT 3 0001 another letter to the primary care
730407 - physician, this one on changing chemotherapy to Navelbine, and per
730408 - note in the first letter explaining limitations of Kaiser's
730409 - correspondence system, per above. ref SDS 0 8U5L
730411 -  ..
730412 - This letter implements planning yesterday on 061217. ref SDS 44 SU7H
730414 -  ..
730415 - Millie says to the primary care physician...
730416 -
730417 -    1.  I received a call last Thursday from Oncology pharmacy on
730418 -        changing treatment to Navelbine. ref DIT 3 0001  I requested a
730419 -        report on Kaiser's review of compatibility with patient
730420 -        history, including issues listed on 061208. ref SDS 42 LU3J
730422 -         ..
730423 -    2.  Past conflicts in medications with Avastin causing PE, reported
730424 -        on 041104, ref SDS 13 RZ4I, and recent experience with Diflucan,
730425 -        reported on 061214, ref SDS 43 XF77, and cited in another
730426 -        letter to Kaiser earlier today, per above, ref SDS 0 5M5Y,
730427 -        suggest this is a good time to check compatibility for changing
730428 -        treatment, particularly with respect to rising infection
730429 -        problems, and WBC, hemoglobin, etc., blood counts. ref DIT 3
730430 -        KJ6H
730432 -         ..
730433 -    3.  Since I have not heard back from the person who called about
730434 -        this, can you please follow up. ref DIT 3 BL6N
730435 -
730436 -            [On 061226 report to Kaiser that Brad called to follow up
730437 -            on the call from Oncology and gave an excellent explanation
730438 -            of research on Navelbine compatibility with patient
730439 -            history, and plans to confirm in a letter. ref SDS 46 EL4O
730441 -             ..
730442 -            [On 061227 Millie's letter to Kaiser commends Brad's work
730443 -            in the pharmacy assisting patients with carefully
730444 -            researched and lucid explanations of Navelbine chemotherapy
730445 -            compatibility issues. ref SDS 47 KN5X
730446 -
730448 -  ..
7305 -
7306 -
7307 - 1238
7308 -
730801 - Doctor's letter responding to Millie's letter today does not follow up
730802 - on conflicts between Navelbine and patient history; only addresses
730803 - Navelbine combining with other drugs, per below. ref SDS 0 U16H
730804 -
730805 -
730806 -
730807 -
730808 -
730809 -
7309 -

SUBJECTS
Navelbine Vinorelbine Tartrate Protocol Single Agent Combine Taxoter

AH03 -
AH0401 -  ..
AH0402 - Navelbine Single Agent Combine Taxotere Capecitabine Conflict 2nd Opinions
AH0403 -
AH0404 - Follow up ref SDS 42 Q74O. ref SDS 35 WR3Y.
AH0405 -
AH0406 -    4.  Navelbine was recommended in 2nd opinions.  Initially on
AH0407 -        041117, UCSF proposed single agent or combined with Taxotere.
AH0408 -        ref DIT 3 JN7H  However, recent opinion received on 060929 Benz
AH0409 -        proposes Navelbine and capecitabine. ref SDS 35 WR3Y
AH0411 -         ..
AH0412 -    5.  Please submit Kaiser's analysis on this issue. ref DIT 3 WO8F
AH0413 -
AH0414 -
AH0416 -  ..
AH05 -
AH06 -
AH07 - 1238
AH08 -
AH0801 - Doctor Advises Kaiser Recommends Single Agent Treatment
AH0802 - Medical Mistakes Cursory Generalizations Prevent Communication
AH0803 - Patient Care Harmed Cursory Generalizations Prevent Communication
AH0804 -
AH0805 - Millie received ref DRT 2 0001 from the doctor responding to the
AH0806 - letter earlier this morning, ref DIT 3 0001, asking about conflicts
AH0807 - between proposed treatment with Navelbine and patient profile, per
AH0808 - above, ref SDS 0 EB6J, and also about resolving conflict in Benz 2nd
AH0809 - opinions on Navelbine treatments, also, per above. ref SDS 0 Q74O
AH0811 -  ..
AH0812 - Primary care physician says...
AH0813 -
AH0814 -        At this time only single agent treatment would be recommended.
AH0815 -        Otherwise, all possibilities of treatment become rapidly
AH0816 -        exhausted.
AH0818 -  ..
AH0819 - Doctor does not respond to questions on Navelbine compatibility with
AH0820 - patient history, discussed with Oncology Pharmacy, per above.
AH0821 - ref SDS 0 427M
AH0823 -  ..
AH0824 - The doctor repeats past comments on 041130 that single agents are
AH0825 - recommended at this time to avoid exhausing all treatment
AH0826 - possibilities. ref SDS 15 5X4J  This was repeated a few weeks earlier
AH0827 - on 061208. ref SDS 42 Q74O
AH0829 -  ..
AH0830 - Cursory generalizations to avoid constructive response reduces doctor
AH0831 - patient partnership that relies on effective communication, called out
AH0832 - in Kaiser's Healthwise Handbood, reviewed on 990625. ref SDS 1 4185
AH0833 - Defeats purpose of timely correspondence delivery with Kaiser's
AH0834 - electronic mail system, reported on 051121. ref SDS 23 V25O
AH0836 -  ..
AH0837 - This response seems unsatisfying, similar to the letter on 060721,
AH0838 - ref SDS 29 O64U, which led to seeking 2nd opinion on 060725 for
AH0839 - reasoned, professional advice. ref SDS 31 QR6Y  Previously, on 061006
AH0840 - Millie was dissatisfied with poor quality of correspondence from
AH0841 - primary care physician, failing to answer patient questions, and
AH0842 - failing to explain reasoning and background in patient history that
AH0843 - supports diagnosis and treatment decisions. ref SDS 36 GW3J
AH0845 -  ..
AH0846 - Risk assessment on exhausting all treatment possibilities requires a
AH0847 - list of drugs available to treat IBC, requested on 041130, and again
AH0848 - on 060711.
AH0849 -
AH0850 -
AH0851 -
AH0852 -
AH09 -

SUBJECTS
Case Study Couplets Double-agent Chemotherapy Prescribed 6 Times Sin

AQ03 -
AQ0401 -  ..
AQ0402 - Case Study Double Agent Treatment Routinely Prescribed Patient History
AQ0403 -
AQ0404 - Millie's patient history shows most chemotherapy treatments have been
AQ0405 - double-agents (also "couplets")....
AQ0406 -
AQ0407 -        1.  Adriamycin Cytoxan prescribed
AQ0408 -            treatment......................... 020321, ref SDS 3 6SWS
AQ0410 -             ..
AQ0411 -        2.  Adriamycin Cytoxan treatment
AQ0412 -            started........................... 020423, ref SDS 4 0001
AQ0414 -             ..
AQ0415 -        3.  Taxotere prescribed, AC not
AQ0416 -            effective......................... 020603, ref SDS 5 WO4O
AQ0418 -             ..
AQ0419 -        4.  Bevacizumab (Avastin) combined
AQ0420 -            with Taxol treatment prescribed
AQ0421 -            as Millie's best course of
AQ0422 -            treatment......................... 040309, ref SDS 7 WG80
AQ0424 -             ..
AQ0425 -        5.  Bevacizumab (Avastin) combined
AQ0426 -            with Taxol treatment
AQ0427 -            started........................... 040420, ref SDS 8 9Z5J
AQ0429 -             ..
AQ0430 -        6.  Bevacizumab (Avastin) combined
AQ0431 -            with Taxol treatment ends due
AQ0432 -            to side effects pulmonary
AQ0433 -            embolism.......................... 041104, ref SDS 13 RZ4I
AQ0435 -             ..
AQ0436 -        7.  Patient asks about continuing
AQ0437 -            with single agent treatment using
AQ0438 -            Taxol that was effective and did
AQ0439 -            not cause blood clot problems,
AQ0440 -            doctor deferred until primary
AQ0441 -            care physician returns from
AQ0442 -            vacation.......................... 041104, ref SDS 13 Q59K
AQ0444 -             ..
AQ0445 -        8.  Doctor rejects double-agent treatment
AQ0446 -            with Taxotere and capecitabine
AQ0447 -            (Xeloda) recommended by Doctor Benz
AQ0448 -            at UCSF 2nd opinion; notes single
AQ0449 -            agent treatment preserves
AQ0450 -            limited options for
AQ0451 -            patient........................... 041130, ref SDS 15 5X4J
AQ0453 -             ..
AQ0454 -        9.  Primary care physician rejects
AQ0455 -            treatment with single agent Taxol
AQ0456 -            or Taxotere previously effective
AQ0457 -            for Millie........................ 041130, ref SDS 15 0293
AQ0459 -             ..
AQ0460 -       10.  Doctor proposes treatment with
AQ0461 -            couplet protocol combining
AQ0462 -            Novel Epothilones BMS-247550
AQ0463 -            with capeticatine................. 041210, ref SDS 16 CF9F
AQ0465 -             ..
AQ0466 -       11.  Patient asks about treatment
AQ0467 -            with single agent Taxol or
AQ0468 -            Taxotere.......................... 041230, ref SDS 17 2V85
AQ0470 -             ..
AQ0471 -       12.  Doctor prescribes 2 treatments with
AQ0472 -            double-agent chemtherapy Adriamycin
AQ0473 -            Cytoxan (AC) in order to qualify
AQ0474 -            patient for drug trial with double-
AQ0475 -            agent Novel Epothilones BMS-247550
AQ0476 -            combines with
AQ0477 -            capeticatine...................... 041230, ref SDS 17 XQ41
AQ0479 -             ..
AQ0480 -       13.  Doctor switches from AC to double-
AQ0481 -            agent chemtherapy combining Taxotere
AQ0482 -            with capecitabine
AQ0483 -            (Xeloda).......................... 050329, ref SDS 19 T58M
AQ0485 -             ..
AQ0486 -       14.  Doctor prescribes double-agent
AQ0487 -            chemotherapy treatment for 3rd
AQ0488 -            relapse of IBC combining
AQ0489 -            Taxotere with capecitabine
AQ0490 -            (Xeloda).......................... 060711, ref SDS 27 PF3O
AQ0491 -
AQ0492 -
AQ0493 -
AQ0494 -
AQ0495 -
AQ0496 -
AQ0497 -
AQ0498 -
AQ05 -

SUBJECTS
Enlarged Right Ventricle Cor Pulmonale Heart Disorder Patient Reques

BC03 -
BC0401 -  ..
BC0402 - Cor Pulmonale Heart Disorder Request Examination Heart Specialist
BC0403 - Heart Examination Enlarged Right Ventricle Request Heart Specialist
BC0404 - Enlarged Right Ventricle Examination Heart Specialist Patient Request
BC0405 -
BC0406 - Follow up ref SDS 42 VJ4J. ref SDS 40 VJ4J.
BC0407 -
BC0408 - Millie submitted ref DIT 4 0001 another letter to the primary care
BC0409 - physician, this one on getting a heart examination by a specialist,
BC0410 - and per note in the first letter explaining limitations of Kaiser's
BC0411 - correspondence system, per above. ref SDS 0 8U5L
BC0413 -  ..
BC0414 - This letter implements planning yesterday on 061217, ref SDS 44 0F9M,
BC0415 - to follow up Millie letter on 061027 requesting prognosis on when
BC0416 - exercise can be resumed in the gym to restore fitness. ref SDS 37 0C4I
BC0418 -  ..
BC0419 - Millie says to the primary care physician...
BC0420 -
BC0421 -    1.  In our meeting on 061208 you discussed findings in the PET test
BC0422 -        on 060930 that report enlarged right ventricle, and commented
BC0423 -        that examination with the stethoscope, ref DIT 4 0001, and Sa
BC0424 -        O2 99% indicate symptoms of Cor Pulmonale are not very severe
BC0425 -        yet. ref SDS 42 VJ4J
BC0427 -         ..
BC0428 -    2.  Hopefully, Coumadin treatments will manage this problem, and
BC0429 -        the PET/CT scan test scheduled for 061227, ref DIT 4 9Q6F, may
BC0430 -        shed more light on scope and requirements for treatment.
BC0431 -        ref SDS 42 1U4I
BC0433 -         ..
BC0434 -    3.  As we go forward, Kaiser's Team Care practice can provide
BC0435 -        review by a heart specialist to support initial impressions.
BC0436 -        ref DIT 4 HW7G  This would address my continuing symptoms of
BC0437 -        fatigue, shortness of breath, heavy chest, etc., with normal
BC0438 -        activity. ref SDS 42 CV5L
BC0440 -  ..
BC0441 - On 061208 Millie asked about examination by a heart specialist to
BC0442 - confirm clearance for resulming work outs in the gym to improve
BC0443 - physical fitness and relieve symptoms of pulmonary embolism.
BC0444 - ref SDS 42 HZ39
BC0445 -
BC0446 -
BC0448 -  ..
BC05 -
BC06 -
BC07 - 1244
BC08 -
BC0801 - Doctor Says Enlarged Right Ventricle Not Life Threatening for Years
BC0802 - Cor Pulmonale Enlarged Right Ventricle Not Life Threatening for Years
BC0803 -
BC0804 - Millie received ref DRT 3 0001 from the doctor responding to the
BC0805 - letter earlier this morning, ref DIT 4 0001, asking about examination
BC0806 - by heart specialist of Cor Pulmonale heart disorder due to enlarged
BC0807 - right ventricle, per above, ref SDS 0 VC4M, and also about resolving
BC0808 - conflict in Benz 2nd opinions on Navelbine treatments, also, per
BC0809 - above. ref SDS 0 Q74O
BC0811 -  ..
BC0812 - Primary care physician says...
BC0813 -
BC0814 -        This potential problem will most likely not become clinically
BC0815 -        relevant considering that it takes years to progress to a point
BC0816 -        where it becomes life threatening. ref DRT 3 0001
BC0818 -  ..
BC0819 - Feeling that something "most likely" will occur can be supported by
BC0820 - referral to specialist.
BC0821 -
BC0822 -            [On 061227 Millie letter notifies Kaiser of continuing
BC0823 -            symptoms pulmonary embolism and heart disorder Cor
BC0824 -            Pulmonale from enlarged right ventricle; proposes
BC0825 -            examination by heart specialist, ref SDS 47 645I, and
BC0826 -            suggests waiting to discuss during meeting on 070105 after
BC0827 -            results of PET/CT test on 061227 are reported. ref SDS 47
BC0828 -            B995
BC0829 -
BC0830 -
BC0831 -
BC0832 -
BC09 -

SUBJECTS
Commend Primary Care Physician Oncology Kaiser Team Care 5 Year Care

BI03 -
BI0401 -  ..
BI0402 - Commend Primary Care Physician 5 Year Care Complex Cancer Case
BI0403 -
BI0404 - Follow up ref SDS 42 K36G, ref SDS 40 K36G.
BI0406 -  ..
BI0407 - Millie submitted ref DIT 5 0001 another letter to the primary care
BI0408 - physician, this one commending care over past 5 years, and requesting
BI0409 - Tumor Board review, and per note in the first letter explaining
BI0410 - limitations of Kaiser's correspondence system, per above. ref SDS 0
BI0411 - 8U5L
BI0413 -  ..
BI0414 - This letter implements planning yesterday on 061217. ref SDS 44 GK5L
BI0416 -  ..
BI0417 - Millie says to the primary care physician...
BI0418 -
BI0419 -    1.  I want to take this occassion to commend your excellent work,
BI0420 -        and the entire Kaiser team for my care the past 5 years.
BI0421 -        Medical practice is a lot of hard work tracking countless
BI0422 -        details, far more complex than building a Boeing 747.  There
BI0423 -        are bound to be ups and downs.  Kaiser's commitment to
BI0424 -        excellence shines through in your work allocating time for
BI0425 -        review, analysis, and communications. ref DIT 5 0001
BI0427 -  ..
BI0428 - Level of effort required by Kaiser illustrated by complexity of 36
BI0429 - pending issues on 061208. ref SDS 42 LU3J  Progress eliminating errors
BI0430 - and omissions from the medical chart is presented on 061208.
BI0431 - ref SDS 42 FE4I
BI0432 -
BI0433 -
BI0434 -
BI0435 -
BI0436 -
BI0437 -
BI05 -

SUBJECTS
Strategy Treatment Plan IBC 3rd Relapse Tumor Board Review Major Cha

BV03 -
BV0401 -  ..
BV0402 - IBC Expert Panel Tumor Board Productive Review Millie's Complex Case
BV0403 - Tumor Board Review on Changing Treatment Expansion of Disease
BV0404 - Work Up Patient Profile Develop Options Strategy Treatment IBC Relapse
BV0405 - Strategy Treatment Options Scenarios Planning Patient Work Up Deferred
BV0406 -
BV0407 - Follow up ref SDS 42 K36G, ref SDS 40 K36G.
BV0408 -
BV0409 - Background on Tumor Board considerations is reported in another record
BV0410 - today. ref SDS 45 FW9K  Case study shows difficulty applying Kaiser's
BV0411 - Tumor Board capabilities. ref SDS 45 6W3X
BV0413 -  ..
BV0414 - Major change in patient status can be supported by Tumor Board
BV0415 - assistance reviewing patient history and proposing solutions.
BV0416 - Recently, on 061208 a major change occurred in Millie's case when the
BV0417 - doctor determined that effectiveness of treatment current has declined
BV0418 - with Taxotere and capecitiabine (Xeloda) chemotherapy. ref SDS 42 P69G
BV0420 -  ..
BV0421 - This letter implements planning yesterday on 061217. ref SDS 44 OA8O
BV0423 -  ..
BV0424 - Letter to primary care physician continues...
BV0425 -
BV0426 -    2.  Periodic review of case history offers timely notice of
BV0427 -        critical issues that inevitably get lost in the shuffle.  Can
BV0428 -        Kaiser assemble a panel for Tumor Board review of doctors with
BV0429 -        surgery and oncology expertise and with IBC experience more
BV0430 -        closely targeted to my patient profile: post-mastectomy, 3rd
BV0431 -        relapse secondary IBC, PE, Cellulitis, etc.? ref DIT 5 E46I
BV0433 -  ..
BV0434 - Implements discussion during meeting at Kaiser on 061208, ref SDS 42
BV0435 - P69G, citing Millie's letter to Kaiser on 061027 requesting review of
BV0436 - treatment strategy. ref SDS 37 KJ7K
BV0438 -  ..
BV0439 - Letter to primary care physician continues...
BV0440 -
BV0441 -    3.  A 5 year review with mounting issues seems like a good time to
BV0442 -        draw on Kaiser's vast resources for ideas on my care, and for
BV0443 -        lessons learned to help others. ref DIT 5 Q47H
BV0445 -         ..
BV0446 -    4.  Please let me know if Kaiser can do a Tumor Board review?
BV0447 -        ref DIT 5 M47M
BV0448 -
BV0449 -           [On 061227 letter to Doctor asks about progress arranging
BV0450 -           Tumor Board review. ref SDS 47 6L3F
BV0451 -
BV0452 -           [On 061228 doctor submits summary of patient history
BV0453 -           submitted to UCSF for participation in clincial drug trial
BV0454 -           as providing "5 year review" of complex patient history in
BV0455 -           place of Tumor Board support for analysis of diagnosis and
BV0456 -           treatment planning. ref SDS 49 NP8G
BV0457 -
BV0458 -
BV0459 -
BV0460 -
BV0461 -
BV0462 -
BV0463 -
BV05 -

SUBJECTS
Quarterly Review Patient History Precision Access to Case Studies Pi

CV03 -
CV0401 -  ..
CV0402 - Quarterly Review Patient History Access to Case Studies
CV0403 -
CV0404 - Follow up ref SDS 42 FE4I, ref SDS 9 0001.
CV0406 -  ..
CV0407 - Millie submitted ref DIT 6 0001 another letter to the primary care
CV0408 - physician, this one on reviewing the SDS record for feedback on doctor
CV0409 - patient partnership, and per note in the first letter explaining
CV0410 - limitations of Kaiser's correspondence system, per above. ref SDS 0
CV0411 - 8U5L
CV0413 -  ..
CV0414 - This letter implements planning yesterday on 061217. ref SDS 44 PK4L
CV0416 -  ..
CV0417 - Decided not to mention at this time opportunity to correct errors and
CV0418 - refine accuracy with feedback on Progress Notes in the Medical Chart,
CV0419 - listed on 061208, ref SDS 42 FE4I, including the evident error of
CV0420 - linking cancer with lung and lymph nodes. ref SDS 42 JP4L
CV0422 -  ..
CV0423 - Millie says to the primary care physician...
CV0424 -
CV0425 -    1.  Progress Notes from the Medical Chart have been very helpful.
CV0426 -        You seemed to indicate that feedback from the patient called
CV0427 -        out in Healthwise Handbook cannot be applied, because doctor's
CV0428 -        cannot enter clarifications. [on 061208, ref SDS 42 N54K]  This
CV0429 -        presents a dilemma of how to support doctor/patient
CV0430 -        partnership? ref DIT 6 0001
CV0432 -         ..
CV0433 -    2.  Possibly, quarterly review of a record for one meeting with
CV0434 -        access to case studies would be helpful without overburdening
CV0435 -        your time.  This would give you a chance to correct impressions
CV0436 -        by the patient that drift off course in communications, and
CV0437 -        also provide instructions that refine the practice in a way
CV0438 -        that supports your work. ref DIT 6 YU6G
CV0440 -         ..
CV0441 -    3.  For example, the record of our meeting on 061208 begins with a
CV0442 -        summary, ref DIT 6 JW7F, and has links to more details of
CV0443 -        various issues discussed. ref SDS 42 0001
CV0445 -         ..
CV0446 -    4.  This record will not be helpful for every doctor; not every
CV0447 -        patient can produce this work, but you might have ideas on how
CV0448 -        to make it useful. ref DIT 6 SW7K
CV0449 -
CV0450 -
CV0452 -  ..
CV05 -
CV06 -
CV07 - 1311
CV08 -
CV0801 - Millie received ref DRT 4 0001 from the doctor responding to the
CV0802 - letter earlier this morning, ref DIT 6 0001, asking about doctor
CV0803 - patient partnership to improve accuracy of Progress Notes in the
CV0804 - Medical Chart through feedback, per above, ref SDS 0 MF4I,
CV0806 -  ..
CV0807 - Primary care physician says...
CV0808 -
CV0809 -        We always are looking for ways to improve care and
CV0810 -        communication. ref DRT 4 0001
CV0812 -  ..
CV0813 - The doctor does not address the question in Millie's letter on
CV0814 - reviewing patient history, beginning with the record on 061208, and
CV0815 - determining the most constructive way to apply the record in the
CV0816 - doctor patient partnership to improve communication that avoids errors
CV0817 - and omissions in medical practice, cited as a major problem of health
CV0818 - care, reported on 990912. ref SDS 2 0001
CV0819 -
CV0820 -
CV0821 -
CV0822 -
CV0823 -
CV0824 -
CV0825 -
CV0826 -
CV0827 -
CV0828 -
CV0829 -
CV0830 -
CV09 -