CONTACTS
SUBJECTS
Check List Medical Quality Care Case Management Health Care Check Li
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up
140502 -
140503 -
140504 -
140505 -
140506 -
140508 - ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - This series of letters started by Gary on using SDS for check lists
140902 - support, which he encountered at a seminar or related research on
140903 - good management practices.
140905 - ..
140906 - Check lists to improve quality care through medical case management
140907 - that reduces errors or omission, and thus enable comprehensive care.
140908 - Research on 990912, public reports omission is major cause, that
140909 - increases costs of health care mistakes. ref SDS 2 0001
140911 - ..
140912 - Kaiser's Healthwise Handbook provides a checklist for avoiding medical
140913 - mistakes, calling for feedback to check accuracy of communication,
140914 - reported on 990625 0945. ref SDS 1 5740
140916 - ..
140917 - Morris was included in the communication stream and noted check lists
140918 - are not effective for managing cancer.
140920 - ..
140921 - This morning, sent letter to Morris saying...
140922 -
140923 - 1. Subject: Causation for Cancer and Check Lists
140924 - Date: Sun, 18 Mar 2012 00:45:42 -0700
140933 - ..
140934 - 2. You switched the topic a bit in your letter on February 29, see
140935 - below. ref SDS 0 YB5M
140937 - ..
140938 - 3. Generally, the body always has cancerous cells at very low
140939 - levels, because the body constantly grows new cells. Some are
140940 - mutations that don't work correctly, i.e, cancerous, drawing on
140941 - local tissue that accelerates growth, while killing healthy
140942 - cells. The immune system kills cancer cells, i.e., mutations
140943 - that don't fit patterns of healthy cells.
140945 - ..
140946 - 4. Genetics, diet, lifestyle, exercise, and age influence
140947 - immunity, and thus drive cancer. When Doctor Johnson
140948 - despaired, telling Millie 11 times over 10 years to get her
140949 - affairs in order, Millie would smile and say...
140951 - ..
140952 - "None of us will get out of this alive. Do the best you can
140953 - and leave the rest to God. Let's look at your work plan."
140955 - ..
140956 - 5. If the immune system weakens, some mutations, i.e., cancer
140957 - cells, survive and form a mass. If the mass grows critical, it
140958 - cannot be destroyed, even when immunity rises, evidenced by
140959 - rise of WBC. This condition is diagnosed as "cancer."
140961 - ..
140962 - 6. Typically, cancer that overwhelms the immune system eventually
140963 - causes symptoms of illness, including low energy.
140965 - ..
140966 - 7. Sometimes symptoms are not easily recognized, as occurs with
140967 - diabetes. Sometimes people "are in denial" of even severe
140968 - symptoms for weeks, months, even years refusing care in hopes
140969 - cancer will just go away.
140971 - ..
140972 - 8. Cancer is relentless. Starting treatment at stage I or II has
140973 - good chances of treatment beating it back to a point where the
140974 - immune system can regain control. In that case the patient has
140975 - remission, and lives life normally without continuous
140976 - treatment.
140978 - ..
140979 - 9. If treatment is delayed to stage III prognosis for longevity
140980 - falls markedly, and of course delaying treatment to stage IV
140981 - reduces survivability to weeks and months, at most a few years.
140982 - Living with stage IV cancer like Mil did in continuous
140983 - treatment for nearly 10 years is rare and takes luck, emotional
140984 - resolve, and focused care, shown for example by the record on
140985 - 090213. ref SDS 4 PQTX
140987 - ..
140988 - 10. Patients often succumb to maladies induced and compounded by
140989 - cancer, rather than the cancer itself. As shown, Millie
140990 - suffered many collateral maladies. Each had to be beaten back
140991 - in time to sustain quality of life essential to maintain will
140992 - to live.
140994 - ..
140995 - 11. If mutated cells are contained in local tissue, cancer might be
140996 - removed with surgery or killed with radiation. Doctors strive
140997 - to maintain "local control" that lengthens survival and quality
140998 - of life.
141000 - ..
141001 - 12. Cancer "metastasizes" when cells reach the blood stream and
141002 - spread everywhere. Surgery and radiation are then less viable.
141004 - ..
141005 - 13. Metastatic cancer is typically treated with systemic agents,
141006 - like chemotherapy, and recently "targeted therapy," though
141007 - limited to clinical trials. However, most patients don't
141008 - survive past adjuvant care to qualify for clinical trials.
141009 - Chemotherapy to treat cancer, also lowers immunity making the
141010 - patient more vulnerable to fatal disease, like pneumonia, and
141011 - also causes patients to feel "terrible," lowering desire to
141012 - continue treatment long enough to reduce cancer back to a
141013 - manageable level.
141015 - ..
141016 - 14. Patients may respond to certain forms of severe diet, called
141017 - "alternative therapy." This high risk strategy sometimes works
141018 - for awhile in the same way some patients can reduce
141019 - cholesterol, including LDL without resort to medications,
141020 - currently "statins."
141022 - ..
141023 - 15. Check lists help providers deliver comprehensive care that
141024 - extends quality of life using evidenced based medical practice,
141025 - reviewed in the letter to Kaiser on 090725 2017. ref SDS 5 T55T
141027 - ..
141028 - 16. This probably goes beyond your comments on causation for
141029 - cancer, but may be helpful down the road.
141030 -
141036 -
141037 - *******************************
141039 - ..
141040 - Morris' letter says...
141041 -
141042 - 1. Date: 29 February 2012 2143
141043 - Subject: Checklist Manifesto: How to Get Things Right
141047 -
141048 - Most look back for justification, and to get what they can from
141049 - others.[...Morris responds to the letter on 120226 explaining
141050 - innate cognitive process of relying on experience. ref SDS 0
141051 - 0Q69...]. Seldom do they find causation for things like
141052 - cancer, just vague statistics for a population in general...
141056 -
141057 -
141058 - *********************************
141060 - ..
141061 - Letter to Morris says...
141062 -
141063 - -----Original Message-----
141064 - 1. Subject: Re: The Checklist Manifesto: How to Get Things Right
141065 - Sent: Sunday, February 26, 2012 11:14 PM
141069 - ..
141070 - 2. People innately look back to understand causation that guides
141071 - the work and resolve disputes using experience, history,
141072 - knowledge, study, analysis.
141073 -
141074 -
141075 - ************************
141077 - ..
141078 - Letter from Morris says...
141079 -
141080 - 1. Checklists are a challenge in medicine. The same three
141081 - symptoms will be present in tens of thousands of diseases. I
141082 - worked for Bectin-Dickinson in the 1970s, and we looked at
141083 - automated diagnostics. It was a bust from the beginning. The
141084 - Flu has 99% the same symptoms as a heart attack and at least
141085 - 1000 other things we had in the database. In the end, I feel
141086 - it is still largely an art, and not a science.
141088 - ..
141089 - 2. Lawyers and patients always look back in retrospect, and say
141090 - oh, this symptom should have led the doctor to know that it
141091 - could have been the actual disease it turned out to be. The
141092 - current lawsuit driven mentality has caused the ordering of
141093 - countless tests to "rule out" things, but even this takes
141094 - years, and often the disease progresses to the point where more
141095 - advanced symptoms limit the search.
141097 - ..
141098 - 3. There are very few disease specific medical tests.
141099 - Interestingly, most of them are for active STDs and advanced
141100 - stage cancers.
141102 - ..
141103 - 4. Keep thinking,
141108 -
141110 - ..
141111 - Letter to Garry with copy to Morris says...
141112 -
141113 - 1. Subject: Re: The Checklist Manifesto: How to Get Things Right
141114 - Date: Wednesday, February 22, 2012 10:17 AM
141122 - ..
141123 - 2. Good article on applying project management practices for
141124 - better outcomes in health care. [...responding to Gary's letter
141125 - received earlier today, shown below. ref SDS 0 LQ9K...]
141127 - ..
141128 - 3. Health care case management is poor, despite check lists,
141129 - because doctors are busy. Limited time kills good management
141130 - everywhere - in construction, finance, engineering, gardening,
141131 - procurement...everywhere. SDS tries to make it faster and
141132 - easier to use good management, but doing nothing is always
141133 - faster and easier than doing anything.
141135 - ..
141136 - 4. In Mil's case, Doctor Johnson could have used a checklist on 3
141137 - symptoms of IBC to start treatment on 020109, 18 months before
141138 - diagnosis and treatment occurred. Early treatment makes a big
141139 - difference in surviving cancer, noted by the doctor 040504 (see
141140 - line 1914), ref SDS 3 WI8F
141142 - ..
141143 - 5. Kaiser and others have check lists on the wall, but they become
141144 - mere wallpaper, if issues do not arise regularly in the
141145 - doctor's practice. This presents opportunity for
141146 - doctor/patient partnership to leverage medical assets by
141147 - maintaining focus on critical issues.
141149 - ..
141150 - 6. Doctors get used to meeting with patients to address one or two
141151 - big issues. Oncology is different, more like doctors who treat
141152 - diabetes that causes numerous afflictions. In that case, the
141153 - list of issues can become very large, and so overwhelms the
141154 - doctor. Check lists are then essential to provide
141155 - comprehensive care that optimizes outcomes.
141157 - ..
141158 - 7. Check lists in medical practice have social dimensions. In
141159 - Mil's case, after events on 040504, Doctor Johnson was more
141160 - open to support. When he came into the examination room, if he
141161 - had not read the agenda submitted to guide the meeting, he went
141162 - back to his office to read it with links to relevant
141163 - background. He was then prepared to work through the check
141164 - list collaboratively with the patient team. When Mil died
141165 - after nearly 10 years of continuous care, the doctor called and
141166 - told her daughter Pam, and daughter-in-law, Kim, that Millie
141167 - survived with quality of life worth living because her care was
141168 - more comprehensive than other patients get.
141170 - ..
141171 - 8. So, there is a record showing check lists make a difference, if
141172 - applied collaboratively, to overcome a doctor's hectic
141173 - schedule; otherwise, they become wallpaper, like so much in the
141174 - quality movement that is form without substance. You ran into
141175 - a lot of this on the FCS project at Boeing.
141177 - ..
141178 - 9. The article you submitted cited use of submittals in project
141179 - management. On Broadwater Dam, all of the submittals on the
141180 - generator, the primary purpose of the project, were returned by
141181 - the engineer marked "not reviewed." There was no category on
141182 - the submittal form for "Not Reviewed." They just made it up as
141183 - a convenient way to avoid marking "not approved, resubmit", and
141184 - all related to completion delay and bonuses, i.e., time and
141185 - money.
141187 - ..
141188 - 10. The Engineer and the owner permitted Voith to go ahead with
141189 - manufacture and installation of an unapproved design. Guess
141190 - what? When they threw the switch 2 years later, the whole
141191 - powerhouse shook with vibration. Noise was unbearable. Took
141192 - another 10 years of legal battles and modifications for the
141193 - state to begin selling power, all in the name of "expediting"
141194 - by avoiding good management practice.
141196 - ..
141197 - 11. Thanks again for an interesting article. Morris may have
141198 - further comment from experience with project management at
141199 - Intel, earlier at Chips, and recently attending a conference
141200 - presenting current fashion to save time and money by avoiding
141201 - good management.
141202 -
141209 -
141210 -
141211 -
141213 - ..
141214 - Checklist Manifesto: How to Get Things Right - Doctor Atul Gawande
141215 -
141216 - Letter from Gary says...
141217 -
141218 - 1. Subject: The Checklist Manifesto: How to Get Things Right
141219 - Date: 22 February 2011 0253
141225 - ..
141226 - 2. The book "The Checklist Manifesto: How to Get Things Right"
141227 - makes the point and evolves a technology about checklists that
141228 - we might want to consider including in some version of SDS.
141230 - ..
141231 - SDS supports nested checklists: things to do, work plans, work
141232 - performed, within a framework of a chronology, context, and connection
141233 - that strengthen management practice, including health care, discussed
141234 - above. ref SDS 0 YX5G
141236 - ..
141237 - Gary's letter continues...
141238 -
141239 - 3. We already have features that support some aspects of
141240 - checklists, but we might be able to do better.
141241 -
141242 - https://www.assoc-amazon.com/e/ir?t=httpwwwhitecc-20
141244 - ..
141245 - Since sources on Amazon.com are dynamic, "here today, and gone
141246 - tomorrow," research found other sources that explain this book: "The
141247 - Checklist Manifesto"....
141248 -
141249 - http://gawande.com/the-checklist-manifesto
141250 -
141251 - http://www.thechecklistmanifesto.com/
141252 -
141253 - http://us.macmillan.com/thechecklistmanifesto/AtulGawande
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