THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: June 25, 1999 09:45 AM Friday;
Rod Welch
Communication doctor/patient partnership drives due diligence in healthcare.
1...Summary/Objective
2...Kaiser's Healthwise Handbook Sets Communication Guidelines
3...Health Care Directory Updated Healthwise Handbook
4...Patient Assistant Common Administration Essential New World Order
5...Questions, Problems, Suggestions about services submitted by patients,
6...Common Administration Supported by Patient Assistance
7...Patient Assistance Provides Support Working with Bureaucracy
8...Appointments to See Doctor
9...Meetings Scheduled Based on Level of Urgency
10...Partnership Proposed by Kaiser for Doctor/Patient Communications
11...Team Care Applies Partnership with Patients to Improve Health Care
12...Doctor Patient Partnership Communication Critical Component Good Care
13...Communication Doctor Patient Partneship Critical Effective Health Care
14...Doctor Change for Effective Health Care Partnership
15...Change Physician for Effective Health Care Partnership
16...Partnership Change Physician for Effective Health Care
17...Email Critical Component Effective Communication Partnership
18...Communication Disscussion Capture Record Review Feedback Productivity
19...Productivity Communication Disscussion Capture Record Review Feedback
20...Accuracy Saves Lives Time Money with Careful Due Diligence
21...Communications Due Diligence Converts Discussion into Action
22...Chronology Context Connection Communication Metrics for Accuracy
.....a...Good discussion yields accurate diagnosis, and good "treatment
.....b...Listening critical component of communication.
.........Patient Assistance Essential Effective Health Care
.........Accuracy Complete Patient History in Medical Chart
.........Healthwise Handbook Calls for Patient Review Medical Chart
.........Medical Chart Critical Component Communication Treatment Plans
.........Written Records Symptoms Diagnosis Treatment in Medical Chart
.............Medical Records Documentation Accuracy Communications
.............Don't Trust Your Memory
.............The Defensible Medical Record
23...Healthwise Handbook Requirements Written Records and Feedback
24...Be Prepared for Meeting with Written Record and Feedback for Accuracy
25...Written Record Feedback Improve Listening Enable People to be Prepared
.....d...Be prepared for effective meetings with the doctor (typically
.....e...Understanding Memory Accuracy Writing Improves Communication
.........Writing Improves Communication Memory Accuracy Understanding
.....f...Follow up with Feedback Improves Accuracy Communication
.........Feedback Get Things Done Correctly with Timely Follow Up
.........Ping Pong Feedback Recursively Refines Accuracy Medical Chart
26...Time to Think Limits Ability to Execute Good Management Practices
27...Intelligence Added to Communication Lifts Management Productivity
28...Communication Drives Management Poor Execution Brings Bad Management
29...Execution Weak Link Degrades Management to Entropy Due to Limited Time
.....Communication Fails Due to Ignorance, Fear and Denial
30...Culture, Preference, Attitude and Psyche Prevent Good Management
.....Advantages of Communication in Medical Practice
31...Common Sense Does Not Produce Effective Medical Management
32...Partnering Should Not Substitute Common Sense for Expertise
33...Shared decision needs clarification of responsibility between the
34...Due Diligence 2nd Opinions Invest Time to Double Check Accuracy
35...Ounce Prevention Worth Pound of Cure; 2nd View Saves a lot of Sorrow
36...2nd Opinion Double Check Strengthens Accuracy of Medical Practice
37...Knee Exam Shows Possible Problems that Require Corrective Work
38...Surgery on Left Knee in 1972, 1988; New Problems Right Knee
39...New Therapies May Justify Knee Repair by Kaiser
40...Shoulder Rotator Cuff Impingement; Self-healing Continued
41...Physical Exam Scheduled for 990628; New Primary Care Doctor
42...Cholesterol Test Due 990629; From Planning on 940722
43...Prostate Cancer Blood Test Today; Complete on 990628
.....Background on Physical Exam and Prostate Cancer Test in 1994
44...Primary Care Doctor Changed to Park Shadelands
45...Internet Facilitates Communication with Doctors
46...Communication with Patient Helps Primary Care Doctor
47...15 Minutes Allocated for Patient Visits with Doctors
48...Medical Chart Main Patient Care Record of Treatment History
49...Not Enough Time to Follow Kaiser Guidelines on Medical Practice
50...Medical History Procedures Take too Much Time Away from Treatment
51...Team Care Relies on Patient's Medical History
52...Kaiser's Team Care Relies on Patient's Medical History
53...Primary Care Doctor Changed to Syed E. Naqvi
.................The Team that cares for you
..............
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CONTACTS
0201 - Kaiser Permanente - Shadelands
020101 - Walnut Creek, CA
020102 - Ms. Sylvia Connolly, M.D.; Physician
020103 - Medicine Urgent Care
SUBJECTS
Medical, Kaiser
Exam 990625 Knee, Physical, Prostrate Cancer
Blood Pressure/Pulse
Temperature
0606 -
0606 - ..
0607 - Summary/Objective
0608 -
060801 - Follow up ref SDS 29 8365.
060802 -
060803 - Examination of knees showed problems that will be treated based on
060804 - eight (8) new therapies. ref SDS 0 4420 Shoulder seems not to be
060805 - seriously injured; medication and exercise was prescribed. ref SDS 0
060806 - 4662 Changed Primary Care doctor and scheduled physical exam for
060807 - 990628. ref SDS 0 6840 Prostate cancer test will be performed with
060808 - the physical exam. ref SDS 0 7885 Kaiser's guidelines for medical
060809 - management, ref SDS 0 3822, provide common administration ref SDS 0
060810 - 1456, that aids the doctor patient partnership, and team care
060811 - practice. ref SDS 0 4185 Kaiser making progress using computers,
060812 - ref SDS 0 2541, and provides strong requirements for due diligence to
060813 - ensure accurate communications as the engine of effective healthcare.
060814 - ref SDS 0 3190 Communication Metrics for better listening fits the
060815 - Kaiser model for accuracy. ref SDS 0 JY9J Diagnosis and treatment
060816 - further requires capturing comprehensive patient history, and relying
060817 - on the record in the medical chart. ref SDS 0 TD5S Research supports
060818 - Kaiser's requirements for written records, rather than rely on
060819 - personal memory. ref SDS 0 GT62 However, doctors have limited time to
060820 - prepare patient history and to review organizational memory for due
060821 - dilegence to ensure accurate diagnosis and careful treatment planning.
060822 - This suggests a stronger role for the doctor/patient partnership.
060823 - ref SDS 0 1978
060825 - ..
060826 - Submitted ref DIT 1 0001 to Sylvia linked to this record.
060827 -
060828 - [On 990628 developed correlation between medical management and
060829 - other professions, sent letters on potential for Communication
060830 - Metrics to improve process, so there is less need for lawyers...
060831 - i.e., substitute management intelligence for legal intelligence.
060832 - ref SDS 55 0001]
060834 - ..
060835 - [On 990628 physical exam, prostate test. ref SDS 56]
060837 - ..
060838 - [On 990628 Kaiser having difficulty getting communication to
060839 - Doctor Sylvia Connolly. ref SDS 56 1026]
060841 - ..
060842 - [On 990628 Doctor Syed Naqvi checking with Sue to get letter on
060843 - medical history, including the record for today. ref SDS 56 2223
060845 - ..
060846 - [On 990701 Sylvia had not received letter; she is checking with
060847 - Sue to improve communication. ref SDS 57 2295]
060849 - ..
060850 - [On 990706 Jeanne trying to transmit the letter. ref SDS 58 0001]
060851 -
060852 -
060854 - ..
0609 -
0610 -
0611 - Administration
0612 -
061201 - Met with administration rep. Used Kaiser ID card to register for
061202 - examination scheduled for 0945 this morning.
061204 - ..
061205 - Paid $10 fee.
061207 - ..
061208 - Received invoice ref DRT 1
061210 - ..
061211 - Waited for about 30 minutes.
061213 - ..
061214 - Blood pressure was taken: 111/67
061216 - ..
061217 - Temperature: 97.4
061218 -
061219 - [On 990628 different readings occurred. ref SDS 56 7855]
061221 - ..
061222 - Waited for another 10 minutes, then was taken to an examination room.
061224 - ..
061225 - Waited 20 minutes in examination room for Sylvia.
061226 -
061227 -
061228 -
0613 -
SUBJECTS
Healthwise Handbook Sets Communication Guidelines Suggestions Reques
Chapter 1 Healthwise Handbook Sets Communication Guidelines Suggesti
Healthwise Handbook Sets Communication Guidelines Suggestions Reques
1105 -
110601 - ..
110602 - Kaiser's Healthwise Handbook Sets Communication Guidelines
110603 -
110604 - While waiting for the doctor in the examination room, reviewed...
110605 -
110606 -
110607 - Kaiser Permanente
110608 - Healthwise Handbook
110609 -
110611 - ..
110612 - ... ref OF 5 published by...
110613 -
110614 - Healthwise,
110615 - P.O. Box 1989,
110616 - Boise, ID 83701,
110617 - 800-706-9646
110619 - ..
110620 - "To Our Readers" requests suggestions for improving Kaiser's patient
110621 - handbook. ref OF 5 9672
110622 -
110623 - a. Kaiser should formulate training on how patients and doctors
110624 - can implement communication guidelines, since communication is
110625 - the predicate to treatment, as pointed out in Chapter 2,
110626 - below. ref SDS 0 4185
110628 - ..
110629 - b. Outline of subjects in the Healthwise Handbook provides an
110630 - organic structure applied with the SDS subject index to
110631 - organize work in medical practice for effective health care.
110633 - ..
110634 - This is similar to using PMBOK and ISO for the subject index
110635 - on good management practices, reviewed on 950721.
110636 -
110637 - [On 020504 FAR provides organic structure to organize
110638 - procurement work. ref SDS 97 XV7L
110639 -
110640 - [On 040312 lecture outline on 21st century science provides
110641 - organic structure for organizing the record and finding
110642 - relevant history on science. ref SDS A4 0Q6M
110644 - ..
110645 - [On 080204 Healthwise Handbook cited by Kaiser general
110646 - instructions for additional guidance on head injuries.
110647 - ref SDS E8 TE51
110649 - ..
110650 - c. A training film can show advantages of good communication set
110651 - out in the Handbook, but shows obstacles that doctors and
110652 - patients have to overcome, with the help of Kaiser's staff.
110654 - ..
110655 - The film reviewed on 971229 is an example. ref SDS 36
110657 - ..
110658 - [On 990701 efforts by Sylvia show Kaiser goals can be
110659 - accomplished, film would help. ref SDS 57 0877]
110661 - ..
110662 - [On 991028 Craig's letters show training can help.
110663 - ref SDS 82 8499]
110665 - ..
110666 - [On 990924 high cost of medical mistakes shows
110667 - communication training needed. ref SDS 75 0009]
110669 - ..
110670 - [On 991103 submitted letter on training. ref SDS 84 5933]
110672 - ..
110673 - [On 991216 discussed with Tom Driscoll. ref SDS 88 1920]
110675 - ..
110676 - [On 991221 report doctors not communicating adequately with
110677 - patients, need education and processes. ref SDS 89 0001]
110678 -
110680 - ..
110681 - Healthwise has a web page...
110682 -
110683 - http://www.healthwise.org
110684 -
110685 - ...shown on page viii. ref OF 5 9672
110686 -
110687 - [On 990706 Healthwise web site does not have email contact. I
110688 - called and requested Handbook online. ref SDS 58 4116]
110690 - ..
110691 - Health Plan Customer service number...
110692 -
110693 - 800 955 9940
110694 -
110695 - d.. ref OF 5 2542
110696 -
110697 - How is this different from scope of services for Customer
110698 - Service rep at ref OF 6 2112, cited below? ref SDS 0 2842
110700 - ..
110701 - H Caulfield, Executive Director, and Richard G. Barnaby, President
110702 - and CEO, say the Handbook is a guide to manage health in partnership
110703 - with Kaiser. ref OF 5 2720
110705 - ..
110706 - Table of contents is at ref OF 5 4144.
110707 -
110708 -
110709 -
110710 -
110711 -
110712 -
110713 -
1108 -
SUBJECTS
Questions Problems Suggestions Improving Quality of Health Care Subm
Contacting Kaiser
Questions, Suggestions
Health Plan Customer Service 800 955 9940
Department Manager
Nursing Supervisor
Physician Chief of Serivce
Patient Assistant
Urgent Appointments for Medical Care
Routine Appointments for Medical Care
2412 -
241301 - ..
241302 - Health Care Directory Updated Healthwise Handbook
241303 -
241304 - Chapter 1 covers how to contact Kaiser. ref OF 6
241305 -
241306 - "Health Care Directory" is a publication by each local Kaiser facility
241307 - that has information to update the Healthwise Handbook. ref OF 6 2880
241308 -
241309 - The Health Care Directory is mailed to patients. ref OF 6 0336
241311 - ..
241312 - To get a current copy call 800 955 9940, ref OF 6 5904,
241313 -
241314 -
241316 - ..
241317 - Patient Assistant Common Administration Essential New World Order
241318 - Questions, Problems, Suggestions about services submitted by patients,
241319 - ref OF 6 4416, to...
241320 -
241321 - • personal provider
241322 - • department manager
241323 - • nursing supervisor
241324 - • physician chief of the service in question.
241325 -
241326 - ...need names, phone numbers, email addresses.
241328 - ..
241329 - This is procedure is a step in the right direction, but is too
241330 - cumbersome. Doctors and patients need an assistant role with
241331 - tools to coordinate Kaiser's complex organization performing
241332 - case management. Doctor's are too busy seeing constant
241333 - patients, making calls, handling documents, attending staff
241334 - meetings, and delivering papers to professional conferences.
241335 - More patients, regulations, procedures, technologies,
241336 - stakeholders, and layers of organization, i.e., bureaucracy.
241337 - impact patient care, because people get mixed up in constant
241338 - meetings, calls, and documents. Little details slip through
241339 - the cracks, causing delays, errors, and omissions. Successful
241340 - medical practice that extends life increases complexity of
241341 - patient history. Advancing complexity of modern health care
241342 - requires a new player with tools that make sense of complexity
241343 - by "connecting the dots" in time to be effective. There is
241344 - not enough time to track objectives, requirements, and
241345 - commitments, and also keep up with changes in procedures and
241346 - new treatments.
241347 -
241348 - [On 990912 national reporting cites study showing high
241349 - cost of medical mistakes caused by errors omissions in
241350 - patient history writtin in the medical chart.
241351 - ref SDS 71 4T4H
241353 - ..
241354 - [On 0990924 letter on improving medical practice cites
241355 - need for Patient Assistant role with tools to support
241356 - case management because modern medical practice
241357 - becoming very complex. ref SDS 75 2955
241359 - ..
241360 - Submitting ideas for improvement to a personal care provider
241361 - conflicts with doctors having limited time for communication,
241362 - cited by Doctor Sylvia Connoly today, per below. ref SDS 0
241363 - 1978 There is further problem of denial from inherent
241364 - conflict reporting problems to the person who may have
241365 - committed error, that resists action to avoid accountability.
241366 -
241367 -
241368 -
2414 -
SUBJECTS
Patient Assistance Provides Support Working with Bureaucracy Could P
2803 -
280401 - ..
280402 - Common Administration Supported by Patient Assistance
280403 - Patient Assistance Provides Support Working with Bureaucracy
280404 -
280405 - "Patient Assistance" provides support by hospital staff called out in
280406 - the Healthwise Handbook. ref OF 6 1122
280407 -
280408 - The number is listed in Health Care Directory.
280410 - ..
280411 - Patient Assistance by hospital staff could be an effective support
280412 - role, provided the role has authority to act.
280413 -
280414 - [On 990706 received name and number for patient assistance.
280415 - ref SDS 58 6156
280417 - ..
280418 - Healthwise Handbook also recommends patients rely on spouse and
280419 - friends for assistance with hospital consumer skills, essential for
280420 - effective care with accurate communication on diagnosis, prognosis,
280421 - and work plans, discussed below. ref SDS 0 JY9J
280423 - ..
280424 - How does Patient Assistance interact with the doctor's using the
280425 - "Physician Assistant" role, per below? ref SDS 0 7H6J
280427 - ..
280428 - What record is generated to show useful assistance, rather than
280429 - mere organizational cover up?
280431 - ..
280432 - Customer Service Representative has information on health plan
280433 - coverage and billings. 800 464 4000. ref OF 6 2112
280434 -
280435 - How is this different from health plan customer service shown
280436 - above? ref SDS 0 5711
280438 - ..
280439 - Advise Nurse can provide initial information, and make appointments to
280440 - see a doctor. ref OF 6 1995 and ref OF 7 0567
280442 - ..
280443 - Patient Assistance could accomplish requirements for Common
280444 - Administration defined on 990328, ref SDS 43 9641, and reviewed on
280445 - 990419. ref SDS 45 9420
280447 - ..
280448 - [On 990719 Kathy Welch likes this idea. ref SDS 63 1408]
280450 - ..
280451 - [On 990924 used Patient Advocate idea in letter on avoiding
280452 - medical mistakes. ref SDS 75 2775]
280454 - ..
280455 - [On 991006 submitted idea to Kaiser. ref SDS 78 7280]
280457 - ..
280458 - [On 991008 Patient Assistance does some of this.
280459 - ref SDS 79 2688]
280460 -
280461 -
280462 -
280463 -
280464 -
2805 -
SUBJECTS
Appointments to See Doctor Meetings Scheduled Based on Level of Urge
2903 -
290401 - ..
290402 - Appointments to See Doctor
290403 - Meetings Scheduled Based on Level of Urgency
290404 -
290405 - Appointments to see a doctor are based on...
290406 -
290407 - Urgent, ref OF 6 1127
290408 -
290409 - Turns out we saw an "urgent care" doctor today. Not sure if we
290410 - can really say this was an "urgent" matter, but it is not
290411 - something we wanted to put off, so... ref SDS 0 0970
290413 - ..
290414 - Routine, ref OF 6 1947
290415 -
290416 -
290417 -
290418 -
290419 -
290420 -
2905 -
SUBJECTS
Partnership Communication Model Shared Responsibilities Doctor/Patie
Collaboration SDS Multiple Users Changes Attitudes about Good Manage
ASB Planning Collaboration Standard SDS Enables Accurate Understandi
Communication Partnership Doctor Patient Most Important Factor of Su
Doctor/patient Partnership Critical Health Care Model Communication
5107 -
510801 - ..
510802 - Partnership Proposed by Kaiser for Doctor/Patient Communications
510803 - Team Care Applies Partnership with Patients to Improve Health Care
510804 - Doctor Patient Partnership Communication Critical Component Good Care
510805 - Communication Doctor Patient Partneship Critical Effective Health Care
510806 -
510807 - Chapter 2 of Kaiser's Healthwise Handbook covers communication for
510808 - medical management that reflects good practices for every sector of
510809 - the economy. ref OF 7 0000
510811 - ..
510812 - Kaiser recommends a doctor/patient partnership to manage quality and
510813 - cost of health care. ref OF 7 5418 Kaiser says patients should be
510814 - proactive capturing the record of meetings, ref SDS 0 3190, and
510815 - reviewing feedback with the doctor and other care givers. ref SDS 0
510816 - 3960
510817 -
510818 - [...below, Kaiser recommends patient assistance with spouse and
510819 - friends to strengthen health care with accurate communication and
510820 - comprehensive analysis. ref SDS 0 JY9J
510822 - ..
510823 - Since health care professionals rarely have time for deliberation and
510824 - reflection, Kaiser's "partnership" model provides an effective path to
510825 - strengthen case management through synergy of complementary tasks,
510826 - explained in NOW. ref OF 25 Q09I Good management practices capturing
510827 - an accurate record in medicine are, also, the right prescription for
510828 - government, education, engineering, fixing the car, building a house,
510829 - a hotel, a boat, space shuttle, computer.... everything improves with
510830 - timely accurate understanding achieved through Knowledge Management,
510831 - see again NWO. ref OF 25 FD7K
510832 -
510833 - [...below, Kaiser calls for communication to capture a written
510834 - record of discussion, and feedback to verify accuracy that reduces
510835 - mistakes. ref SDS 0 TD6Q
510837 - ..
510838 - [...see below, Kaiser calls for primary care physician to assist
510839 - the patient obtaining 2nd opinions to support major decisions,
510840 - including surgery. ref SDS 0 455N
510842 - ..
510843 - [On 990628 developed correlation between medical management and
510844 - other professions, and management intelligence reduces need for
510845 - lawyers; sent letters on potential for Communication Metrics to
510846 - improve process. ref SDS 55 0001
510848 - ..
510849 - [On 990715 proposed partnership model for S&C. ref SDS 61 2448]
510851 - ..
510852 - [On 990720 articles support partnership concept. ref SDS 63 0846]
510854 - ..
510855 - [On 990925 delay using conventional mail hampered medical report.
510856 - ref SDS 76 2303]
510858 - ..
510859 - [On 040419 surgeon explains that Kaiser's team care practice
510860 - supported by doctor/patient partnership helps avoid mistakes by
510861 - ensuring planned follow up with cross-departmental examinations
510862 - are performed. ref SDS A5 XU75
510864 - ..
510865 - [On 041125 1339 HHS publication No. 00-PO38 by the Agency for
510866 - Healthcare Research and Quaity (AHHQ) says the single most
510867 - important way to prevent medical mistakes is for patients to be an
510868 - active member of the health care team; taking part in every
510869 - decision gets better results. ref SDS B7 2R4O
510871 - ..
510872 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer recommends
510873 - patients be their own project manager for effective care through
510874 - the doctor patient partnership. ref SDS C1 F25K
510876 - ..
510877 - [On 051121 Kaiser plan email support for doctor/patient
510878 - partnership communication. ref SDS D3 V25O
510880 - ..
510881 - [On 060106 Kaiser email system paralyzes productivity eviscerates
510882 - doctor patient communication. ref SDS D5 1O8F
510884 - ..
510885 - [On 060809 advice nurse notifies patient that clear, concise,
510886 - complete communication from the patient helped Kaiser provide
510887 - effective care. ref SDS D8 NY4J
510889 - ..
510890 - [On 061218 cursory generalizations impede communication reduces
510891 - effectiveness doctor patient partnership causing poor health care.
510892 - ref SDS E2 VW7O
510894 - ..
510895 - [On 080403 doctor asks patient to prepare letter coordinating UCSF
510896 - prescription for treatment implemented on referral by Kaiser.
510897 - ref SDS F0 4U9O
510899 - ..
510900 - [On 080403 doctor patient partnership expedites lab work and saves
510901 - time to maintain meetings on schedule. ref SDS F0 I15N
510903 - ..
510904 - [On 080423 UCSF applies doctor patient partnership requests scope
510905 - of blood draw from patient that is prescribed in the Chemotherapy
510906 - Orders issued by the doctor. ref SDS F1 1P6M
510908 - ..
510909 - [On 080911 article reports many medical mistakes occur from
510910 - mental errors by doctors involving communication.
510911 - ref SDS F2 PD7F
510913 - ..
510914 - [On 081018 Doctor Stritter's patient advocacy practice seems to
510915 - complement ideas for Kaiser to implement palliative care project,
510916 - by adding energy to assist the physician and the patient manage
510917 - expanding complexities of health care. ref SDS E2 IS6U
510919 - ..
510920 - Communication makes partnership effective starting with a primary care
510921 - physician, called out in the Healthwise Handbook, ref OF 7 2068, and
510922 - discussed with the doctor today explaining Team Care practice.
510923 - ref SDS 0 2784
510925 - ..
510926 - Partnership requirements in the Healthwise Handbook offer a powerful
510927 - communication model for collaboration. ref OF 7 5508 Kaiser's Team
510928 - Care brochure applies partnership to leverage shared responsibilities,
510929 - ref SDS 0 8008 Patients are directed to trust common sense, also,
510930 - reviewed below, ref SDS 0 0881, and discussed with Sylvia today in
510931 - selecting a primary care physician. ref SDS 0 2541
510932 -
510933 - [...below, second opinions called out in Healthwise Handbook
510934 - applies doctor patient partnership expanding doctor's span of
510935 - attention correlations patient history with diagnosis and
510936 - prescribing treatment options. ref SDS 0 455N
510938 - ..
510939 - [On 080911 second opinions implement doctor patient partnership
510940 - essential to provide broad range of analysis for primary care
510941 - physician whose diagnosis is bounded by recent experience, and
510942 - limited trainning. ref SDS F2 4R4H
510944 - ..
510945 - On 940728 Doctor Kory Zipperstein in Kaiser's San Francisco
510946 - Dermatology Department advised SDS records support Communication
510947 - Metrics for effective doctor/patient partnership. ref SDS 16 0001
510948 -
510949 - [On 000207 meeting at Kaiser to change primary care physician,
510950 - ref SDS 91 2783; Doctor Racah at Kaiser agreed to experiment using
510951 - SDS and email to support doctor/patient partnership for better
510952 - communication. ref SDS 91 VM68
510954 - ..
510955 - [On 000208 Doctor Racah found that SDS enables amazing records
510956 - with accuracy comparable to tape recordings. ref SDS 92 0001
510958 - ..
510959 - [On 060809 Kaiser advice nurse notifies patient that
510960 - clear, concise, complete communication enables effective
510961 - patient care. ref SDS D7 NY4J
510963 - ..
510964 - [On 080403 UCSF requests doctor patient partnership support
510965 - referral coordination with Kaiser because communication is too
510966 - complicated takes too much time; delay for cognitive overhead too
510967 - frustrating. ref SDS F0 U27M
510969 - ..
510970 - "Partnership" is a critical ingredient of medical team care practice
510971 - for meeting new realities of an exploding case load over the next 20
510972 - years. As "Baby Boomers" become senior citizens with increased
510973 - medical needs, partnership will become a crucial strategy for
510974 - delivering effective medical services. Strains on execution of good
510975 - medical practice due to limited time, will increase with information
510976 - overload that impacts all sectors in the economy, reviewed on 980307.
510977 - ref SDS 38 3151
510979 - ..
510980 - "Attitude" prevents good case management in health care, as in general
510981 - management, cited by Fortune in an article reviewed today while
510982 - waiting to see a doctor at Kaiser. Fortune reports that successful
510983 - CEOs grab a pen and start writing at the end of meetings to confirm
510984 - understandings and follow up. Research found that most CEOs fail
510985 - because they refuse to execute common communication practics of good
510986 - management, ref SDS 54 0460, and that preference, or "attitude," due
510987 - to inexperience and sometimes "laziness," block execution. ref SDS 54
510988 - 4914
510989 -
510990 - [On 050415 timely communication through doctor patient partnership
510991 - avoids error failing to prescribe Nupigen needed for cancer
510992 - patient to maintain steady state-treatment. ref SDS C5 XU9L
510994 - ..
510995 - [On 050824 Advice Nurse being persistant reminding the surgeon to
510996 - implement requirements in Kaiser's Healthwise Handbook following
510997 - up patient calls to collaborate and coordinate via email on
510998 - accuracy of communication and patient medical history. ref SDS C7
510999 - 4M7N
511001 - ..
511002 - [On 050826 referral doctor in Oakland was not familiar with Kaiser
511003 - organizational memory on patient history; background submitted
511004 - during the meeting was described as the only summary available, as
511005 - helpful, but was too late for the doctor to be prepared, so the
511006 - entire meeting was based on recollections of personal memory.
511007 - ref SDS C8 BL8N
511008 -
511009 -
511010 -
511011 -
5111 -
SUBJECTS
Email Critical Component Effective Communication Partnership Deliver
Doctor Change for Effective Health Care Partnership
6004 -
600501 - ..
600502 - Doctor Change for Effective Health Care Partnership
600503 - Change Physician for Effective Health Care Partnership
600504 - Partnership Change Physician for Effective Health Care
600505 - Email Critical Component Effective Communication Partnership
600506 -
600507 - Changing the physician is recommended to remedy ineffective
600508 - partnership. ref OF 7 7811
600510 - ..
600511 - Today, Doctor Sylvia Connolly prefers conventional mail. ref SDS 0
600512 - 1846 and ref SDS 0 2652
600513 -
600514 - [On 990628 Sue Jeulis, Admin Assistant to Physician in Chief
600515 - reported doctors at Kaiser do not have time to review information
600516 - from patients on medical history. ref SDS 56 2262]
600518 - ..
600519 - [On 990628 Doctor Syed Naqvi at Kaiser wanted to review medical
600520 - history developed by patient. ref SDS 56 2223]
600522 - ..
600523 - [On 990802 Doctor Naqvi prefers conventional methods, rather than
600524 - clear, concise, complete communication on the Internet. ref SDS 66
600525 - 9108]
600527 - ..
600528 - [On 990813 Doctor Naqvi confirms preference Kaiser's standard
600529 - methods. ref SDS 67 1254]
600531 - ..
600532 - [On 990910 Doctor Craig Boulris wants conventional mail due to
600533 - limited time. ref SDS 70 2040]
600535 - ..
600536 - [On 000207 meeting at Kaiser to change primary care physician,
600537 - ref SDS 91 2783; Doctor Racah at Kaiser agreed to experiment using
600538 - SDS and email to support doctor/patient partnership for better
600539 - communication. ref SDS 91 VM68
600541 - ..
600542 - [On 000208 Doctor Racah found email facilitates communication
600543 - delivering SDS amazing records with accuracy comparable to tape
600544 - recordings. ref SDS 92 0001
600546 - ..
600547 - [On 020708 the radiologist wants patients to ask questions during
600548 - meetings, but there is not enough time to review the record to
600549 - ensure effective listening. ref SDS A0 WK7K
600550 -
600551 -
600552 -
600553 -
600554 -
6006 -
SUBJECTS
Kaiser Healthwise Handbook Excellent Procedures to Make Meetings Pro
Meetings Productivity Procedures Excellent Kaiser Healthwise Handboo
Communication Medical Practice Good Discussion Enables Good Treatmen
7605 -
760601 - ..
760602 - Communication Disscussion Capture Record Review Feedback Productivity
760603 - Productivity Communication Disscussion Capture Record Review Feedback
760604 -
760605 - Communication is the key ingredient of "partnership" for effective
760606 - teamwork in medicine, as in other fields, ref OF 7 2080, and as
760607 - discussed above. ref SDS 0 4185 On 921021 professional event at Cal
760608 - Tech citied communication as the critical component of productivity in
760609 - project management. ref SDS 4 5692 On 970707 work devolves toward
760610 - entropy when information overload overwhelms practitioners.
760611 - ref SDS 31 0108
760613 - ..
760614 - Kaiser's Team Care model of "partnership," reviewed above, ref SDS 0
760615 - YS49, fosters collaboration, where doctors meet regularly with
760616 - colleagues and supervisors, and with patients for examinations to
760617 - diagnose, prescribe and administer treatement. Covey recommends that
760618 - people seek first to "understand," then prescribe, reviewed on 921205.
760619 - ref SDS 5 2231 Dynamics of limited time and "attitude" prevent
760620 - effective communication that hampers Team Care goals for partnership,
760621 - per above. ref SDS 0 4928
760622 -
760623 - [On 020217 meetings are the fundamental team process for
760624 - productivity where people discuss, analyse, and decide the
760625 - course of action, ref SDS 94 1332, taking effective action
760626 - requires continual alignment to verify accuracy of
760627 - communication and actions with original sources. ref SDS 94
760628 - 9360
760630 - ..
760631 - Nurses and Physician Assistants implement Kaiser's Team Care practice
760632 - by communicating directly with patients to support the doctor.
760633 - ref OF 7 2958
760634 -
760635 - This reflects the communication assistant role explained in the
760636 - New World Order... paper. ref OF 10 6369
760638 - ..
760639 - Patient assistance for effective communication, discussed below,
760640 - ref SDS 0 JY9J, complements physician assisant role, and patient
760641 - assistance provided by the hospital for handling billings,
760642 - described above. ref SDS 0 1456
760643 -
760644 - [On 050215 Millie treated by physician asssistant, new role who
760645 - could provide support for working intelligently using SDS for
760646 - Communication Metrics. ref SDS C4 DL6J
760648 - ..
760649 - [On 050215 research indicates PAs are a cost cutting effort
760650 - rather to enable quality care by assisting the doctor/patient
760651 - partnership with accurate communication. ref SDS C4 OR42
760653 - ..
760654 - [On 060809 advice nurse notifies patient that clear, concise,
760655 - complete communication from the patient helped Kaiser provide
760656 - effective care. ref SDS D7 NY4J
760658 - ..
760659 - [On 061227 Sally's daughter Katie is studying to become
760660 - physician assistant. ref SDS E4 N47G
760662 - ..
760663 - [On 061227 discussions with Millie's primary care physician on
760664 - leveraging doctor patient partnership to improve accuracy of
760665 - medical practice and reduce mistakes that saves lives, time,
760666 - and money. ref SDS E4 T86F
760667 -
760668 -
760669 -
760671 - ..
760672 - Accuracy Saves Lives Time Money with Careful Due Diligence
760673 - Communications Due Diligence Converts Discussion into Action
760674 - Chronology Context Connection Communication Metrics for Accuracy
760675 -
760676 - Kaiser's presents a due diligence checklist for efficient case
760677 - management based on effective communication and thorough documentation
760678 - of patient history, typical of requirements for engineering management
760679 - reviewed recently on 990524. ref SDS 47 0876
760681 - ..
760682 - a. Good discussion yields accurate diagnosis, and good "treatment
760683 - plans," under the Kaiser doctor/patient partnership model,
760684 - ref OF 7 7548, reviewed above, which is a common goal for
760685 - communications to support proactive risk management.
760686 - ref SDS 0 4185
760688 - ..
760689 - "Good" discussion aids collaboration, coordination, and
760690 - planning for comprehensive care by "connecting the dots" in an
760691 - expanding record of complex patient history, which otherwise
760692 - overwhelms span of attention, reviewed on 950204. ref SDS 18
760693 - 0550
760694 -
760695 - [On 000124 example applying communication checklist for
760696 - examination at Kaiser, ref SDS 90 XF8H; doctor cites
760697 - advantages of due diligence checklist for evaluating
760698 - treatment options. ref SDS 90 2772
760700 - ..
760701 - [On 030710 doctor maintains patient positive attitude by
760702 - withholding details of medical problems that may cause
760703 - emotional alarm and trauma that reduce quality of life and
760704 - will to continue treatment. ref SDS A2 IF8G
760706 - ..
760707 - [On 040429 meeting with surgeon reported biopsy made
760708 - findings of new cancer but the pathology report was not
760709 - submitted that diagnosed IBC and this diagnosis was
760710 - withheld from the patient. ref SDS A6 F66N
760712 - ..
760713 - [On 040504 primary care physician withholds patient
760714 - diagnosed with IBC one of the most aggressive forms of
760715 - breast cancer. ref SDS A7 WI8F
760717 - ..
760718 - [On 040517 primary care physician submits biopsy without
760719 - discussion and continues to withhold notice that IBC
760720 - diagnosed and presents major change in patient status
760721 - from stage II to stage IV. ref SDS A8 6T5G
760723 - ..
760724 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
760725 - recommends patients be their own project manager for
760726 - effective care through the doctor patient partnership.
760727 - ref SDS C1 F25K
760729 - ..
760730 - [On 050812 example of patient history for diagnosis and
760731 - treatment planning. ref SDS C6 6L4M
760733 - ..
760734 - [On 051121 Kaiser email support for doctor/patient
760735 - partnership communication. ref SDS D3 V25O
760737 - ..
760738 - [On 060428 no other patients follow Kaiser Guidelines for
760739 - communication using test and doctor reports in the medical
760740 - chart to submit feedback on errors and omissions,
760741 - correlations, implications and nuance to strengthen
760742 - accuracy of diagnosis and treatment. ref SDS D6 W54L
760744 - ..
760745 - [On 060809 Kaiser advice nurse notifies patient that
760746 - clear, concise, complete communication enables effective
760747 - patient care. ref SDS D7 NY4J
760749 - ..
760750 - [On 061020 primary care physician withholds findings in CT
760751 - test of heart disorder Cor Pulmonale enlarged right
760752 - ventricle. ref SDS E0 VJ4J
760754 - ..
760755 - [On 061208 primary care physician withholds diagnosis of
760756 - lung cancer. ref SDS E1 G25K
760758 - ..
760759 - SDS design using chronology for common storage, and organic
760760 - structure for context management helps doctors and patients
760761 - invest time for "connecting the dots" to analyse examinations
760762 - and tests, see POIMS. ref OF 19 8555 Accurate diagnosis
760763 - enables timely and effective treatment. Working intelligently
760764 - by understanding cause and effect strengthens due diligence in
760765 - medical practice, based on the model of analysis and planning
760766 - posited by Drucker, and reviewed on 931130. ref SDS 7 6150
760767 - Others, like Covey call for capturing the record in a diary to
760768 - sharpen understanding of cause and effect based on the
760769 - chronology of events, reviewed on 921205. ref SDS 5 1121 SDS
760770 - support for chronology, context, and connection makes good
760771 - practice faster and easier, and therefore more consistent.
760772 -
760773 - [...see below, Kaiser due diligence requires doctors to
760774 - help patients get 2nd opintions for backup on diagnosis
760775 - and prescriptions. ref SDS 0 455N
760777 - ..
760778 - [On 050913 Kaiser's risk management requires doctors to
760779 - take a "Time Out" performing a due diligence checklist
760780 - that verifies accuracy of diagnosis, assessment of
760781 - treatment options, and planning implementation of
760782 - prescriptions for surgery. ref SDS C9 Q95M
760784 - ..
760785 - [On 050923 Healthwise Handbook contains a checklist of
760786 - requirements for doctors to take a Time Out and perform
760787 - due diligence answering patient questions on proposed
760788 - surgery. ref SDS D0 O85O
760789 -
760791 - ..
760792 - b. Listening critical component of communication.
760793 - ref OF 7 2068
760794 -
760795 - Patient Assistance Essential Effective Health Care
760797 - ..
760798 - The Healthwise Handbook proposes spouse, family, and friends
760799 - watch out for patient interests assisting with hospital
760800 - consumer skills for effective communications. ref OF 7 P776
760801 - Communication facilitates collaboration through doctor patient
760802 - partnership, per above, ref SDS 0 4185, essential for timely,
760803 - comprehensive work up, accurate diagnosis, work plan,
760804 - prognosis, and monitoring, per above. ref SDS 0 3190 Kaiser's
760805 - "patient assistance" guidance complements physician
760806 - assistance, also, described in the Healthwise Handbook, per
760807 - above. ref SDS 0 7H6J These roles leverage teamwork to
760808 - optimize use of medical resources and expertise for delivering
760809 - cost effective care.
760810 -
760811 - [On 041125 US HHS publication recommends patients ask a
760812 - spouse or friend to attend meetings with the doctor to
760813 - facilitate thorough, accurate communication. ref SDS B7
760814 - JH4V
760816 - ..
760817 - [On 080318 some people resist getting help with meetings,
760818 - rely on 2 x 3 inch shirt pocket diary to manage complex
760819 - patient history. ref SDS E9 9G6U
760821 - ..
760822 - [On 080911 article reports many medical mistakes occur
760823 - from mental errors by doctors involving communication.
760824 - ref SDS F2 PD7F
760826 - ..
760827 - [On 081018 Doctor Stritter's patient advocacy practice
760828 - seems to complement ideas for Kaiser to implement
760829 - palliative care project, by adding energy to assist the
760830 - physician and the patient manage expanding complexities
760831 - of health care. ref SDS F3 IS6U
760833 - ..
760834 - Communication leverages the doctor/patient partnership,
760835 - reviewed above. ref SDS 0 4185 An accurate record of
760836 - discussion written in the Medical Chart is the primary metric
760837 - of listening that authenticates conversation for accurate
760838 - understanding, with alignment to relevant sources and
760839 - background on patient history, discussed below. ref SDS 0 TD6Q
760841 - ..
760842 - Following up with feedback between the doctor and patient is
760843 - another metric of accurate listening, called out in Kaiser's
760844 - handbook. ref OF 7 5084 SDS supports eight (8) steps of
760845 - Communication Metrics, listed in POIMS, ref OF 19 365F, to
760846 - enable accurate understanding and timely follow up, reported
760847 - on 990527. ref SDS 19 WO9P Kaiser calls for a "ping pong"
760848 - feedback method, called out by the Healthwise Handbook,
760849 - reviewed below. ref SDS 0 3960
760851 - ..
760852 - Action is the ultimate metric of effective listening, which is
760853 - aided by proactive management working intelligently that
760854 - captures the record, and gets feedback to make adjustments in
760855 - time to avoid mistakes by continually refining accuracy with
760856 - alignment to orginal sources, called out by management
760857 - standards, reviewed on 950721. ref SDS 20 1740
760858 -
760859 -
760860 -
760861 -
7609 -
SUBJECTS
Healthwise Handbook Calls for Patient Review Medical Chart Medical C
AF03 -
AF0401 - ..
AF0402 - Accuracy Complete Patient History in Medical Chart
AF0403 - Healthwise Handbook Calls for Patient Review Medical Chart
AF0404 - Medical Chart Critical Component Communication Treatment Plans
AF0405 - Written Records Symptoms Diagnosis Treatment in Medical Chart
AF0406 -
AF0408 - ..
AF0409 - c. Medical chart showing a well ordered record of patient history
AF0410 - should be reviewed by the patient for effective decisions.
AF0411 - ref OF 7 0612
AF0413 - ..
AF0414 - Documenting work history in a well ordered record is a common
AF0415 - practice in engineering management, reviewed on 990524,
AF0416 - ref SDS 47 0876, and for general project management calling
AF0417 - for traceability to original sources, reviewed on 950721.
AF0418 - ref SDS 20 1740
AF0419 -
AF0420 - [...see below on capturing accurate record of patient
AF0421 - history in medical chart. ref SDS 0 TD6Q
AF0423 - ..
AF0424 - [...see below calling for ping pong feedback to verify
AF0425 - accuracy. ref SDS 0 3960
AF0427 - ..
AF0428 - Regular review of medical chart strengthens accuracy of
AF0429 - communication, ref SDS 0 3190, that supports collaboration for
AF0430 - effective doctor patient partnership, called out in Healthwise
AF0431 - Handbook, above. ref SDS 0 YS49
AF0433 - ..
AF0434 - [On 060428 no other patients follow Kaiser Guidelines for
AF0435 - communication using medical reports to submit feedback on
AF0436 - errors and omissions, correlations, implications and
AF0437 - nuance to strengthen accuracy for diagnosis and treatment.
AF0438 - ref SDS D6 W54L
AF0440 - ..
AF0441 - Research on the internet found....
AF0443 - ..
AF0444 - Medical Records Documentation Accuracy Communications
AF0445 -
AF0446 -
AF0447 - 1. Dictionary of Occupational Titles...
AF0448 -
AF0449 - http://www2.jobtrak.com/help_manuals/outlook/ocos103.html
AF0451 - ..
AF0452 - When you enter a hospital, you see a whirl of white coats
AF0453 - of physicians, nurses, radiologic technologists, and
AF0454 - others. Every time these health care personnel treat a
AF0455 - patient, they record what they observed and did to the
AF0456 - patient. This record includes information the patient
AF0457 - provides about their symptoms and medical history, and
AF0458 - also the results of examinations, reports of x rays and
AF0459 - laboratory tests, and diagnoses and treatment plans.
AF0460 - Medical record technicians organize and evaluate these
AF0461 - records for completeness and accuracy.
AF0463 - ..
AF0464 - Requirements for documentation to authenticate accuracy of daily work
AF0465 - and communications aligns with ISO specifications for traceability to
AF0466 - original sources showing an audit trail that connects cause and
AF0467 - effect, reviewed on 950721. ref SDS 20 1740 Covey calls for keeping a
AF0468 - journal for accurate understandings, reviewed on 921205. ref SDS 5
AF0469 - 2231
AF0471 - ..
AF0472 - [...below, Kaiser's Team Care policy requires doctors
AF0473 - to know the medical history of patients receiving their
AF0474 - care. ref SDS 0 6970
AF0476 - ..
AF0477 - [...below, industry standards, and regulations for good
AF0478 - management are generally ignored and not enforced.
AF0479 - ref SDS 53 GO9O
AF0481 - ..
AF0482 - [On 990912 national reporting cites study showing high
AF0483 - cost of medical mistakes caused by errors omissions in
AF0484 - patient history writtin in the medical chart.
AF0485 - ref SDS 71 4T4H
AF0487 - ..
AF0488 - [On 020504 FAR requires documentation of communications
AF0489 - to authenticate accuracy of daily work. ref SDS 97 XV7L
AF0491 - ..
AF0492 - [On 041014 patient review medical chart shows
AF0493 - illegible, ref SDS B1 PF7I, errors and ommissions.
AF0494 - ref SDS B1 T49J
AF0496 - ..
AF0497 - [On 041018 UCSF checked documentation to verify
AF0498 - accuracy of patient history. ref SDS B2 EN6S
AF0500 - ..
AF0501 - [On 041019 Stanford checked record to verify accurate
AF0502 - understanding of patient medical history. ref SDS B3
AF0503 - BV92
AF0505 - ..
AF0506 - [On 041213 Edison credited for contemporaneous record
AF0507 - in scientific research and engineering development and
AF0508 - design. ref SDS C2 DK4N
AF0510 - ..
AF0511 - [On 041212 Andy Grove, CEO Intel, and survivor of
AF0512 - cancer recommends patients be their own project manager
AF0513 - for effective care through the doctor patient
AF0514 - partnership. ref SDS C1 F25K
AF0516 - ..
AF0517 - [On 041230 doctor cannot find reason proposed stopped
AF0518 - previously to assess viability of resuming same
AF0519 - treatment. ref SDS C3 5R5O
AF0521 - ..
AF0522 - [On 051130 contemporaneous documentation to authenticae
AF0523 - accuracy of communications required by AIA standards
AF0524 - for design and construction, citing Leonardo Da Vinci,
AF0525 - and Edison. ref SDS D4 J15G
AF0527 - ..
AF0528 - When assembling a patient's medical record, technicians,
AF0529 - who may also be called health information technicians,
AF0530 - first make sure that the medical chart is complete. They
AF0531 - ensure that all forms are present and properly identified
AF0532 - and signed, and that all necessary information is on a
AF0533 - computer file. Sometimes, they talk to physicians or
AF0534 - others to clarify diagnoses or get additional information.
AF0535 -
AF0536 - [On 041014 medical records technicians failed to
AF0537 - assemble medical record for second opinion. ref SDS B1
AF0538 - GI9F
AF0540 - ..
AF0541 - [On 041212 Andy Grove, CEO Intel, and survivor of
AF0542 - cancer recommends patients be their own project manager
AF0543 - for effective care through the doctor patient
AF0544 - partnership. ref SDS C1 F25K
AF0546 - ..
AF0547 - Medical record technicians' duties vary with the size of
AF0548 - the facility. In large to medium facilities, technicians
AF0549 - may specialize in one aspect of medical records or
AF0550 - supervise medical record clerks and transcribers while a
AF0551 - medical record administrator manages the department (see
AF0552 - the statement on health services managers....
AF0553 -
AF0554 - http://www2.jobtrak.com/help_manuals/outlook/ocos014.html
AF0555 -
AF0556 - ...elsewhere in the Handbook). In small facilities an
AF0557 - accredited record technician may manage the department.
AF0558 -
AF0560 - ..
AF0561 - Don't Trust Your Memory
AF0562 - The Defensible Medical Record
AF0564 - ..
AF0565 - 2. The patient's medical chart, prepared when events are
AF0566 - vivid in your mind, is often the only source of important
AF0567 - medical care details that may otherwise be forgotten.
AF0568 -
AF0569 - http://www.thedoctors.com/risk/general/recordkeeping/j4234.asp
AF0571 - ..
AF0572 - The Doctors Company
AF0573 - 185 Greenwood Road
AF0574 - P.O. Box 2900
AF0575 - Napa, CA 94558-0900
AF0576 - (800) 421-2368
AF0577 - E-mail: info@thedoctors.com
AF0579 - ..
AF0580 - Mark Gorney, M.D., F.A.C.S., clinical professor
AF0581 - emeritus of plastic surgery at Stanford University, is
AF0582 - a founding member of The Doctors Company, Dr Gorney,
AF0583 - the company's medical director for 18 years, remains on
AF0584 - the board and continues in the role of senior
AF0585 - consultant.
AF0587 - ..
AF0588 - Paula A. Jenkins, senior vice president of The Doctors
AF0589 - Company Claims, oversees the company's national claims
AF0590 - operations. Ms. Jenkins has been with The Doctors
AF0591 - Company since 1987 and has more than 20 years of
AF0592 - experience with health care liability claims. She
AF0593 - holds a bachelor of arts degree from California State
AF0594 - University, Los Angeles, and has a graduate degree in
AF0595 - executive business management from the University of
AF0596 - California, Los Angeles.
AF0598 - ..
AF0599 - Joan Bristow is vice president of The Doctors Company
AF0600 - Patient Safety and Loss Prevention. Ms. Bristow has
AF0601 - been with The Doctors Company since 1993. Her
AF0602 - extensive risk experience includes developing and
AF0603 - implementing loss prevention programs for health care
AF0604 - organizations nationwide, auditing physician offices,
AF0605 - working as a consultant for accrediting agencies, and
AF0606 - speaking at health care forums.
AF0608 - ..
AF0609 - Frequently, such details of the patient's medical
AF0610 - management relate to events that occurred months or even
AF0611 - years earlier. Suddenly, a few seemingly unimportant
AF0612 - details can become the focal point...
AF0614 - ..
AF0615 - There is no adequate substitute for a detailed medical
AF0616 - chart to refresh your recollection of total patient
AF0617 - history, physical findings, and your earlier thought
AF0618 - processes.
AF0620 - ..
AF0621 - Requirements for documentation to authenticate accuracy of daily work
AF0622 - and communications aligns with ISO specifications for traceability to
AF0623 - original sources showing an audit trail that connects cause and
AF0624 - effect, reviewed on 950721. ref SDS 20 1740
AF0625 -
AF0626 - [...below, Kaiser's Team Care policy requires doctors
AF0627 - to know the medical history of patients receiving their
AF0628 - care. ref SDS 0 6970
AF0630 - ..
AF0631 - [On 990912 national reporting cites study showing high
AF0632 - cost of medical mistakes caused by errors omissions in
AF0633 - patient history writtin in the medical chart.
AF0634 - ref SDS 71 4T4H
AF0636 - ..
AF0637 - [On 041014, medical chart illegible, ref SDS B1 W78K,
AF0638 - errors and ommissions need support for accuracy to
AF0639 - implement Kaiser's guidelines on using the Medical
AF0640 - Chart for patient care. ref SDS B1 T49J
AF0642 - ..
AF0643 - [On 041018 medical chart often illegible, incomplete
AF0644 - not relied upon for 2nd opinion, reported at UCSF.
AF0645 - ref SDS B2 EN63
AF0647 - ..
AF0648 - [On 041212 Andy Grove, CEO Intel, and survivor of
AF0649 - cancer recommends patients be their own project manager
AF0650 - for effective care through the doctor patient
AF0651 - partnership. ref SDS C1 F25K
AF0653 - ..
AF0654 - [On 041230 primary care physician asked patient for
AF0655 - reasons chemotherapy regimine was changed to another
AF0656 - drug, illustrating importance of timely, accurate
AF0657 - records on patient history in the medical chart.
AF0658 - ref SDS C3 XQ84
AF0659 -
AF0660 -
AF0661 -
AF0662 -
AF07 -
SUBJECTS
Healthwise Handbook Requirements Written Records Feedback Ping Pong
AQ03 -
AQ0401 - ..
AQ0402 - Healthwise Handbook Requirements Written Records and Feedback
AQ0403 - Be Prepared for Meeting with Written Record and Feedback for Accuracy
AQ0404 - Written Record Feedback Improve Listening Enable People to be Prepared
AQ0405 -
AQ0406 -
AQ0407 - d. Be prepared for effective meetings with the doctor (typically
AQ0408 - scheduled for 10 to 15 minutes) by submitting a written
AQ0409 - history of symptoms, which the doctor can review, incorporate,
AQ0410 - and analyse in relation to prior work entered in the Medical
AQ0411 - Chart for an accurate record of patient history. ref OF 7 3430
AQ0412 - and ref OF 7 1450 (see Medical Chart discussed above.
AQ0413 - ref SDS 0 TD5S)
AQ0414 -
AQ0415 - [...below, Sylvia confirms doctors are scheduled to
AQ0416 - patients for 10 to 15 minutes. ref SDS 0 2652
AQ0418 - ..
AQ0419 - [On 000207 doctors are pressed for time because meetings
AQ0420 - with patients are scheduled every 15 minutes, so there is
AQ0421 - not enough time to verify accuracy of communication, nor
AQ0422 - to write clear, concise, complete records for the medical
AQ0423 - chart, including prescriptions. ref SDS 91 0788
AQ0425 - ..
AQ0426 - On 960205 people waste 70% of the day in meetings because
AQ0427 - nobody invests time to be prepared by capturing the record and
AQ0428 - reviewing relevant history in organizational memory.
AQ0429 - ref SDS 25 5902 Part of the problem is people cannot find
AQ0430 - critical details in the time available (10 - 15 minutes for
AQ0431 - medical examinations), reported on 960406. ref SDS 26 4249
AQ0432 -
AQ0434 - ..
AQ0435 - e. Understanding Memory Accuracy Writing Improves Communication
AQ0436 - Writing Improves Communication Memory Accuracy Understanding
AQ0437 -
AQ0438 - Writing medical history from communication in meetings, calls,
AQ0439 - and diagnostic reports builds shared efforts for good
AQ0440 - medicine, ref OF 7 2080, under Kaiser's partnership model,
AQ0441 - discussed above. ref SDS 0 4185 Doctors and patients can "be
AQ0442 - prepared" for effective meetings by reviewing patient medical
AQ0443 - history. Capturing a written record of medical history from
AQ0444 - discussion and analysis on symptoms and treatment is called
AQ0445 - out in Kaiser's Healthwise Handbook, ref OF 7 5063, along with
AQ0446 - plans for medical tests and test results, also, called out in
AQ0447 - the Handbook. ref OF 7 3465
AQ0449 - ..
AQ0450 - Adding alignment with links to original sources strengthens
AQ0451 - accuracy, called out by management standards reviewed on
AQ0452 - 950721, ref SDS 20 1740, that assists the doctor in generating
AQ0453 - a useful patient history in the medical chart, ref OF 7 5084,
AQ0454 - also, reviewed above. ref SDS 0 3190
AQ0455 -
AQ0456 - [On 041019 Stanford checked record to verify accurate
AQ0457 - understanding of patient medical history. ref SDS B3 BV92
AQ0459 - ..
AQ0460 - Communication Metrics defined on 950327, ref SDS 19 WO9P,
AQ0461 - supports Kaiser's call for written records connected to
AQ0462 - original sources to improve listening with better memory of
AQ0463 - patient medical history, and better follow up to get things
AQ0464 - done, per above. ref SDS 0 JY9J POIMS lists SDS support for
AQ0465 - eight (8) steps to understand accurately, and follow up
AQ0466 - thoroughly. ref OF 19 685K
AQ0467 -
AQ0468 - [...below, Kaiser's Team Care policy requires doctors to
AQ0469 - know the medical history of patients receiving their care.
AQ0470 - ref SDS 0 6970
AQ0472 - ..
AQ0473 - [...below, doctors seeing patients every 10 to 15 minutes
AQ0474 - do not have time to perform requirements for communication
AQ0475 - by writing the record, making review to be prepared, and
AQ0476 - providing feedback to verify accuracy of the Medical Chart
AQ0477 - on patient history. ref SDS 0 1978
AQ0479 - ..
AQ0480 - [...below, industry standards, and regulations for good
AQ0481 - management are generally ignored and not enforced.
AQ0482 - ref SDS 0 GO9O
AQ0484 - ..
AQ0485 - [On 990912 national reporting cites study showing high
AQ0486 - cost of medical mistakes caused by errors omissions in
AQ0487 - patient history writtin in the medical chart. ref SDS 71
AQ0488 - 4T4H
AQ0490 - ..
AQ0491 - [On 991028 Robert Pearl, CEO of Kaiser, submits letter
AQ0492 - citing Kaiser's goals for quality team care. ref SDS 82
AQ0493 - 0800]
AQ0495 - ..
AQ0496 - [On 000124 Doctor Vincint Yamamoto advised that patient
AQ0497 - communication is not provided to Doctors in the Medical
AQ0498 - Chart. ref SDS 90 7600]
AQ0500 - ..
AQ0501 - [On 020504 FAR require documentation showing alignment of
AQ0502 - daily communication with objectives, requirements, and
AQ0503 - commitments, ref SDS 97 XV7L; governement generally is
AQ0504 - unable to perform these requirements. ref SDS 97 NS6F
AQ0506 - ..
AQ0507 - [On 041014, medical chart illegible, ref SDS B1 W78K,
AQ0508 - errors and ommissions shows there is not enough time for
AQ0509 - communication essential to good medicine; need support for
AQ0510 - accuracy to implement Kaiser's guidelines on using the
AQ0511 - Medical Chart for patient care. ref SDS B1 T49J
AQ0513 - ..
AQ0514 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
AQ0515 - recommends patients be their own project manager for
AQ0516 - effective care through the doctor patient partnership.
AQ0517 - ref SDS C1 F25K
AQ0518 -
AQ0520 - ..
AQ0521 - f. Follow up with Feedback Improves Accuracy Communication
AQ0522 - Feedback Get Things Done Correctly with Timely Follow Up
AQ0523 - Ping Pong Feedback Recursively Refines Accuracy Medical Chart
AQ0524 -
AQ0525 - Feedback is a "ping pong" process that clarifies and verifies
AQ0526 - accuracy of understandings, as set out in Kaiser's Healthwise
AQ0527 - Handbook, ref OF 7 1395, calling for accurate record of
AQ0528 - patient history in the medical chart, per above. ref SDS 0
AQ0529 - TD5S
AQ0531 - ..
AQ0532 - Aligns with review of Covey on 921205 citing effective
AQ0533 - listening is a critical element of "good managment" that is
AQ0534 - difficult to implement due to limited time and perceptions
AQ0535 - that Communication Metrics are "overkill." ref SDS 5 IR4N
AQ0536 -
AQ0537 - [...in another record today, successful CEOs use good
AQ0538 - management practice.
AQ0540 - ..
AQ0541 - See, also, "listening," above. ref SDS 0 3190
AQ0543 - ..
AQ0544 - Doctors do not have time for feedback, per Doctor Sylvia
AQ0545 - Connolly below. ref SDS 0 1978 On the other hand, Doctor
AQ0546 - Zipperstein reported on 940728 that communication metrics
AQ0547 - using feedback helped him and saved time. ref SDS 16 0001
AQ0548 -
AQ0549 - [On 991130 example of feedback. ref SDS 86 0899
AQ0551 - ..
AQ0552 - [On 000207 Doctor Racah reviewed and approved procedures
AQ0553 - for working intelligently with written diaries to confirm
AQ0554 - meetings, and feedback to refine accuracy. ref SDS 91 1125
AQ0556 - ..
AQ0557 - [On 020708 the radiologist wants patients to ask questions
AQ0558 - during meetings, but there is not enough time to review
AQ0559 - the record to ensure effective listening. ref SDS A0 WK7K
AQ0561 - ..
AQ0562 - [On 000208 feedback in letter from Doctor Racah says the
AQ0563 - record of the meeting was accurate. ref SDS 92 0001]
AQ0565 - ..
AQ0566 - [On 040429 the surgeon feels that writing things down
AQ0567 - helps maintain clarity and comprehension in the medical
AQ0568 - record that can guide, supplment and confirm verbal
AQ0569 - discussion. ref SDS A6 FK9F
AQ0571 - ..
AQ0572 - [On 041110 Stanford Medical Center people giving up, fear
AQ0573 - of accountability prevents timely, accurate communication;
AQ0574 - stifle, proactive management, taking initiative to enable
AQ0575 - effective care. ref SDS B5 2J42
AQ0577 - ..
AQ0578 - [On 041019 Stanford checked record to verify accurate
AQ0579 - understanding of patient medical history. ref SDS B3 BV92
AQ0581 - ..
AQ0582 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
AQ0583 - recommends patients be their own project manager for
AQ0584 - effective care through the doctor patient partnership.
AQ0585 - ref SDS C1 F25K
AQ0587 - ..
AQ0588 - [On 050824 Advice Nurse being persistant reminding the
AQ0589 - surgeon to implement requirements in Kaiser's Healthwise
AQ0590 - Handbook following up patient calls to collaborate and
AQ0591 - coordinate via email on accuracy of communication and
AQ0592 - patient medical history. ref SDS C7 4M7N
AQ0594 - ..
AQ0595 - [On 050826 referral doctor in Oakland was not familiar
AQ0596 - with Kaiser organizational memory on patient history;
AQ0597 - background submitted during the meeting was described as
AQ0598 - the only summary available, as helpful, but was too late
AQ0599 - for the doctor to be prepared, so the entire meeting was
AQ0600 - based on recollections of personal memory. ref SDS C8 BL8N
AQ0602 - ..
AQ0603 - [On 051121 Kaiser email support for doctor/patient
AQ0604 - partnership communication. ref SDS D3 V25O
AQ0606 - ..
AQ0607 - [On 060428 no other patients follow Kaiser Guidelines for
AQ0608 - communication using medical reports to submit feedback on
AQ0609 - errors and omissions, correlations, implications and
AQ0610 - nuance to strengthen accuracy for diagnosis and treatment.
AQ0611 - ref SDS D6 W54L
AQ0613 - ..
AQ0614 - [On 070201 0800 Brigid and Jackie indicated SDS record for
AQ0615 - meeting with Doctor Rugo at UCSF on 070130 is accurate
AQ0616 - like a tape recording; but, Kaiser's "ping pong" feedback
AQ0617 - system for doctors to verify accuracy of communication
AQ0618 - with patients is not necessary because the doctor and
AQ0619 - assistants are diligent writing thorough accurate notes in
AQ0620 - the Medical Chart on examinations and calls; she feels
AQ0621 - nobody has enough time to verify accuracy. ref SDS E6 NW9J
AQ0623 - ..
AQ0624 - [On 070307 Coagulation Control Clinic case manager advises
AQ0625 - that a hectic schedule prevents saving lives, time, and
AQ0626 - money by working quickly with email to provide feedback
AQ0627 - for accurate communications called out by Kaiser's
AQ0628 - guidelines. ref SDS E7 P38G
AQ0630 - ..
AQ0631 - [On 090520 1203 Pamela in Kaisre's Expedited Claims
AQ0632 - Department refused to support Kaiser's "ping pong" system
AQ0633 - of feedback loops because she has been taught that
AQ0634 - verifying accuracy is unnecessary overkill. ref SDS F4
AQ0635 - CV32
AQ0636 -
AQ0637 -
AQ0638 -
AQ0639 -
AQ0640 -
AQ07 -
SUBJECTS
Execution Weak Link Degrades Management to Entropy Due to Limited Ti
AR03 -
AR0401 - ..
AR0402 - Time to Think Limits Ability to Execute Good Management Practices
AR0403 - Intelligence Added to Communication Lifts Management Productivity
AR0404 - Communication Drives Management Poor Execution Brings Bad Management
AR0405 - Execution Weak Link Degrades Management to Entropy Due to Limited Time
AR0406 -
AR0407 - As noted, partnership and collaboration through communication improve
AR0408 - everything. ref SDS 0 4185 Provisions in Chapter 2 of the Healthwise
AR0409 - Handbook strengthen "listening" for better understanding, ref SDS 0
AR0410 - TD6Q, and timely follow up with feedback that avoids mistakes.
AR0411 - ref SDS 0 3960 Adding support for understanding and follow up fits
AR0412 - the model of Communication Metrics developed on 950327. ref SDS 19
AR0413 - WO9P
AR0415 - ..
AR0416 - Building a dam, designing computers, baking a cake, fixing the car,
AR0417 - like going to the doctor, all benefit from organizing information, and
AR0418 - adding analysis, alignment with objectives, requirements, and
AR0419 - commitments, adding summary linked to details for precision access,
AR0420 - and feedback for accuracy. Integrating these common elements of good
AR0421 - management add "intelligence" to management that lifts productivity,
AR0422 - as specified in POIMS. ref OF 9 0582
AR0423 -
AR0424 - [On 990628 developed correlation between medical management and
AR0425 - other professions, showing "intelligence" reduces the need for
AR0426 - litigation, by reducing mistakes. ref SDS 55 0001
AR0428 - ..
AR0429 - [On 990912 article reports high cost of mistakes. ref SDS 71 0001]
AR0431 - ..
AR0432 - [On 020708 examples adding "intelligence" to information that
AR0433 - improves accuracy of communication in many fields. ref SDS 99 MZ6O
AR0435 - ..
AR0436 - Good guidelines alone, however, are not enough. Good results require
AR0437 - consistent execution, i.e., performing the guidelines, as set out in
AR0438 - the review of Stephen Covey's book on 921205 explaining time is the
AR0439 - enemy of consistent performance that builds good work habits.
AR0440 - ref SDS 5 6013
AR0441 -
AR0442 - Doctor Connolly explains below doctors do not have enough time for
AR0443 - communication, ref SDS 0 1978, called out in Kaiser's manual, per
AR0444 - above. ref SDS 0 3190
AR0445 -
AR0446 - [On 991025 Drucker calls for technology to "routinize" good
AR0447 - management practices following a model of cognitive science.
AR0448 - ref SDS 81 0785
AR0450 - ..
AR0451 - [On 991221 report doctors not communicating adequately with
AR0452 - patients, need education and processes. ref SDS 89 0001
AR0454 - ..
AR0455 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
AR0456 - recommends patients be their own project manager for effective
AR0457 - care through the doctor patient partnership. ref SDS C1 F25K
AR0459 - ..
AR0460 - [On 041230 doctor cannot find in the Medical Chart, including
AR0461 - hospital computers, reasoning for stopping treatment previously
AR0462 - in order to assess viability of resuming same treatment.
AR0463 - ref SDS C3 5R5O
AR0465 - ..
AR0466 - [On 060809 Kaiser advice nurse notifies patient that
AR0467 - clear, concise, complete communication enables effective
AR0468 - patient care. ref SDS D7 NY4J
AR0470 - ..
AR0471 - Peter Drucker worried in his book Management Tasks, Practices, and
AR0472 - Responsibilities that people have given up on improving management
AR0473 - because communication is 80% of a manager's time and is too
AR0474 - complex to manage, reviewed on 931130. ref SDS 7 3851 Kissinger
AR0475 - also worried on 940609 that giving up on good communication makes
AR0476 - management an "Alice in Wonderland" of continual bumbling.
AR0477 - ref SDS 11 4238
AR0479 - ..
AR0480 - On 951026 published requirements for good management are ignored
AR0481 - by industry. ref SDS 22 3384
AR0482 -
AR0483 - [On 020204 Powers report on Enron's collapse into bandruptcy
AR0484 - shows management failed to implement directive for using an
AR0485 - audit trail showing daily work aligns with objectives,
AR0486 - requirements and commitments. ref SDS 93 EX5O
AR0488 - ..
AR0489 - [On 020504 FAR require documentation showing alignment of
AR0490 - daily communication with objectives, requirements, and
AR0491 - commitments, ref SDS 97 XV7L; governement generally is unable
AR0492 - to perform these requirements. ref SDS 97 NS6F
AR0494 - ..
AR0495 - [On 020522 ISO 9000 audit passed without actual compliance
AR0496 - with requirements for traceability to original sources,
AR0497 - eviscerates good management practice. ref SDS 98 KR6J
AR0499 - ..
AR0500 - Fortune magazine's lead article, published on 990621, reports CEOs
AR0501 - failing due to poor execution, reviewed in another record today,
AR0502 - ref SDS 54 0001, and confirming the report on 970910 that
AR0503 - executives do not have time to think. ref SDS 33 3479 Failure to
AR0504 - "think," i.e., use intelligence, causes poor execution, mistakes,
AR0505 - loss, conflict, crisis, and calamity. When good management seems
AR0506 - beyond reach due to limited time using available tools, ignorance,
AR0507 - fear, and denial cause people to give up, noted by Drucker.
AR0508 - ref SDS 0 FL3F
AR0509 -
AR0510 - [On 011003 study showing people have given up on good
AR0511 - management.
AR0513 - ..
AR0514 - [On 030826 NASA Chief Administrator reports to Congress that
AR0515 - a culture of denial drives people to convert "requirements"
AR0516 - for good management into suggestions that are then dismissed
AR0517 - as unnecessary overkill, when tools and methods people are
AR0518 - required to use make good management beyond reach.
AR0519 - ref SDS A3 8K4G
AR0521 - ..
AR0522 - The same factors impede execution of Kaiser's communication
AR0523 - guidelines...
AR0524 -
AR0525 -
AR0526 -
AR0527 -
AR06 -
SUBJECTS
Default Null Subject Account for Blank Record
AS03 -
AS0401 - ..
AS0402 - Communication Fails Due to Ignorance, Fear and Denial
AS0403 -
AS0404 - Kaiser's Healthwise Handbook demonstrates that Communication is a
AS0405 - predicate to action in medical practice, as in other fields, cited
AS0406 - in proposal #9961176 to National Science Foundation, ref OF 11
AS0407 - 5561, submitted on 990615. ref SDS 49 0001 Communication supports
AS0408 - execution; but, communication failure leads to constant mistakes,
AS0409 - crisis, conflict and added cost.
AS0410 -
AS0411 - [On 990628 developed correlation between medical management and
AS0412 - other professions, and management intelligence reduces need for
AS0413 - lawyers; sent letters on potential for Communication Metrics to
AS0414 - improve process. ref SDS 55 0001]
AS0416 - ..
AS0417 - [On 990813 example poor medical communication. ref SDS 67 0001]
AS0419 - ..
AS0420 - [On 990910 example failed communication with Doctor Boulris.
AS0421 - ref SDS 70 3038]
AS0423 - ..
AS0424 - [On 990912 article on high cost of medical mistakes.
AS0425 - ref SDS 71 0001]
AS0427 - ..
AS0428 - [On 020504 study shows professional standards for communication
AS0429 - practices and requirements on good management specified in FAR,
AS0430 - ISO, Health Care, Covey, Drucker, law, contract notice
AS0431 - provisions, and 2,000 years of literacy for contemporaneous
AS0432 - documentation for alignment and feedback to work intelligently,
AS0433 - quickly, and accurately are ignored in government, business,
AS0434 - health care, every sector. ref SDS 97 NS6F
AS0436 - ..
AS0437 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
AS0438 - recommends patients be their own project manager for effective
AS0439 - care through the doctor patient partnership. ref SDS C1 F25K
AS0441 - ..
AS0442 - Communication failure is caused by...
AS0443 -
AS0444 - a. Doctors and patients have limited time and limited span of
AS0445 - attention. (see below. ref SDS 0 1978)
AS0446 -
AS0447 - Limited span of attention causes critical nuance to be
AS0448 - overlooked. Details are omitted that cause mistakes and
AS0449 - take time to correct. Limited time causes recognition of
AS0450 - key facts to be forgotten before they are captured in
AS0451 - action items that can be tracked by "management systems."
AS0453 - ..
AS0454 - b. Doctors see many patients and so commingle understandings
AS0455 - from one patient to another.
AS0457 - ..
AS0458 - c. Meaning drift occurs due to information density overloads
AS0459 - span of attention; management systems are then overwhelmed
AS0460 - causing continual mistakes, i.e., bumbling; people are
AS0461 - ignorant of this process, deny it occurs, and are
AS0462 - unwilling to maintain alignment. ref OF 10 5918
AS0463 -
AS0464 - [On 080811 article reports most medical mistakes are
AS0465 - caused by doctor mental errors. ref SDS F2 U17Q
AS0467 - ..
AS0468 - d. Feedback fails for reasons in the NWO... ref OF 10 2670
AS0470 - ..
AS0471 - e. Fear of accountability reduces communication, reviewed on
AS0472 - 980405.
AS0473 -
AS0474 -
AS0475 -
AS0476 -
AS05 -
SUBJECTS
Default Null Subject Account for Blank Record
AT03 -
AT0401 - ..
AT0402 - Culture, Preference, Attitude and Psyche Prevent Good Management
AT0403 -
AT0404 - Doctors are acutely aware of the tension between investing time for
AT0405 - planning and taking immediate action. see POIMS. ref OF 9 2049
AT0406 - Mistakes necessarily escalate in emergencies when time is short and
AT0407 - decisions must be taken on-the-fly. Conditions on the battlefield,
AT0408 - during a natural disaster, like earthquakes, hurricanes, etc., or
AT0409 - emergencies, like a train wreck, require spontaneous decisions by
AT0410 - people who are tired and stressed under the rule...
AT0412 - ..
AT0413 - lose some in order to save many
AT0415 - ..
AT0416 - This management method is evident in hospital television programs that
AT0417 - show the excitement of emergency room medical practice. Everyone
AT0418 - applauds the script writers who tug at the limits of human emotion
AT0419 - using the ultimate issue of life and death. This gives the impression
AT0420 - that very "good" people can work quickly on complex matters without
AT0421 - error, which is false.
AT0423 - ..
AT0424 - Outside the emergency setting, the rule "lose some to save many" only
AT0425 - applies on a sliding scale.
AT0427 - ..
AT0428 - Spontaneous excitement and applause for reacting on impulse are the
AT0429 - antithesis of planning and analysis to avoid oversight and mistake.
AT0430 - However, "attitude" borne of hubris, sloth, and insulation from
AT0431 - accountability under an "inertia of success," described by Grove (see
AT0432 - on 980307, ref SDS 37 3740), and further described as "denial" in a
AT0433 - study on the high cost of medical mistakes, reported on 990912,
AT0434 - ref SDS 71 3416, cause continual mistakes due to continued reliance on
AT0435 - spontaneous medical practice, commonly called...
AT0437 - ..
AT0438 - feel good management
AT0439 -
AT0440 -
AT0441 - ...reviewed on 911123, ref SDS 3 1331, because it is fast and easy,
AT0442 - rather than using good communication procedures layed out in Kaiser's
AT0443 - Handbook, which take time, and often seem boring. ref SDS 0 3190
AT0445 - ..
AT0446 - On 990505 management at San Francisco International Airport reported
AT0447 - "attitudes" had to change before trying to improve communication.
AT0448 - ref SDS 46 4732
AT0449 -
AT0450 - [On 990817 management wants commitment to improve before taking
AT0451 - steps to improve communication. ref SDS 69 6829]
AT0453 - ..
AT0454 - An article in Fortune reviewed today says CEOs fail because personal
AT0455 - psyche avoids good communication practice that seems boring,
AT0456 - ref SDS 54 4914, compared to crisis management that is fun and
AT0457 - exciting.
AT0458 -
AT0459 - [On 990912 article on high cost of medical mistakes.
AT0460 - ref SDS 71 0001]
AT0462 - ..
AT0463 - Kaiser's Handbook reflects ISO rules for "documentation" to discover
AT0464 - problems and maintain alignment of work with requirements, reviewed on
AT0465 - 950721. ref SDS 20 1740 Most medical practice fits the model of
AT0466 - investing time for good medical "intelligence," rather than taking
AT0467 - immediate action. Kaiser recognizes that talking, alone, which seems
AT0468 - at the moment to provide fast and easy communication, causes bigger
AT0469 - problems later.
AT0470 -
AT0471 - [On 990910 Doctor does not have time to review medical history, and
AT0472 - wants patient to select relevant medical history, rather than the
AT0473 - doctor. ref SDS 70 9130
AT0475 - ..
AT0476 - [On 020504 study shows professional standards for communication
AT0477 - practices and requirements on good management specified in FAR,
AT0478 - ISO, Health Care, Covey, Drucker, law, contract notice provisions,
AT0479 - and 2,000 years of literacy for contemporaneous documentation for
AT0480 - alignment and feedback to work intelligently, quickly, and
AT0481 - accurately are ignored in government, business, health care, every
AT0482 - sector. ref SDS 97 NS6F
AT0484 - ..
AT0485 - As with other industries, medical analysis and planning are limited by
AT0486 - personal preference, as reviewed on 961222. ref SDS 29 8402 Today,
AT0487 - Doctor Sylvia Connolly made this point. ref SDS 0 1978 New realities
AT0488 - of information overload in the modern era reduce time for analysis
AT0489 - that provides traceability to original sources, see on 951026.
AT0490 - ref SDS 22 3245
AT0491 -
AT0492 - [On 990628 Admin Assistant to Physician in Chief reported doctors
AT0493 - at Kaiser do not have time to review information from patients on
AT0494 - medical history. ref SDS 56 2262]
AT0496 - ..
AT0497 - [On 990802 Doctor prefered patients leave phone messages rather
AT0498 - than submit medical history via web mail. ref SDS 66 9108 He
AT0499 - confirmed objective to avoid receiving medical history from patient
AT0500 - via web mail, in a letter on 990813. ref SDS 67 1254]
AT0502 - ..
AT0503 - Like health care, all professions have guidelines for communication,
AT0504 - ref SDS 0 3190, including documentation and analysis, but economics
AT0505 - and personal preference, commonly called "attitude," reduce the time
AT0506 - applied to comply with policies, requirements, guidelines, and
AT0507 - regulations. New realities of a new world order of chronic
AT0508 - information overload from constant meetings, calls, and documents,
AT0509 - there is never enough time for working intelligently by investing
AT0510 - intellectual capital.
AT0511 -
AT0512 - On 940608 article on quality management relates practices
AT0513 - nearly identical to those in Kaiser's Handbook. ref SDS 10 7441
AT0515 - ..
AT0516 - On 950807 business school does not use work practices it
AT0517 - teaches executives to use. ref SDS 21 2013]
AT0519 - ..
AT0520 - On 951221 article shows Information Technology (IT) industry
AT0521 - has strong requirements for documentation of work, problems and
AT0522 - analysis. ref SDS 24 0966
AT0524 - ..
AT0525 - On 961204 government unable to implement its published
AT0526 - guidelines for managing contracts. ref SDS 27 8951
AT0528 - ..
AT0529 - On 970603 Intel has requirements for good management that
AT0530 - nobody follows. ref SDS 30 S196 and ref SDS 30 5803 The core
AT0531 - problem is that understandings from communications break down
AT0532 - and are not carried out. ref SDS 30 TY8F
AT0534 - ..
AT0535 - On 980307 Andy Grove, CEO of Intel, recommends copious notes to
AT0536 - avoid ambiguity of mental maps that cause mistakes, delay and
AT0537 - extra cost. ref SDS 38 3668
AT0539 - ..
AT0540 - On 980722 Intel has published procedures for preparing and
AT0541 - reporting on meetings, ref SDS 40 2937, but poor execution
AT0542 - limits usefulness of guidelines. ref SDS 40 8440
AT0544 - ..
AT0545 - On 990416 Caltrans engineers do not have time to prepare daily
AT0546 - diaries, causing huge cost overruns. ref SDS 44 6960
AT0548 - ..
AT0549 - On 990525 IT engineers don't like to write and management does
AT0550 - not allocate time for documentation. ref SDS 48 0966
AT0551 -
AT0552 - [On 990628 developed correlation between medical management and
AT0553 - other professions, and management intelligence reduces need for
AT0554 - lawyers; sent letters on potential for Communication Metrics to
AT0555 - improve process. ref SDS 55 0001]
AT0556 -
AT0557 -
AT0558 -
AT0559 -
AT0560 -
AT06 -
SUBJECTS
Default Null Subject Account for Blank Record
AU03 -
AU0401 - ..
AU0402 - Advantages of Communication in Medical Practice
AU0403 -
AU0404 - Medical practice has unique advantages that make communication
AU0405 - more effective than in other industries...
AU0406 -
AU0407 - a. Communication is direct between consumer and worker. There is
AU0408 - less disconnect than occurs in organizational bureaucracy that
AU0409 - delays and impairs implementation.
AU0411 - ..
AU0412 - b. Doctors have more authority to take immediate action, without
AU0413 - having to get approval from a hierarchy.
AU0415 - ..
AU0416 - These factors increase the potential for Kaiser's idea to enslist
AU0417 - the aid of self-interested patients to perform some of the work in
AU0418 - developing a record essential for communication to be effective.
AU0419 - Increasing rewards increases the willingness to perform good
AU0420 - management practice.
AU0422 - ..
AU0423 - Communication Metrics provides new tools and processes for organizing
AU0424 - information to maintain alignment. This supports effective medical
AU0425 - practice within the time available to doctors and patients for
AU0426 - generating "intelligence."
AU0427 -
AU0428 -
AU0429 - http://www.welchco.com
AU0431 - ..
AU0432 - Discussed guidelines with Sylvia during exam. ref SDS 0 1978
AU0434 - ..
AU0435 - On 940728 Doctor Zipperstein in Kaiser's San Francisco Dermatology
AU0436 - Department reported that Communication Metrics supports effective
AU0437 - medical history. ref SDS 16 0001
AU0438 -
AU0439 - [On 990915 Jeanne Bradley supports Com Metrics. ref SDS 73 4988]
AU0440 -
AU0441 -
AU0442 -
AU0443 -
AU0444 -
AU0445 -
AU0446 -
AU05 -
SUBJECTS
Healthwise Handbook, Chapter 2
Concurrent Discovery, Common Administration
Partnering, TQM for Contracts
Responsibility Shared
Decisions Shared
AZ07 -
AZ0801 - ..
AZ0802 - Common Sense Does Not Produce Effective Medical Management
AZ0803 - Partnering Should Not Substitute Common Sense for Expertise
AZ0804 -
AZ0805 - Kaiser recommends that patients trust commen sense to help doctors
AZ0806 - remember to perform adequate analysis, based on checklists in Chapter
AZ0807 - 2. ref OF 7 0605
AZ0809 - ..
AZ0810 - This position seems to make the patient a "project manager" or a
AZ0811 - "co-pilot" responsible to review with the doctor a long list of tasks
AZ0812 - to perform and conditions to check, in advance of "take-off."
AZ0813 -
AZ0814 - [On 990912 Kaiser's doctor explained that burden of information
AZ0815 - and limited time force reliance on patient. ref SDS 70 2040]
AZ0817 - ..
AZ0818 - The purpose of the checklist in Kaiser's Handbook is to avoid
AZ0819 - relying on "common sense," so that specialized, expert "sense" is
AZ0820 - applied. Only a trained "co-pilot" can be expected to adequately
AZ0821 - review the range of issues to consider in advance of "take-off."
AZ0823 - ..
AZ0824 - Defects in relying on common sense are set out in the New World
AZ0825 - Order... paper. ref OF 10 4235
AZ0827 - ..
AZ0828 - Doctors are trained for 8 years to acquire uncommon sense.
AZ0830 - ..
AZ0831 - Patients should rely on the training, expertise and experience of the
AZ0832 - doctor to provide professional medical management.
AZ0834 - ..
AZ0835 - Partnership, advocated by Kaiser, ref OF 7 5418, can be effective
AZ0836 - based on the relationship between owner and builder. One party has
AZ0837 - expertise and a duty to perform. The other party has goals and
AZ0838 - exercises approval. Contractors often view owner inquiry as
AZ0839 - interference. Inept owner oversight delays work and increases cost.
AZ0840 - "Partnership" must transcend conflicting interests and perspectives.
AZ0842 - ..
AZ0843 - A patient, however, is both the "owner" and the object of medical
AZ0844 - work. Lifestyle (diet and habits) impacts health, which is a
AZ0845 - dynamic process; whereas, a building is a static environment.
AZ0846 - When work plans are set, the contractor is solely responsible to
AZ0847 - perform. But a doctor is dependent on the patient to follow
AZ0848 - treatment plans. As well, the human body is more complex than a
AZ0849 - structure, so impacts of any particular effort, are never fully
AZ0850 - knowable. Medical practice is more art than science, largely
AZ0851 - trial and error, e.g., doing tests, ref OF 7 2640, medication,
AZ0852 - ref OF 5 4720 and ref OF 7 3465; surgery. ref OF 7 2838 Plans and
AZ0853 - specs are rarely prepared to define the scope of work and
AZ0854 - prescribe work steps to achieve results; although, "work up" is a
AZ0855 - powerful medical practice that strives to provide rigor and
AZ0856 - deliberation to health care.
AZ0858 - ..
AZ0859 - Can medicine move closer to the engineering model of using plans
AZ0860 - and specs?
AZ0862 - ..
AZ0863 - Additionally, biological "structures" are designed to fail sooner
AZ0864 - or later. No amount of expertise nor effort can avoid "failure."
AZ0865 - We are all "spoiling" at different rates. Medicine prolongs the
AZ0866 - inevitable. This condition invites negative attitudes, that
AZ0867 - excuse poor performance.
AZ0868 -
AZ0869 - [On 020221 Malthusian demographic delimma successful health
AZ0870 - care exposes endless new infirmities of an aging population.
AZ0871 - ref SDS 95 Y27F
AZ0872 -
AZ0873 -
AZ0875 - ..
AZ0876 - Shared decision needs clarification of responsibility between the
AZ0877 - expert doctor, hired to perform a service, and an interested party,
AZ0878 - the patient. ref OF 7 2640
AZ0879 -
AZ0880 - On 940103 reviewed article on partnering. ref SDS 8 9674
AZ0881 -
AZ0882 - On 971021 submitted initiative to improve partnering. ref SDS 34
AZ0883 - 1212
AZ0885 - ..
AZ0886 - On 990414 Caltrans had problems using partnering. ref SDS 44 8845
AZ0888 - ..
AZ0889 - Kaiser's guidelines may go too far in seeking to make the patient
AZ0890 - responsible for medical expertise. ref OF 7 1740 It is a fine
AZ0891 - line between providing oversight, and exercising professional
AZ0892 - judgement.
AZ0894 - ..
AZ0895 - What research and opinions have been rendered on provisions to
AZ0896 - "share" responsibility at page 15. ref OF 7 1740
AZ0898 - ..
AZ0899 - [On 990912 Kaiser's doctor explained that burden of information and
AZ0900 - limited time force reliance on patient. ref SDS 70 2040]
AZ0901 -
AZ0902 -
AZ0903 -
AZ0904 -
AZ0905 -
AZ10 -
SUBJECTS
Second Opinion Invaluable Aid for Avoiding Mistakes Double Entry Sys
B103 -
B10401 - ..
B10402 - Due Diligence 2nd Opinions Invest Time to Double Check Accuracy
B10403 - Ounce Prevention Worth Pound of Cure; 2nd View Saves a lot of Sorrow
B10404 - 2nd Opinion Double Check Strengthens Accuracy of Medical Practice
B10405 -
B10406 - Kaiser's Healthwise Handbook calls for the primary care physician to
B10407 - perform due diligence by helping the patient get 2nd opinions.
B10408 - ref OF 7 4266 Collaborating expands the pool of expertise and
B10409 - experience to optimize patient outcomes. Coordinating diverse medical
B10410 - support fits the model of doctor-patient partnerhip that Kaiser
B10411 - prescribes for effective care, discussed above. ref SDS 0 4185
B10412 - Performing due diligence requires communication based on accurate
B10413 - patient history and analysis of test resutls to formulate accurate
B10414 - diagnosis and effective treatment plans. (again, see above,
B10415 - ref SDS 0 3190)
B10416 -
B10417 - [On 050913 Kaiser's risk management requirements tell doctors to
B10418 - take a "Time Out" for due diligence to verify accuracy of
B10419 - diagnosis, assessment of treatment options, and planning
B10420 - implementation of prescriptions for surgery. ref SDS C9 Q95M
B10422 - ..
B10423 - [On 050923 Healthwise Handbook requires doctor's to take a Time
B10424 - Out and perform due diligence answering patient questions on
B10425 - proposed surgery. ref SDS D0 O85O
B10427 - ..
B10428 - This sound medical practice fits the time honored model in other
B10429 - industries for saving time and money by using double entry bookkeeping
B10430 - methods to verify accuracy. Getting a second opinion to discover
B10431 - small, critical details that guide medical decisions aligns with
B10432 - construction practice to avoid costly, tragic mistakes...
B10434 - ..
B10435 - Measure twice cut once!!
B10437 - ..
B10438 - There is a similar practice in the law, where decisions are reviewed
B10439 - based on independent analysis of the record to see if anything was
B10440 - overlooked that might lead to a different course of action.
B10442 - ..
B10443 - Kaiser's idea to get a second opinon from a different type of doctor
B10444 - who treats similar problems, ref OF 7 4266, provides broader
B10445 - perspective evaluating the same data, that avoids the common problem
B10446 - that...
B10447 -
B10448 - When you have a hammer everything looks like a nail.
B10450 - ..
B10451 - [On 020726 primary care physician in Oncology applied Kaiser's
B10452 - guidance for getting backup 2nd opinion, by asking for support
B10453 - from another doctor in a different discipline, Doctor Moini at Mt
B10454 - Diablo, who provided Millie's radiation treatments on referral
B10455 - from Kaiser. ref SDS A1 YO6K
B10457 - ..
B10458 - [On 040419 surgeon relying on doctor in Oncology Department for
B10459 - notice on making examinations to double check assessment of
B10460 - patient progress. ref SDS A5 V17L
B10462 - ..
B10463 - [On 040419 Millie asks surgeon for 2nd opinion on left breast
B10464 - inflammation diagnosed as Cellulitis, ref SDS A5 789F; surgeon
B10465 - takes biopsy. ref SDS A5 1572; biopsy report on 040517 diagnoses
B10466 - inflammatory breast cancer, ref SDS A8 7D6F; on 040614 primary
B10467 - care physician changes patient cancer status from stage II to
B10468 - stage IV. ref SDS A9 6M9H
B10470 - ..
B10471 - [On 041005 Millie asks doctor about worsening symptoms of
B10472 - pulmonary embolism, ref SDS B0 RZ4I; doctor diagnoses lack of
B10473 - fitness, ref SDS B0 OG5L; Millie planning 2nd opinion to support
B10474 - the medical team. ref SDS B0 AW6M
B10476 - ..
B10477 - [On 041018 2nd opinion from UCSF recommends Kaiser investigate
B10478 - symptoms for pulmonary embolism, ref SDS B2 LX96; on 041103 Kaiser
B10479 - ordered emergency CT test for PE. ref SDS B4 NL4N; on 041104
B10480 - Kaiser diagnoses pulmonary embolism, ref SDS B4 N43I; prescribes
B10481 - treatment for life. ref SDS B4 4Y9G
B10483 - ..
B10484 - [On 041117 2nd opinion report from Doctor Benz meeting at UCSF on
B10485 - 041018 suggests follow on treatment with capecitabine and
B10486 - Taxotere. ref SDS B6 OU6S
B10488 - ..
B10489 - [On 041209 2nd opinion from Doctor Guardino at Stanford Cancer
B10490 - Center recommends treatment with Adriamycin and Cytoxin (AC).
B10491 - ref SDS B9 SN88
B10493 - ..
B10494 - [On 041230 Kaiser implements Stanford 2nd opinion prescribes
B10495 - treatment with Adriamycin and Cytoxin (AC). ref SDS C3 XQ41
B10497 - ..
B10498 - [On 050415 Kaiser switches treatment to Taxotere capecitabene
B10499 - (Xeloda), ref SDS C5 407N; per recommendation by Doctor Benz 2nd
B10500 - opinion at UCSF on 041117. ref SDS B6 OU6S
B10502 - ..
B10503 - [On 050923 2nd opinion reviewed by surgeon recommends initial test
B10504 - biopsies, ref SDS D0 SZ6M, to identify very wide mastectomy and
B10505 - breast replacement to reduce chances of cancer recurrence.
B10506 - ref SDS D0 7J67
B10508 - ..
B10509 - [On 051012 surgeon implements 2nd opinion for test biopsies to
B10510 - identify scope of mastectomy surgery. ref SDS D1 DG6J
B10512 - ..
B10513 - [On 051021 surgeon implements 2nd opinion for very wide mastectomy
B10514 - to reduce chances of recurrence. ref SDS D2 EG5L
B10516 - ..
B10517 - [On 060821 UCSF 2nd opinion recommends treatment for cancer
B10518 - clinical trial cetuximab and Carboplatin. ref SDS D9 W66J
B10520 - ..
B10521 - [On 070105 Kaiser implemented UCSF 2nd opinion and made referral
B10522 - for treatment in clinical trial cetuximab and Carboplatin.
B10523 - ref SDS E5 PK68
B10525 - ..
B10526 - [On 080911 second opinions implement doctor patient partnership
B10527 - essential to provide broad range of analysis for primary care
B10528 - physician whose diagnosis is bounded by recent experience, and
B10529 - limited trainning. ref SDS F2 4R4H
B10531 - ..
B10532 - [On 081018 Doctor Stritter has a patient advocacy practice
B10533 - described as "beyond the 2nd opinion," ref SDS F3 F49I; this fills
B10534 - an important requirement to help patients and doctors manage
B10535 - complex health care problems effectively. ref SDS F3 QK6H
B10536 -
B10537 -
B10538 -
B10539 -
B10540 -
B10541 -
B10542 -
B106 -
SUBJECTS
Medical, Knees,
Cartilage Pills to Repair
Therapies - 8 New Procedures
Examination
B406 -
B40701 - ..
B40702 - Knee Exam Shows Possible Problems that Require Corrective Work
B40703 -
B40704 - I related the occurrence of pain in both knees after running, as for
B40705 - example in tennis. Condition has existed since about 1993, but has
B40706 - worsened over the past year.
B40707 -
B40708 - During exercise, knees become painful after 20 minutes or so. It is
B40709 - difficult to stop and change direction.
B40711 - ..
B40712 - Taking several days off, relieves pain. We need a solution that
B40713 - permits a level of exercise that maintains health, e.g., weight and
B40714 - colesterol issues.
B40715 -
B40716 - [On 990706 Kaiser suggests cortisone for initial treatment of
B40717 - pain. ref SDS 58 0001]
B40719 - ..
B40720 - [On 990713 Kaiser suggest more exercise to reduce cholesterol....
B40721 - ref SDS 60 7469]
B40723 - ..
B40724 - Walking up stairs is difficult after exercise, for several hours to a
B40725 - day.
B40726 -
B40727 - [On 991011 treatment using Glucosamine was successful for a
B40728 - patient with more severe symptoms. ref SDS 80 0900]
B40730 - ..
B40731 - Sylvia examined the knees, and seemed to find evidence of arthritis in
B40732 - the left knee. ref SDS 0 5152
B40733 -
B40734 - [On 990816 Christy performed similar exam. ref SDS 68 8769]
B40735 -
B40736 - [On 990910 Craig did similar exam, to supplement xrays.
B40737 - ref SDS 70 4822]
B40739 - ..
B40740 - Sylvia will review her findings with orthopedic people.
B40741 -
B40742 - My letter, ref DIT 1 3360, submits the article on knee therapies,
B40743 - discussed below. ref SDS 0 5400
B40744 -
B40745 - [On 990628 left note for Sylvia to call on this. ref SDS 56 0526]
B40746 - ..
B40747 - Kaiser will notify about meeting for further consideration of
B40748 - corrective work.
B40750 - ..
B40751 - I asked Sylvia for a report of her findings, as discussed in Kaiser's
B40752 - guideline manual, the Healthwise Handbook.
B40753 -
B40754 - [On 990701 Sylvia called - she had submitted a report which had
B40755 - not yet been received - she reviewed preliminary comments by
B40756 - orthopedist. ref SDS 57 9662]
B40758 - ..
B40759 - [On 990701 Sylvia needs article on knee therapies to complete
B40760 - review. ref SDS 57 0855]
B40762 - ..
B40763 - [On 990706 received Sylvia's report, confirming comments on
B40764 - 990701. ref SDS 58 0001]
B40766 - ..
B40767 - [On 990706 Jeanne Bradley trying to get letter to Sylvia with
B40768 - attached article on knee therapies. ref SDS 58 2107]
B40770 - ..
B40771 - [On 990719 reviewed Synvisc knee treatment. ref SDS 63 9894]
B40773 - ..
B40774 - [On 990722 Syed completing research on knees. ref SDS 64 2646]
B40776 - ..
B40777 - [On 990731 followed up with Syed. ref SDS 65 0001]
B40778 -
B40779 -
B40781 - ..
B40782 - Surgery on Left Knee in 1972, 1988; New Problems Right Knee
B40783 -
B40784 - The left knee was damaged in 1972 from a fall of about 36' onto a
B40785 - concrete floor. Surgery removed cartilage at that time.
B40786 -
B40787 - Follow up surgery was performed on 881011. Findings and scope of work
B40788 - are reported at ref SDS 1 0001, with linkages to post op review.
B40790 - ..
B40791 - Now, 11 years later, occurrence of past problems with the left knee,
B40792 - and new problems with the right knee, cited above, ref SDS 0 4420,
B40793 - point to the need for further action.
B40794 -
B40795 - [On 990708 Jeanne advised that Sylvia is waiting for the medical
B40796 - history, to submit a complete package for review by orthopedist.
B40797 - ref SDS 59 6699]
B40799 - ..
B40800 - [On 990713 asked Syed to assist Sylvia, because computer problems
B40801 - have delayed submission. ref SDS 60 7332]
B40802 -
B40803 -
B40805 - ..
B40806 - New Therapies May Justify Knee Repair by Kaiser
B40807 -
B40808 - A recent article mentions 8 new therapies for knee problems, which may
B40809 - justify support by Kaiser to repair the knees in this case.
B40810 -
B40811 - Sylvia asked for a copy of article to include in her report. She said
B40812 - it can help the orthopedic expert make a complete review of treatment
B40813 - options, when she presents my case for considerration, per above.
B40814 - ref SDS 0 0882
B40815 -
B40816 - [On 990701 Sylvia will get article from Sue Juelis in my letter...
B40817 - ref DIT 1, per, ref SDS 57 0855]
B40819 - ..
B40820 - [On 990708 Jeanne submitted the article on knee therapies to
B40821 - Sylvia, and advised that Sylvia is waiting for the medical history,
B40822 - to submit a complete package to the orthopedist. ref SDS 59 6699]
B40823 - ..
B40824 - After the meeting, I told Millie while driving home from San
B40825 - Francisco this afternoon, that Sylvia wanted the article. Millie said
B40826 - she still has it.
B40828 - ..
B40829 - Article was published by USA Weekend; May 14 - 16, 1999, page 8...
B40830 -
B40831 -
B40832 - Bad knees never had it so good
B40833 -
B40834 -
B40835 - 8 new therapies are ready to help. ref OF 1 0001
B40836 - ..
B40837 - At the end of the article, there is a link to the web for more
B40838 - information on these emerging therapies. ref OF 1 5727
B40839 -
B40840 - http://www.nih.gov/niams/healthinfo/kneeprobs.htm
B40841 -
B40842 - My letter, ref DIT 1 3360, submits the article on knee therapies,
B40843 - discussed below. ref OF 1 0001
B40845 - ..
B40846 - [On 990706 reviewed web site and it seems to indicate cartilage
B40847 - replacement is not for arthritis problems. ref SDS 58 0001]
B40848 - ..
B40849 - One method injects hyaluronic acid (HA), into the knee that
B40850 - lubricates and cushions the knee to treat previous injury or wear and
B40851 - tear. ref OF 1 7921
B40852 -
B40853 - [On 990719 Synvisc seems to be this treatment. ref SDS 63 9894]
B40855 - ..
B40856 - Another method uses cartilage tissue removed from the patients knee;
B40857 - it is cultured for several weeks, then implanted. ref OF 1 4968
B40858 -
B40859 - [On 990910 medical history was not provided for knee examination.
B40860 - ref SDS 70 3038]
B40861 -
B40862 - [On 990925 Doctor's report does not review all of the new
B40863 - therapies. ref SDS 76 4955]
B40865 - ..
B40866 - [On 991011 Craig says he reviewed article. ref SDS 80 2304]
B40868 - ..
B40869 - [On 991125 sent information to Steve. ref SDS 85 7654]
B40870 -
B40872 - ..
B40874 - ..
B40875 - What does Kaiser recommend with respect to "pill" therapies for
B40876 - repairing damaged cartilage?
B40878 - ..
B40879 - I forgot to ask about...
B40880 -
B40881 - Osteokinetics
B40882 -
B40883 - ...pills, manufactured by Shaklee, discussed on 990324. ref SDS 42
B40884 - 3828
B40886 - ..
B40887 - I have not been able to find information on the web, that explains
B40888 - this product or a family of products.
B40889 - ..
B40890 - Is Kaiser using this method?
B40892 - ..
B40893 - How can we investigate the merits of pill therapies relative to the
B40894 - other methods discussed in the USA Weekend article. ref SDS 0 5400
B40896 - ..
B40897 - [On 990701 Kaiser does not recommend these pills. ref SDS 57 2015]
B40899 - ..
B40900 - [On 990910 Kaiser recommends Glucosamine pills. ref SDS 70 5628]
B40901 -
B40902 -
B40903 -
B410 -
SUBJECTS
Shoulder Right
Medication
B604 -
B60501 - ..
B60502 - Shoulder Rotator Cuff Impingement; Self-healing Continued
B60503 -
B60504 - Reviewed history of right shoulder over 6 - 12 months.
B60505 -
B60506 - Problem arose from overhead tennis serve, similar to throwing a
B60507 - football, baseball. May have occurred because of inadequate warm-up,
B60508 - since it seemed to come on fairly suddenly. Pain increased to the
B60509 - point of impairing sleep. Normal overhead serve was impossible.
B60511 - ..
B60512 - Friends have urged MRI exam.
B60514 - ..
B60515 - Others who have had similar problems required surgery, but some have
B60516 - solved the problem with chiropractic therapy - stretching.
B60517 - ..
B60518 - Over the past 3 - 4 weeks, there seems to have been a sudden and
B60519 - evident improvement in the shoulder.
B60521 - ..
B60522 - Now, after warming up serving a tennis ball, say 5 - 10 times, the
B60523 - normal serving motion can be used without pain for a two set match.
B60525 - ..
B60526 - I was able, for example, today, to touch both hands behind my back,
B60527 - which has not been possible for the past 6 months to a year.
B60529 - ..
B60530 - The left arm/shoulder/hand, still reaches farther up my back, than the
B60531 - right side, but there is definite improvement in being able to touch
B60532 - both hands together behind the back.
B60534 - ..
B60535 - Sylvia advised these conditions indicate rotator cuff problems, where
B60536 - fibers have torn, but not enough that can or need to be repaired by
B60537 - surgery, as in a more severe tear.
B60538 - ..
B60539 - Sylvia suggests home treatment rather than referral for MRI and
B60540 - examination by a specialist. Since mild tennis activity once or twice
B60541 - a week, seems to have brought improvement, this can be continued, with
B60542 - adequate warm up, and reduced activity if pain returns.
B60544 - ..
B60545 - Sylvia described the general problem as...
B60546 -
B60547 - Impingement Syndrome
B60548 -
B60549 - ...and submitted a booklet published by Kaiser's Physical Therapy
B60550 - Department. ref OF 3
B60552 - ..
B60553 - The brochure shows on page 3, ref OF 3 5782, exercises similar to
B60554 - the pendulum motion that Norm demonstrated on 990612, at the family
B60555 - reunion. ref SDS 51 7140
B60556 - ..
B60557 - Sylvia prescribed motrin to decrease inflammation, which is set
B60558 - out in part 1a of section 2. ref OF 3 2640
B60559 -
B60560 - The Admin rep submitted a prescription, 99176 010163, claim check
B60561 - #63. ref DRT 2
B60562 -
B60563 - She advised that the Kaiser Pharmacy, at the entrance of the
B60564 - medical center, can provide the medicine.
B60565 -
B60566 - "Motrin" is not mentioned in the prescription document, and there
B60567 - is nothing that shows alignment between Sylvia's explanation and
B60568 - what is to be provided, based on the document. ref DRT 2
B60570 - ..
B60571 - After meeting with Sylvia, I visited the pharmacy.
B60572 - ..
B60573 - The pharmacy rep advised that the prescription could not be
B60574 - provided for another 20 minutes or so. I explained the need to go
B60575 - into San Francisco. The rep suggested picking up the prescription,
B60576 - when I return to Concord in the afternoon, noting that the medication
B60577 - can be obtained from the pharmacy anytime before 990702. ref DRT 2
B60578 - 7254
B60579 -
B60580 - [On 990628 received medicine. ref SDS 56 4488]
B60581 -
B60582 -
B60583 -
B606 -
SUBJECTS
Prostrate Cancer Testing
Annual Physical
Primary Care Physician
Cholesterol
Medical Practice
Doctor's Don't Have Time to Write
Time Not Enough to Read and Write
Team Care
Patients Review Medical Chart
Not Enough Time Doctors Report Medical History
BK12 -
BK1301 - ..
BK1302 - Physical Exam Scheduled for 990628; New Primary Care Doctor
BK1303 - Cholesterol Test Due 990629; From Planning on 940722
BK1304 - Prostate Cancer Blood Test Today; Complete on 990628
BK1305 -
BK1306 - Follow up ref SDS 12 0989.
BK1307 -
BK1308 - I asked about getting a physical exam and prostate cancer test.
BK1309 -
BK1310 - [On 990628 physical exam performed. ref SDS 56 7855]
BK1312 - ..
BK1313 - The registration document shows a "cholesterol screen" is due on
BK1314 - 990629. ref DRT 1 1419
BK1315 -
BK1316 - [On 990628 Syed to have cholesterol tested. ref SDS 56 3105]
BK1318 - ..
BK1319 - Sylvia did not mention this work. It may be part of the physical
BK1320 - examination scheduled for 990628.
BK1322 - ..
BK1323 - Sylvia asked my age, 55, and background of other tests.
BK1324 -
BK1326 - ..
BK1327 - Background on Physical Exam and Prostate Cancer Test in 1994
BK1328 -
BK1329 - On 940722 Dr. George Matula reported cholesterol should be
BK1330 - re-checked within 3 months. ref SDS 14 0855 Kaiser failed to
BK1331 - perform the work, and lost the records on 940825. ref SDS 17 0001
BK1332 -
BK1333 - [On 990628 Syed to have cholesterol tested. ref SDS 53 3105]
BK1335 - ..
BK1336 - [On 990713 cholesterol high, needs remedy. ref SDS 60 7469]
BK1338 - ..
BK1339 - Prostate cancer blood test was performed on 940629. Results were
BK1340 - requested on 940629, ref SDS 13 0001, and on 940724. ref SDS 15 0001
BK1341 - On 940825 Kaiser lost the records, and did not submit results of
BK1342 - tests. ref SDS 17 0001
BK1343 -
BK1345 - ..
BK1346 - Sylvia explained that prostrate cancer tests now include both a blood
BK1347 - test, and a rectal examination which can be part of the physical
BK1348 - examination.
BK1350 - ..
BK1351 - Sylvia indicated the blood test should not be done the same day as the
BK1352 - rectal exam.
BK1353 -
BK1354 - [On 990628 prostate tests were performed. ref SDS 56 1584]
BK1356 - ..
BK1357 - Sylvia suggested having the blood test done today, after we complete
BK1358 - this meeting. She indicated the work is performed a short distance
BK1359 - from the exam room, where we were meeting, and it would likely require
BK1360 - only a few minutes wait, since there are not usually a lot of people
BK1361 - having this test done.
BK1363 - ..
BK1364 - I agreed to this. After Sylvia got Syed assigned as the primary
BK1365 - doctor, ref SDS 0 6840, the prostate cancer blood test was overlooked
BK1366 - in the rush to get other things done.
BK1367 -
BK1369 - ..
BK1370 - Primary Care Doctor Changed to Park Shadelands
BK1371 -
BK1372 - Sylvia explained that for me to have a physical exam at Kaiser's Park
BK1373 - Shadelands facility, requires changing the primary care physician,
BK1374 - since at this time, the doctor of record is in San Francisco, because
BK1375 - that is where I last saw a doctor in 1994 for a physical exam and
BK1376 - prostrate cancer test. ref SDS 12 0001
BK1378 - ..
BK1379 - Personal health care physician is explained in Chapter 1 of the
BK1380 - Healthwise Handbook on page 4. ref OF 6 1160
BK1382 - ..
BK1383 - I agreed to change the physician of record, since communication failed
BK1384 - with the prior assignment, as reported on 940825. ref SDS 17 0001
BK1385 -
BK1387 - ..
BK1388 - Internet Facilitates Communication with Doctors
BK1389 - Communication with Patient Helps Primary Care Doctor
BK1390 -
BK1391 - Sylvia noted that Kaiser is making greater use of computers to help
BK1392 - patients and doctors communicate, and to improve service to patients
BK1393 - at all Kaiser facilities.
BK1394 -
BK1395 - Sylvia suggested selecting a doctor who emphasizes communication with
BK1396 - the patient.
BK1398 - ..
BK1399 - Sylvia advised that her husband, Tom, is a primary care doctor at Park
BK1400 - Shadelands. He communicates with patients, by email. Sylvia used
BK1401 - Tom's office for my examination, because he is not working at Park
BK1402 - Shadelands today.
BK1404 - ..
BK1405 - There is a notice on the wall of Tom's office for patients to provide
BK1406 - an email address.
BK1408 - ..
BK1409 - This reflects the emerging trend reported in an article on page 16
BK1410 - of...
BK1411 -
BK1412 - Bottom Line - Tomorrow
BK1413 -
BK1414 -
BK1415 - ...volume 7 dated July 1999, under the title...
BK1416 -
BK1418 - ..
BK1419 - Internet - Send Email to your doctor
BK1420 -
BK1422 - ..
BK1423 - Many doctors are willing to communicate with patients through
BK1424 - email... Ask your doctor if he/she uses email or would be
BK1425 - willing to try.
BK1426 -
BK1428 - ..
BK1429 - I wrote my email address on the marking board, and gave Sylvia a
BK1430 - business card with the address...
BK1431 -
BK1432 -
BK1433 - rowelch@ibm.net
BK1434 -
BK1436 - ..
BK1437 - Sylvia advised that she does not use email to communicate with
BK1438 - patients.
BK1439 -
BK1440 - [On 990628 Sue Juelis is trying to send ref DIT 1 via email to
BK1441 - Sylvia through her husband, Tom. ref SDS 56 0034]
BK1442 -
BK1443 - [On 990802 Doctor Syed Naqvi prefers conventional mail.
BK1444 - ref SDS 66 4293
BK1446 - ..
BK1447 - [On 990910 Doctor Craig Boulris prefers conventional mail.
BK1448 - ref SDS 70 2040]
BK1450 - ..
BK1451 - [On 990928 Doctor Boulris began responding to Welch web mail.
BK1452 - ref SDS 77 0001]
BK1454 - ..
BK1455 - Communication Metrics improves email by connecting analysis and
BK1456 - original sources, like the doctor's patient chart, Kaiser's
BK1457 - appointment record, ref DRT 1 0001, and the prescription for the
BK1458 - motrin Sylvia suggests for the shoulder condition. ref DRT 2 0001
BK1460 - ..
BK1461 - Linking communication maintains alignment between action, planning and
BK1462 - requirements, which otherwise fails due to the large amount of
BK1463 - information that overwhelms management systems and people. The U.S.
BK1464 - Air Force report reviewed on 970707 showed that proactive alignment is
BK1465 - needed to prevent information systems from degrading into entropy.
BK1466 - ref SDS 31 0611
BK1467 -
BK1468 - [On 990912 conventional medical practice causes costly mistakes in
BK1469 - patient care. ref SDS 71 0001]
BK1471 - ..
BK1472 - Linking analysis to original source material supports discovery by
BK1473 - patient and doctor of implied and express actions that are needed,
BK1474 - which are otherwise overlooked, and cause rework and problems, as
BK1475 - reported by the U.S. Army Corps of Engineers on 971007. ref DRP 5 4172
BK1477 - ..
BK1478 - The cholesterol test scheduled for 990629, but required in Sep
BK1479 - 1994, is an example of communications that are not properly
BK1480 - aligned. ref SDS 0 4906
BK1482 - ..
BK1483 - Another example is the blood test for prostate cancer which
BK1484 - Sylvia wanted to have done today, but was overlooked due to the
BK1485 - complexity of the meeting. ref SDS 0 5460
BK1486 -
BK1488 - ..
BK1489 - Sylvia advised that Kaiser enters information in the computer, so that
BK1490 - patients can be seen by different doctors at different locations.
BK1492 - ..
BK1493 - This is another a big step in improving medical care at less cost.
BK1495 - ..
BK1496 - She said that medical charts have the most important information for
BK1497 - treating patients, however, this information is not entered in the
BK1498 - computer. Sylvia also noted that medical charts do not have enough
BK1499 - space for the doctor to enter diagnosis and recommendations to the
BK1500 - patient, so there is no context to quide another doctor in applying
BK1501 - the record.
BK1502 -
BK1503 - [On 991028 Robert Pearl, CEO of Kaiser cited Kaiser's computers
BK1504 - make information available. ref SDS 82 1118]
BK1506 - ..
BK1507 - [On 991206 Tom Driscoll confirmed the medical chart is not yet
BK1508 - online. ref SDS 87 0330]
BK1509 -
BK1510 -
BK1511 -
BK1512 -
BK16 -
SUBJECTS
Doctors Do Not Have Time to Follow Kaiser Guidelines for Medical Pra
Doctors Not Enough Time Follow Kaiser Guidelines for Medical Practic
Authentic Conversation Alignment Verify Truth Overkill Writing Every
BM05 -
BM0601 - ..
BM0602 - 15 Minutes Allocated for Patient Visits with Doctors
BM0603 - Medical Chart Main Patient Care Record of Treatment History
BM0604 - Not Enough Time to Follow Kaiser Guidelines on Medical Practice
BM0605 - Medical History Procedures Take too Much Time Away from Treatment
BM0606 -
BM0607 - Sylvia noted Kaiser's guidelines in the Healthwise Handbook that say
BM0608 - good medicine requires good communication on patient history of
BM0609 - symptoms, testing, diagnosis, prescriptions, and analysis of treatment
BM0610 - results. She feels that guidelines for patients to, write notes and
BM0611 - provide feedback refines accuracy of patient history in the Medical
BM0612 - Chart, and this helps the doctor be prepared for effective meetings by
BM0613 - writing a list of 3 or 4 primary subjects to discuss, as reviewed
BM0614 - above. ref SDS 0 5740
BM0616 - ..
BM0617 - Sylvia explained current case loads do not give enough time to write
BM0618 - up the record in the medical chart and review medical history in order
BM0619 - to discover overlooked issues, as called out in Kaiser's guidelines.
BM0620 - ref SDS 0 0889 She indicated Doctors are scheduled to see patients
BM0621 - every 10 to 15 minutes (see above, ref SDS 0 5740) Some examinations
BM0622 - take longer, so people wind up waiting sometimes for long periods to
BM0623 - see a doctor. This leaves little time for written analysis by the
BM0624 - doctor, so the practice is for doctors to jots down a few cursory
BM0625 - words that seem symbolic of first impressions observed at the time.
BM0627 - ..
BM0628 - On the other hand, Doctor Zipperstein reported on 940728 that
BM0629 - communication metrics using feedback helped him save time. ref SDS 16
BM0630 - 0001
BM0631 -
BM0632 - [...see above where Healthwise Handbook calls for primary care
BM0633 - provider to receive suggestions on improving practices called out
BM0634 - in the Handbook. ref SDS 0 0899
BM0636 - ..
BM0637 - [On 000207 doctors are pressed for time because meetings with
BM0638 - patients are scheduled every 15 minutes, so there is not enough
BM0639 - time to verify accuracy of communication, nor to write clear,
BM0640 - concise, complete records for the medical chart, including
BM0641 - prescriptions. ref SDS 91 0788
BM0643 - ..
BM0644 - [On 020402 primary care physician at Kaiser's Oncology Clinic uses
BM0645 - email to collaborate with professional staff, and conversation for
BM0646 - accurate communication with patients. ref SDS 96 V168
BM0648 - ..
BM0649 - [On 040614 the doctor confirmed practice to avoid email
BM0650 - communications from patient, and advised patients to call the
BM0651 - advise nurse on treatment matters. ref SDS A9 O53O
BM0653 - ..
BM0654 - [On 041014 doctor notes on patient visits are sparse and
BM0655 - illegible; there is not enough time for clear, concise, complete
BM0656 - medical history on critical details. ref SDS B1 W78K
BM0658 - ..
BM0659 - [On 041202 Doctor Parsley used email for timely, accurate
BM0660 - coordination between patient, primary care physician and surgeon
BM0661 - on follow up for emergency treatment that found biopsy wound that
BM0662 - failed to heal over 8 months. ref SDS A6 426W
BM0664 - ..
BM0665 - [On 041212 Andy Grove, CEO Intel, and survivor of cancer
BM0666 - recommends patients be their own project manager for effective
BM0667 - care through the doctor patient partnership. ref SDS C1 F25K
BM0669 - ..
BM0670 - [On 050824 Advice Nurse being persistant reminding the surgeon to
BM0671 - implement requirements in Kaiser's Healthwise Handbook following
BM0672 - up patient calls to collaborate and coordinate via email on
BM0673 - accuracy of communication and patient medical history. ref SDS C7
BM0674 - 4M7N
BM0676 - ..
BM0677 - [On 070307 Coagulation Control Clinic case manager advises that a
BM0678 - hectic schedule prevents saving lives, time, and money by working
BM0679 - quickly with email to provide feedback for accurate communications
BM0680 - called out by Kaiser's guidelines. ref SDS E7 P38G
BM0682 - ..
BM0683 - Sylvia's comements today align with the report on 951026 that managers
BM0684 - do not have time to perform ISO requirements for traceability to
BM0685 - original sources. ref SDS 22 3245
BM0687 - ..
BM0688 - [On 041019 Stanford checked record to verify accurate
BM0689 - understanding of patient medical history. ref SDS B3 BV92
BM0691 - ..
BM0692 - Psychology and psychiatry rely on analysis of communication with
BM0693 - patients, because communication is a diagnosis and treatment method,
BM0694 - for example, "narrative therapy," cited by Doctor Busman on 951117.
BM0695 - ref SDS 23 9624 But medical practice has difficulty using this method
BM0696 - for the reason given by Dr Popejoy on 961222, ref SDS 29 0866, and
BM0697 - reviewed above. ref SDS 0 2392 Doctors pressed for time, prefer to
BM0698 - rely on first impressions from what they see at the moment, rather
BM0699 - than understand new information in relation to case history for the
BM0700 - patient. This is reinforced when history is not available because
BM0701 - nobody has time to write things down.
BM0702 -
BM0703 - [On 020708 the radiologist made a similar point. ref SDS A0 EY9N
BM0705 - ..
BM0706 - [On 020204 Enron collapsed into bankruptcy because of failure to
BM0707 - implement requirements for an audit trail showing compliance with
BM0708 - requirements. ref SDS 93 EX5O
BM0710 - ..
BM0711 - [On 020504 FAR require documentation showing alignment of daily
BM0712 - communication with objectives, requirements, and commitments,
BM0713 - ref SDS 97 XV7L; governement generally is unable to perform these
BM0714 - requirements. ref SDS 97 NS6F
BM0716 - ..
BM0717 - [On 030710 the doctor did not have time to analyse test results
BM0718 - for planning treatment and prepare for meeting the patient.
BM0719 - ref SDS A2 7C6W
BM0721 - ..
BM0722 - [On 030826 space Shuttle Columbia exploded due to continual
BM0723 - bumbling sustained by culture of denial at NASA. ref SDS A3 8K4G
BM0725 - ..
BM0726 - An example occurred on 971103 when blood thinner was prescribed to a
BM0727 - patient who was bleeding excessively, because the condition looked
BM0728 - like a blood clot problem. ref SDS 35 0001
BM0729 -
BM0730 - [On 990910 medical history was not available for review by the
BM0731 - doctor. ref SDS 70 3038]
BM0733 - ..
BM0734 - [On 991206 reviewed issue with Tom Driscoll. ref SDS 87 0330]
BM0736 - ..
BM0737 - An article in Fortune reviewed today while waiting to visit Doctor
BM0738 - Connolly, showed that "attitude", also "psyche" prevent CEOs from
BM0739 - following good practice. ref SDS 54 4914 This may be a factor with
BM0740 - doctors as well.
BM0741 -
BM0742 - [On 990628 Sue Jeulis, Admin Assistant to Physician in Chief,
BM0743 - reported that doctors do not have time to review information on
BM0744 - patient medical history. ref SDS 56 2262]
BM0746 - ..
BM0747 - [On 990802 Doctor Naqvi preferred the voice message system.
BM0748 - ref SDS 66 9360]
BM0750 - ..
BM0751 - [On 990910 Doctor Boulris preferred not to review medical history.
BM0752 - ref SDS 70 9130]
BM0754 - ..
BM0755 - [On 990912 limited time causes medical mistakes, ref SDS 71 0001,
BM0756 - attitude of denial hampers improvement. ref SDS 71 3416]
BM0758 - ..
BM0759 - [On 990924 letter, ref DIP 3 1445, explains downsizing forces
BM0760 - doctors to handle increased patient load. ref SDS 75 8055]
BM0762 - ..
BM0763 - [On 991028 Robert Pearl, CEO of Kaiser says doctors have freedom
BM0764 - to practice medicine the way it should be practiced, ref SDS 82
BM0765 - 2555, which limits time to work on improving practice.]
BM0767 - ..
BM0768 - [On 991101 doctors do not have time to review Team Care procedures
BM0769 - supporting doctor/patient partnership. ref SDS 83 0966]
BM0771 - ..
BM0772 - On 970910 executives reported not having enough time to "think," which
BM0773 - hampers communication, management and earnings. ref SDS 33 3479
BM0775 - ..
BM0776 - On 981027 the U.S. Army Corps of Engineers reported costs escalated
BM0777 - from $42M to $72M because there wasn't enough time for good management
BM0778 - practice. ref SDS 39 9152 On 990527 engineers do not have time to
BM0779 - read and write. ref SDS 45 8922
BM0781 - ..
BM0782 - Sylvia noted today that doctors are effective because they communicate
BM0783 - well with patients in conversation, and are skilled, experienced, and
BM0784 - conscientious physicians, without using a computer.
BM0785 -
BM0786 - [On 040517 case study shows challenge to provide good medicine
BM0787 - without reliance on accurate medical history. ref SDS A8 VM6K
BM0789 - ..
BM0790 - [On 041014 medical chart reviewed for 2nd opinion shows patient
BM0791 - history illegible, ref SDS B1 PF7I, errors and ommissions.
BM0792 - ref SDS B1 T49J
BM0794 - ..
BM0795 - A doctor's skill, dedication and the evident organization of a
BM0796 - hospital convey confidence to patients that encourages reliance on the
BM0797 - accuracy of communication, including representations that diagnosis
BM0798 - and treatment plans are supported by connections to patient history.
BM0799 - This heightens requirement for doctors to be proactive in preparing
BM0800 - adequate records, as called out in Kaiser's guidelines, because
BM0801 - communication is the predicate to action. If the record is incorrect
BM0802 - and incomplete, then the work may not meet objectives.
BM0804 - ..
BM0805 - Mechanics are similarly positioned. They work by conversation in
BM0806 - order to expedite, hoping to save time and money for the customer.
BM0807 - This causes a lot of extra work to fix mistakes, because there is more
BM0808 - to communication than good speaking skills, and being a well trained,
BM0809 - hard worker in a big organization. An example occurred on 990603.
BM0810 - ref SDS 50 3050
BM0812 - ..
BM0813 - Kaiser's Healthwise Handbook makes this point. ref SDS 0 4185
BM0815 - ..
BM0816 - An example is the telecon with S&C Ford in San Francisco on 990603.
BM0817 - ref SDS 49 0001
BM0819 - ..
BM0820 - Another example is meeting with Dr. Steve Olsen and his staff on
BM0821 - 961210. ref SDS 28 2378
BM0823 - ..
BM0824 - Another example is a meeting at Intel on 970728. ref SDS 32 2530
BM0826 - ..
BM0827 - More examples are in the record on 950327. ref SDS 19 0200
BM0829 - ..
BM0830 - Doctors, mechanics, engineers and managers, who use computers, make
BM0831 - the same mistakes that people make, who do not use computers, because
BM0832 - people who communicate need help connecting complex information over
BM0833 - time that shows cause and effect. This "intelligence" dimension of
BM0834 - communication, ref OF 7 0582, occurs entirely in the human mind, and
BM0835 - so is overlooked as a critical factor. Doctors and patients must work
BM0836 - together to make this an effective ingredient of patient care, as
BM0837 - recommended by Kaiser's guidelines.
BM0839 - ..
BM0840 - Generally speaking, computers have a lot of "data" and "information,"
BM0841 - but no "intelligence." Kaiser's manual recognizes the value of
BM0842 - medical "records, ref SDS 0 4752, that show the sequence of events
BM0843 - over time. This reflects the fact that the human mind primarily
BM0844 - "reasons" by experience rather than logic, see the record reviewed on
BM0845 - 900303. ref SDS 2 3016 Therefore, automated integration of time and
BM0846 - information that connects human experience should make computers more
BM0847 - valuable to people in their everyday lives.
BM0849 - ..
BM0850 - Sylvia points out, today, that nobody has time to develop good
BM0851 - records, despite Kaiser's guidelines that require good records.
BM0853 - ..
BM0854 - Communication Metrics implemented with SDS makes it fast and easy to
BM0855 - create good records and connect it up into useful "intelligence."
BM0856 - ref OF 7 0582 In a fundamental way, SDS improves the value of the
BM0857 - alphabet by helping people add "intelligence" to information.
BM0859 - ..
BM0860 - Communication Metrics can be reviewed on the web at...
BM0861 -
BM0862 - http://www.welchco.com
BM0863 -
BM0864 -
BM0866 - ..
BM0867 - Team Care Relies on Patient's Medical History
BM0868 - Kaiser's Team Care Relies on Patient's Medical History
BM0869 - Primary Care Doctor Changed to Syed E. Naqvi
BM0870 -
BM0871 - Sylvia advised that Kaiser uses a Team Care model of medical
BM0872 - management. A primary care physician manages medical specialists
BM0873 - required to diagnose, plan and provide treatment. Patients select
BM0874 - their primary care doctor from a list of "Open Panels"...
BM0876 - ..
BM0877 - Adult Primary Care
BM0878 - Diablo Service Area
BM0879 - Open/Closed Panels
BM0881 - ..
BM0882 - It is unclear if this is the Health Care Directory identified in
BM0883 - Chapter 1 of the Healthwise Handbook on page 4. ref OF 6 2106
BM0884 -
BM0885 - [On 061218 Kaiser Tumor Board provides quality control for cancer
BM0886 - patient care, and draws on the Team Care resources to leverage
BM0887 - knowledge solving complex cases. ref SDS E3 FW9K
BM0889 - ..
BM0890 - The form has separate lists for...
BM0891 -
BM0892 - Antioch
BM0893 - Martinez
BM0894 - Pleasanton
BM0895 - Shadelands
BM0896 - Walnut Creek
BM0898 - ..
BM0899 - Another Kaiser publication...
BM0900 -
BM0901 - The Team that cares for you
BM0902 -
BM0903 - ...says...
BM0904 -
BM0905 - Your primary care team is composed of health care professionals
BM0906 - with expertise in family practice, internal medicine, general
BM0907 - medicine, and urgent care.
BM0909 - ..
BM0910 - Sylvia is an "urgent care" doctor, and so cannot be selected as a
BM0911 - Primary Care" doctor.
BM0912 -
BM0913 - The Healthwise Handbook describes a "Personal Care Provider." Not
BM0914 - clear, if this is the same as a Primary... ref OF 6 1160
BM0915 -
BM0917 - ..
BM0918 - Kaiser's Team Care brochure sets a goal to...
BM0919 -
BM0920 - Link [patients] with health care professionals who know [the
BM0921 - patient's]... medical history.
BM0923 - ..
BM0924 - In order to "know" patient medical history, requires communication and
BM0925 - capturing the record, as called for by Kaiser's guidelines.
BM0926 - ref SDS 0 5740
BM0927 -
BM0928 - [On 061218 Kaiser Tumor Board provides quality control for
BM0929 - cancer patient care, and draws on the Team Care resources
BM0930 - to leverage knowledge solving complex cases. ref SDS E3
BM0931 - FW9K
BM0933 - ..
BM0934 - Team Care requires management by the primary care physician to lead
BM0935 - the team. Leadership invests time for research, reviewing patient
BM0936 - history, planning and preparation. Team Care further requires that
BM0937 - the primary care physician has authority to make assignments and
BM0938 - follow up to ensure the work gets done, which requires a lot of
BM0939 - communication.
BM0940 -
BM0941 - [...below, industry standards, and regulations for good
BM0942 - management are generally ignored and not enforced. ref SDS 53
BM0943 - GO9O
BM0945 - ..
BM0946 - [On 990910 medical history not provided to Doctor Boulris,
BM0947 - ref SDS 70 3038, and discussed. ref SDS 70 9130]
BM0949 - ..
BM0950 - [On 990913 requested Patient Assistance to investigate why
BM0951 - policy was not followed. ref SDS 72 8058]
BM0953 - ..
BM0954 - [On 990928 Patient Assistance investigating why medical history
BM0955 - was not delivered to Doctor Boulris. ref SDS 77 3955]
BM0957 - ..
BM0958 - [On 991006 Doctor failed to provide medical history because of a
BM0959 - preference not to use Internet links. ref SDS 78 0002]
BM0961 - ..
BM0962 - Page three of the Team Care brochure says...
BM0963 -
BM0964 - {Kaiser invites}... you to be an active participant in your
BM0965 - health care...,
BM0966 -
BM0967 - This supports the Healthwise Handbook guidence for an effective
BM0968 - doctor/patient partnership, discussed above. ref SDS 0 4185
BM0970 - ..
BM0971 - [On 991028 Robert Pearl, CEO of Kaiser, submits letter citing
BM0972 - Kaiser's goals for quality team care. ref SDS 82 0800]
BM0974 - ..
BM0975 - I initially suggested selecting Tom, because he supports working with
BM0976 - email, per above, ref SDS 0 2541 but, Sylvia said his patient list is
BM0977 - full.
BM0979 - ..
BM0980 - Based on this criteria, Sylvia suggested...
BM0981 -
BM0982 - Syed E. Naqvi, MD
BM0983 -
BM0984 - ... can provide effective communication as a primary care doctor.
BM0986 - ..
BM0987 - [On 990628 began work with Syed. ref SDS 56 0977 and reviewed
BM0988 - communication issues. ref SDS 56 2223]
BM0990 - ..
BM0991 - [On 990802 Syed objected to web mail to improve communiation,
BM0992 - and requested email, and phone messages, which don't work very
BM0993 - well. ref SDS 66 9108]
BM0995 - ..
BM0996 - [On 990813 Syed objected to web mail that requested support of
BM0997 - communication for a meeting on 990910. ref SDS 67 1254]
BM0999 - ..
BM1000 - [On 990910 Kaiser's communication failed, causing lost time and
BM1001 - extra expense. ref SDS 70 3038]
BM1003 - ..
BM1004 - [On 990924 Syed objected to web mail again, indicating failure
BM1005 - to review the record. ref SDS 74 0001]
BM1007 - ..
BM1008 - Syed is shown in the brochure for Park Shadelands -- Team C.
BM1009 -
BM1010 - Medical School: University of Karachi, Pakistan
BM1011 -
BM1012 - Residency/Training: University of Southern California
BM1013 - Medical Center, Los Angles
BM1015 - ..
BM1016 - Board Certified: Internal Medicine
BM1018 - ..
BM1019 - After the examination, we went to the administration work station
BM1020 - outside the examination room. Sylvia spoke with the administrator
BM1021 - about changing the primary care physician. The Administrator entered
BM1022 - Syed Naqvi in the computer as the new primary care physician.
BM1024 - ..
BM1025 - A meeting was schedule with Syed for the physical exam on 990628 1200.
BM1027 - ..
BM1028 - Sylvia left the administration work station, and I forgot about the
BM1029 - action item we set to do the prostate cancer blood test today, so this
BM1030 - was not performed.
BM1031 -
BM1032 - [On 990628 met with Syed. ref SDS 56 0001]
BM1033 -
BM1034 -
BM1035 -
BM1036 -
BM1037 -
BM1038 -
BM11 -
Distribution. . . . See "CONTACTS"