CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Mr. Mark Mangrai; 925 906 2209
020103 - mark.Mangrai@tao.ncal.kp.org
020104 - Patient Assistance

SUBJECTS
Patient Assistant Questions, Suggestions
Medical History, Xrays Not Submitted for Meeting
Medical Chart Missing Information Syed Doesn't Like Email
Click Links Objectionable, Takes Time
Call Centers Error Pronem, Awkward
Policy Procedures on Communication
Attitude Prevents Constructive Change
Atititude Makes Resistance to Communication Metrics Emotional
Primary Care Physician

1511 -    ..
1512 - Summary/Objective
1513 -
151301 - Follow up ref SDS 79 3955, ref SDS 78 3966.
151302 -
151303 -
151304 -  ..
151305 - Team Care Required to Link Doctors with Patient Medical History
151306 - Medical History Not Delivered Because Doctor Will Not Open Web Links
151307 -
151308 - Received ref DRT 1 0001 from Mark saying in pertinant part that...
151309 -
151310 -     Dr. Naqvi will not open links... so he didn't ... submit xrays and
151311 -     medical history to Doctor Boulris.
151312 -
151313 - This responds to my letters...
151314 -
151315 -      ref DIP 16 1870, submitted on 990927. ref SDS 78 2318
151316 -      ref DIP 14 2255, submitted on 990921. ref SDS 73 0477
151317 -      ref DIP 10 5925, submitted on 990913. ref SDS 69 3816
151318 -
151319 - There is no indication in Mark's letter, nor in the record, that Syed
151320 - has tried opening a letter on the web and encountered difficulties
151321 - that warrant using different methods.
151322 -
151323 -     [On 991008 Mark Mangrai, Patient Assistance is trying to set up a
151324 -     meeting. ref SDS 82 0001]
151325 -
151326 -     [On 991019 Mark says Doctors not responding to Patient Assistance.
151327 -     ref SDS 83 0001]
151328 -
151329 -     [On 991101 Mark reports Doctors not responding to instruction from
151330 -     Dr Ross Armstrong, Chief of Internal Medicine. ref SDS 84 0966]
151331 -
151332 -     [On 991109 Mark says meeting will be set. ref SDS 85 0001]
151333 - ..
151334 - Requirements to submit medical history, including xrays, to a
151335 - surgeon for meeting with a patient, are independent of requests by the
151336 - patient....
151337 -
151338 -     1.  Kaiser's Healthwise Handbook sets guidelines for effective
151339 -         communication, reviewed on 990625. ref SDS 41 4752
151340 -
151341 -     2.  Kaiser's "Team Care" policy requires affirmative efforts by
151342 -         the medical team to communicate effectively, as reported on
151343 -         990625. ref SDS 41 2784
151344 -
151345 -     3.  Team Care requires that the medical team link patients with
151346 -         health care professionals who know the patient's medical
151347 -         history. ref SDS 41 6970
151348 -
151349 -         This necessarily requires providing history and xrays to
151350 -         consulting physicians.  This requirement does not depend on
151351 -         patients sending reminders or requests.
151352 -
151353 - In this case, the patient provided on three occassions a fast, simple,
151354 - direct means using the Internet to link the consulting physician with
151355 - relevant medical history.  A preference to use different methods of
151356 - linking, does not excuse performance of the Team Care policy to
151357 - provide medical history to members of the team who are treating the
151358 - patient. ref SDS 41 6970
151359 -
151360 - Kaiser's distribution of xrays and medical history is outside the
151361 - patient's communication channel.  Good medical practice and Team Care
151362 - policy require distribution to attending physicians, independent of
151363 - communication with the patient.
151364 -
151365 - On 990813 the xray technician said Kaiser would send xrays and a
151366 - report to the orthopedic physican for the examination on 990910.
151367 - ref SDS 59 5518  Was Kaiser staff told not to submit xrays, because
151368 - the patient sent reminders to perform this requirement using
151369 - correspondence on the Internet, called "web mail" rather than email?
151370 - ..
151371 - One inference is that someone read the letters from the patient
151372 - and then ordered that Kaiser's policy to provide medical history to
151373 - other team members not be carried out, because of an emotional
151374 - reaction to having been notified by web mail.
151375 -
151376 - If that occurred, it presents an "attitude" problem of significantly
151377 - greater weight because affirmative obstruction is more damaging than
151378 - ordinary mistake or oversight.  It may reflect and overburdened
151379 - schedule that causes out-of-character reactions due to fatigue, as
151380 - reported in the articles on the High Cost of Medical Mistakes, in the
151381 - record on 990912. ref SDS 67 0285
151382 -
151383 - On 991001 "attitude" problems reviewed on $125M loss from space craft
151384 - crashing on Mars. ref SDS 81 3685
151385 -
151386 -
151387 -
151388 -  ..
151389 - Assigning New Primary Care Doctor - Doctor Naqvi will Not Read Email
151390 -
151391 - Mark says...
151392 -
151393 -     When I asked Dr. Naqvi if he felt you should deal with another
151394 -     doctor, he didn't say yes.  He said he just prefers to communicate
151395 -     through traditional channels (advice nurses) and will even read
151396 -     email.  I am still trying to find out if there are doctors here
151397 -     who are comfortable with your style of communications.  As soon as
151398 -     I learn of one, I'll be sure to email you. ref DRT 1 4592
151399 -
151400 - ..
151401 - Submitted ref DIT 1 0001 asking for a meeting with Kaiser
151402 - management on Team Care and communication procedures to avoid future
151403 - mistakes.
151404 -
151405 - We can discuss switching doctors to avoid undue pressure that leads to
151406 - personality issues, cited on 990927, ref SDS 78 3776, and based on
151407 - Kaiser guidelines. ref OF 2 7811
151408 -
151409 -     [On 991008 Mark Mangrai, Patient Assistance is trying to set up a
151410 -     meeting. ref SDS 82 0001]
151411 -
151412 -     [On 000121 Jeanne Bradley explains process to get new Primary Care
151413 -     Physician. ref SDS 86 0783]
151414 -
151415 - Linked to report on 990912 that medical mistakes are caused by
151416 - fatigue, ref SDS 67 0285, and denial. ref SDS 67 3416
151417 - ..
151418 - Raised idea of Patient Advocate using SDS to support medical
151419 - management, ref DIT 1 1581, developed on 990625, ref SDS 41 0899, and
151420 - cited in the letter on medical mistakes submitted 990624. ref SDS 75
151421 - 2775
151422 -
151423 -     [On 991008 Mark Mangrai indicates that Patient Assistance provides
151424 -     this support. ref SDS 82 2688]
151425 -
151426 -
151427 -
151428 -
151429 -