CONTACTS 
0201 - Massachusetts General Hospital                                                                                                                                     O-00000741 0501
020101 - Mr. Michael J. Barry, MD; 617 726 2674                                                                                                                           O-00000741 0501
020103 - Department of Medicine                                                                                                                                           O-00000741 0501
020104 - General Internal Medicine                                                                                                                                        O-00000741 0501
0202 - University of Washington                                                                                                                                           O-00000740 0401
020201 - Mr. Clarence H. Braddock III, MD, MPH                                                                                                                            O-00000740 0401
020202 - Assistant Professor
020204 - College of Medicine                                                                                                                                              O-00000740 0401
020205 - Medicine, Adj Med History and Ethics                                                                                                                             O-00000740 0401

SUBJECTS
Medical Practice Requires Records
Privacy, Security - Discovery
Risk Communication Main Factor of Management Success
Rework Cycle Due to Miscommunication
Risk Management Communication Main Task of Managers, Largest Risk
Telephone Game Shows Meaning Drift, Need to Maintain Shared
70% of Day Wasted in Meetings, Only 10% of Information Can be Used
90% Managers Time Communication
Oral Communication Error Prone
90% Doctor Communication Omits Important Information, 991221

1512 -
1512 -    ..
1513 - Summary/Objective
1514 -
151401 - Follow up ref SDS 7 0000, ref SDS 6 0000.
151402 -
151403 - ABC News reported a study showing patients are not adequately informed
151404 - by doctors in nine out of 10 decisions. ref OF 7 0001  Key information
151405 - was missing from discussions 91% of the time. ref OF 7 6120
151406 -
151407 -     On 990924 communication is the biggest risk in medical practice.
151408 -     ref DIP 2 0001
151410 -      ..
151411 -     This supports the study on 960205 that managers waste 70% of the
151412 -     day in meetings. ref SDS 1 5902  Doctor/patient meetings succumb
151413 -     to the same social and span of attention forces that impact all
151414 -     communications.  On 991108 review shows oral communication is
151415 -     highly prone to error and so needs directed support when accuracy
151416 -     is important. ref SDS 11 4505
151418 -        ..
151419 -       [On 991227 example of information missing from communication
151420 -       with medical executive at Kaiser; striving to be "clear and to
151421 -       the point," results in not being "complete." ref SDS 16 9844]
151423 -        ..
151424 -       [On 000113 Kaiser develops new position of Physician Leader to
151425 -       provide management for medical issues, ref SDS 17 5313, and
151426 -       reports doctor, patient communication is important, but fails to
151427 -       take improvement action, and directs patient not to demand
151428 -       Kaiser correct its work. ref SDS 17 1276
151430 -        ..
151431 -       [On 000118 telecon meeting with Kaiser made progress on pending
151432 -       medical mistakes. ref SDS 19 3248
151434 -        ..
151435 -       [On 000121 Kaiser says problems of medical charts will be solved
151436 -       by new computer. ref SDS 20 0783
151438 -        ..
151439 -       [On 000124 Kaiser reported Doctors are shielded from patient
151440 -       communications. ref SDS 21 3862
151442 -        ..
151443 -       [On 000211 Dale Ames suffered 9 months of incorrect diagnosis,
151444 -       then xrays were mishandled. ref SDS 22 3600]
151446 -        ..
151447 -       [On 050311 doctors have difficulty with communication and
151448 -       collaboration among themselves preparing timely reports,
151449 -       distribution, review, and feedback. ref SDS 24 PB8N
151451 -        ..
151452 -       [On 051103 study shows 34% of patients report experiencing
151453 -       medical mistakes due to communication gap, lack of coordination
151454 -       in team care where several doctors collaborate in providing care
151455 -       to a patient. ref SDS 25 ET68
151457 -      ..
151458 -     President Clinton's announcement on 991207 for a national
151459 -     initiative to cut medical mistakes shows growing awareness of need
151460 -     for improvement. ref SDS 13 0001
151462 -      ..
151463 -     Since communication is 90% of work time, reported in a study on
151464 -     960405, ref SDS 2 6677, it is the biggest risk in enterprise, set
151465 -     out on 990924. ref SDS 7 5576
151467 -      ..
151468 -     Business decisions unsupported, arbitrary, see report on 961218
151469 -     cancellation of RFP #19 for $500K that later caused government to
151470 -     pay $7M plus. ref SDS 3 5790
151472 -      ..
151473 -     On 990718 limited time forces cursory communication by executives.
151474 -     ref SDS 5 6120
151476 -      ..
151477 -     On 990912 study showed communication is major cause of costly
151478 -     medical mistakes. ref SDS 6 0960  On 990924 explain cause and
151479 -     solution, ref SDS 7 0001, in letter. ref DIP 2 0001
151481 -      ..
151482 -     On 991001 important information was omitted in communication on a
151483 -     NASA project that caused space orbiter to crash on Mars, costing
151484 -     $125M. ref SDS 8 0001
151486 -      ..
151487 -     On 991207 President Clinton announced national initiative to
151488 -     reduce medical mistakes. ref SDS 13 0001
151490 -  ..
151491 - Primary care physicians frequently make decisions without involvement
151492 - of the patient.  These findings suggest that the ethical model of
151493 - informed decision-making is not routinely applied in office practice.
151494 - ref OF 7 2052
151495 -
151496 -     On 990625 Kaiser specifies doctor patient partnership. ref SDS 4
151497 -     4185  Communication is key ingredient. ref SDS 4 0806  Feedback
151498 -     metrics make communication effective, ref SDS 4 3960, but doctors
151499 -     do not have time.
151501 -      ..
151502 -     On 990924 explained cause and solution to communication mistakes.
151503 -     ref SDS 7 0001
151505 -  ..
151507 -  ..
151508 - Research was led by Dr. Clarence H. Braddock III at the University of
151509 - Washington in Seattle. ref OF 7 8446   He is listed on UW faculty web
151510 - site at...
151511 -
151512 -           http://www.washington.edu/home/directories.html
151513 -
151514 -   [On 991227 called and sent letter to Doctor Braddock. ref SDS 15
151515 -   0001]
151517 -    ..
151518 -   [On 000611 Doctor Braddock responded. ref SDS 23 5538
151519 - ..
151520 - "New strategies, including more effective and efficient use of
151521 - educational materials and decision aids in office practice, will need
151522 - to be developed and tested as part of the solution," Dr. Michael J.
151523 - Barry of Massachusetts General Hospital in Boston said in the
151524 - editorial. ref OF 7 0504
151525 -
151526 -     On 990625 developed communication training requirement from
151527 -     experience with Kaiser. ref SDS 4 5358
151529 -      ..
151530 -     On 990924 explained cause, ref DIP 2 1680, and solution to medical
151531 -     mistakes. ref DIP 2 5967
151533 -      ..
151534 -     On 991008 listed communication training as issue for review in
151535 -     meeting with Kaiser. ref SDS 9 0899
151537 -      ..
151538 -     On 991103 submitted proposal for com training. ref SDS 10 5933
151540 -      ..
151541 -     On 991216 limited time hampers solution. ref SDS 14 5742
151543 -      ..
151544 -     [On 991227 example of missing information in communication with
151545 -     medical executive at Kaiser. ref SDS 16 9844]
151547 -      ..
151548 -     [On 000113 example citing email as objective and overlooking
151549 -     medical mistakes. ref SDS 17 8268]
151551 -      ..
151552 -     [On 000114 notified Kaiser of problem. ref SDS 18 0001]
151553 -
151555 -  ..
151556 - Doctor Barry has contact information on the Internet...
151557 -
151558 -
151559 -     http://www.partners.org/pw-cgi/dbml.exe?temp=/pweb-view/general/simple-profile.dbml&personnel_id
151560 -
151561 -
151562 - ...under Massachusetts General Hospital....
151563 -
151565 -                     ..
151566 -                    http://www.mgh.harvard.edu/
151567 -
151569 -    ..
151570 -   [On 991227 called and sent letter to Doctor Braccock. ref SDS 15
151571 -   0001]
151572 -
151573 -
151574 -
151575 -
151576 -
151577 -
151578 -
1516 -