The "Doorhandle" moment

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Wed Mar 11 15:03:37 UTC 2015


Helps to have the ToolKit!

On Wed, Mar 11, 2015 at 8:02 AM, Peggy Zuckerman <peggyzuckerman at gmail.com>
wrote:

> To emphasize, anyone is granted the right to use this Patient ToolKit on
> your websites or as a printout as may be needed.  SIDM supported its
> creation and would appreciate any feedback, either to the webmaster or to
> me.
>
> Peggy Zuckerman
>
> On Wed, Mar 11, 2015 at 7:30 AM, Nieder, Kathy (Dr) (BHE) <
> knieder at bhsi.com> wrote:
>
>>
>> It would help me to manage expectations — knowing ahead of time what a
>> patient needs to get from the visit would be helpful. Improves the use of
>> our time in the exam room and might reduce “hidden agendas”. I don’t mean
>> that in a negative aspect, it’s only hidden because WE DON’T HAVE AN
>> AGENDA, as has been so well expressed in previous posts.
>>
>>
>> Kathy Nieder MD
>> Staff Physician, BHMG Ambulatory EHR Physician Champion
>> twitter- at docnieder
>> LinkedIn-www.linkedin.com/in/kathynieder
>>
>>
>>
>>  On Mar 11, 2015, at 10:14 , Michael Grossman <Michael.Grossman at MIHS.ORG>
>> wrote:
>>
>>   Excellent concept. This could lead to productivity in an otherwise
>> idle time and potentially add focus to the visit.
>>
>> M. Grossman, MD MACP
>>
>> *From:* Ross Koppel [mailto:rkoppel at SAS.UPENN.EDU <rkoppel at SAS.UPENN.EDU>]
>>
>> *Sent:* Tuesday, March 10, 2015 7:09 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] The "Doorhandle" moment
>>
>>
>>
>> Comments like these, as frustrating as they are about medical practice,
>> renew my faith in mankind.  Thank you Peggy. Wonderful and humane insights
>>
>> Ross
>>
>>
>>
>>
>>
>> Ross Koppel, PhD, FACMI
>>
>> University of Pennsylvania
>>
>> Sociology Dept.; Sch. of Medicine;      LDI Senior Fellow (Wharton).
>> Sent by old manual Underwood typewriter
>>
>>
>>
>> -------- Original message --------
>> From: Peggy Zuckerman <peggyzuckerman at GMAIL.COM>
>> Date:03/10/2015 2:45 PM (GMT-08:00)
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> Subject: Re: [IMPROVEDX] The "Doorhandle" moment
>>
>> How hard would it be to print up some notepads to be handed out via the
>> receptionist, headed "Your Wishlist for Your Appointment"  or some such.
>> Get the patient to do something to clarify their issues...and half-way down
>> and second headline, "What I REALLY Should Tell the Doctor".  And how hard
>> would it be to give the guy his recent lab or CT report to read before
>> going in to see the doc?
>>
>> The suffering supplicant in the waiting room is not only worried about
>> what ever brought him there, he is also worrying about how much time he is
>> losing from his work--and any subsequent appointments--and if there is any
>> value to his coming to the doctor, especially if he has not yet developed a
>> good relationship with the doctor, if his English is not good, if he fears
>> the worst from the last CT or test, if he really is NOT taking his meds, if
>> his father died of "the same thing".
>>
>> It is a messy and nerve-wracking time, seeming at time designed to
>> diminish the confidence of the patient in his abilities.
>>
>> Peggy Zuckerman
>>
>>
>>
>> On Tue, Mar 10, 2015 at 12:44 PM, Swerlick, Robert A <rswerli at emory.edu>
>> wrote:
>>
>> We are essentially the only profession that routinely schedules meetings
>> with no agendas. Perhaps this would be less of an issue if we made it a
>> point to create agendas for our appointments ahead of time.
>>
>>
>>
>> Bob Swerlick
>>
>>
>>
>> *From:* Bruno, Michael [mailto:mbruno at HMC.PSU.EDU]
>> *Sent:* Tuesday, March 10, 2015 3:07 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] The "Doorhandle" moment
>>
>>
>>
>> It’s a core tenet of psychiatry that you will *ONLY* get to the *real *issues
>> that are on the patient’s mind at that final, “door-handle” moment, and
>> somehow you never seem to hear about them in the 45 minutes of your session
>> that occur before that final moment!*
>>
>>
>>
>> Mike B.
>>
>>
>>
>>
>>
>> _________
>>
>> *I’m not a psychiatrist, but I’m married to one.
>>
>>
>>
>>
>>
>> *From:* Mark H Ebell [mailto:ebell at UGA.EDU <ebell at UGA.EDU>]
>> *Sent:* Tuesday, March 10, 2015 2:14 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Positive tests - surprisingly, patients are
>> not always as receptive as you'd expect them to be
>>
>>
>>
>> Yes, they are dreaded, although often important and illuminating. Just
>> annoying that at the end of a 20 minute encounter, you FINALLY get to what
>> is really important, with a waiting room full of patients. We used to call
>> it the “doorhandle moment” because your hand is on the doorhandle, trying
>> to leave the room.
>>
>>
>>
>> Mark
>>
>>
>>
>> *From: *Peggy Zuckerman
>> *Reply-To: *Society to Improve Diagnosis in Medicine, Peggy Zuckerman
>> *Date: *Tuesday, March 10, 2015 at 1:30 PM
>> *To: *"
>> *Subject: *Re: [IMPROVEDX] Positive tests - surprisingly, patients are
>> not always as receptive as you'd expect them to be
>>
>>
>>
>> I find it fascinating that patients are told not to bring up peripheral
>> issues with the doctor, i.e., "what is your main complaint today?".
>> However, when an lab test reveals some problem that does not yet concern
>> them, or is at yet unrelated to what may well be that peripheral issue, the
>> patient seems not to be concerned.  Is that because the patient has already
>> been told that only the "main" stuff is to be discussed, or was there a
>> barrier created by the limitations of the first visit?
>>
>> As a parent, I used to dread the "by the way" comments from my children
>> as they left for school, I wonder if those same "by the ways" from patients
>> might also be dreaded and deflected.
>>
>> Peggy Zuckerman
>>
>>
>>
>> On Tue, Mar 10, 2015 at 10:05 AM, Bruno, Michael <mbruno at hmc.psu.edu>
>> wrote:
>>
>> Good points!  We are quite convinced that we know best.  But do we?
>>
>>
>>
>>
>>
>> *From:* Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
>> *Sent:* Tuesday, March 10, 2015 12:44 PM
>>
>>
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Positive tests - surprisingly, patients are
>> not always as receptive as you'd expect them to be
>>
>>
>>
>> I agree that Dr. Bruno’s description highlights the complexity of
>> information exchange. What I would also highlight is that more conventional
>> venues for information exchange (patient office visits) suffer from the
>> same problems. We simply were not aware of the issues to the same degree
>> and/or we use a different set of descriptors to catalogue the issues.
>>
>>
>>
>> Patients come to a venue to address a problem they are concerned about.
>> We deploy tools which detect a variety of signals, independent of the
>> reason the patient originally sought care for. We are surprised when the
>> patient has no interest for pursuing problems which they do not perceive.
>> Perhaps we should not be so surprised they do not want to buy or product or
>> service that we are selling them when they see little or no value in them.
>>
>>
>>
>> Rob, I agree that  the new communication tools have not been evaluated
>> adequately. Neither have the old tools.
>>
>>
>>
>> Bob Swerlick
>>
>>
>>
>> *From:* Robert Bell [
>> mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
>> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
>> *Sent:* Tuesday, March 10, 2015 11:55 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Positive tests - surprisingly, patients are
>> not always as receptive as you'd expect them to be
>>
>>
>>
>> Wow, what a great reply.
>>
>>
>>
>> Beautifully expresses all the complexity of medicine and the challenges
>> to reduce error against a relentless sea of obstacles that helps create
>> error.
>>
>>
>>
>> Speaks to patient communication and Portals being adequately evaluate
>> prior to introduction.
>>
>>
>>
>> Well done Michael Bruno.
>>
>>
>>
>> Rob B
>>
>> Sent from my iPad
>>
>>
>> On Mar 10, 2015, at 6:38 AM, "Bruno, Michael" <mbruno at HMC.PSU.EDU> wrote:
>>
>>  Thanks, Tim,
>>
>>
>>
>> It’s great to hear from a fellow “Quality Officer” in a medical
>> practice.  I’m also a quality officer, for a large academic department of
>> Radiology.  This particular issue, of communicating effectively with our
>> patients, is near & dear to my heart.  I’d like to briefly share our own
>> experience in alerting a subset of patients to their test results, an
>> experience which surprised me and my team here and may surprise others on
>> this listerv as well.  We were surprised to encounter a population of
>> patients who were remarkably disengaged, and who weren’t particularly
>> receptive to hearing from us with their test results.  This was quite the
>> opposite of what we expected.
>>
>>
>>
>> In the practice of modern radiology, we encounter a good many unexpected
>> findings—items of varying importance that are turned up on imaging tests
>> that need to be followed up (often after a suitable delay to allow us to
>> better characterize them).  While such findings need to eventually be
>> addressed clinically, they are not the immediate reason for the patient
>> coming to the doctor or undergoing their imaging test.  We dutifully report
>> all of these “incidental” findings to the ordering physician—phoning them
>> when the surprise is a critical one—and trusting them to read our written
>> report when it is not.  As a corollary, there’s quite a bit of pressure to
>> make our reports timely and clear, and these days our formal, signed final
>> reports are predominately delivered electronically through the EMR in a
>> matter of minutes, although providers outside of our center may still get
>> their radiology reports via fax or even through the regular mail.  The
>> issue is particularly problematic for us in Radiology where Radiology
>> intersects the Emergency Department.  We invest a lot of resources to the
>> E.D., and most of our final, written reports on E.D. patients are delivered
>> literally within minutes, plus we always have someone (a faculty member,
>> resident trainee, or both) physically stationed in the E.D. itself to
>> provide immediate availability for consultation.
>>
>>
>>
>> That’s all well and good for the acute findings, *i.e.,* those
>> addressing the clinical question that brought the patient into the E.D.,
>> but it tends not to work all that well for those incidental findings
>> unrelated to the immediate problem and that require a medium to long-term
>> follow up—follow-up which is outside of the purview of the E.D.  In such
>> cases, it falls to the patient’s primary care physician (if there is one)
>> to follow up on the incidental findings, and it’s almost useless for us to
>> even alert the E.D. physician to those findings.  In many cases when we
>> report the findings to the ED physician the patient still isn’t even told
>> of them by that E.D. physician.  Rather, patients are directed to sign a
>> form at the time of their discharge from the E.D. in which they promise to
>> “follow-up with PCP.”  This promise to follow up is generally little more
>> than a charade.  From the patient’s standpoint, they often feel that
>> they’ve (1) just SEEN a doctor, and (2) been SCANNED from top to bottom,
>> and therefore they should be “all good.”  At least until their next acute
>> problem arises and they return once more to the E.D.  In a handful of
>> cases, depending on the nature of those incidental findings, that is a very
>> dangerous complacency.  Their PCP, if they even have one, may never learn
>> they were even seen in the E.D., much less that there were CT or x-ray
>> findings from that E.D. visit which will need to be worked up or at least
>> followed.  So you see the problem.
>>
>>
>>
>> To address this, we’ve developed a “failsafe” plan to alert the patients
>> directly to their incidental findings requiring follow-up, and to encourage
>> them to obtain the recommended follow-up with their PCP.  We also direct
>> them to our Dept. of Family & Community Medicine in the event they don’t
>> have a PCP (which is unfortunately a fairly frequent situation in the E.D.
>> population).  We do so by mailing them a letter.  This is an unusual type
>> of direct communication for Radiologists.  In the U.S., we Radiologists
>> have traditionally been the “doctor’s doctor,” communicating our findings
>> and opinions only with the referring physician, who then relays our
>> impressions to the patient (who, in turn, generally assumes that it was
>> their own doctor who interpreted their CT scans and generated the
>> diagnostic opinions).  The idea for our “Failsafe” program came from the
>> Joint Commission NPSG about involving patients in their own care as a
>> specific safety strategy—and it puts the patient in the middle of the
>> communication chain between us and their PCP.  When we proposed the idea of
>> having Radiologists send letters *directly to patients* – letters
>> addressed to specific patients and signed by a specific Radiologist(!) –
>> with the purpose alerting patients to abnormal findings on their scans
>> without any intermediary physician there to explain the findings, it raised
>> a lot of eyebrows, not least among the Radiologists themselves.  Many
>> worried that the clinical physicians would not appreciate our getting
>> between them and their patients, and others were worried that patients
>> would call us incessantly with questions and consume too much time,
>> destroying our RVU-based productivity.  We also worried that receiving a
>> Failsafe letter would be unduly frightening for patients.  But none of
>> these concerns turned out to actually be a problem.  Our faculty physicians
>> were very receptive to Failsafe, and they universally appreciated the added
>> measure of safety for their patients that the new program provided.  If
>> anything, they wanted to see the program expanded.  And very few calls from
>> patients came to us.
>>
>>
>>
>> Our Failsafe letter does not attempt to explain the findings or their
>> significance to the patients.  Rather, it merely alerts them that “their
>> Radiologist” found something on their scan requiring follow-up, and urges
>> them to see their doctor to discuss the findings (or call the Family
>> Medicine office to arrange a follow up if they don’t have their own PCP).
>> We have so far limited the program to E.D. patients, based on the rationale
>> above, and currently we send out about 6 – 8 letters per week, and have
>> been doing so for about three years now.   But when I phoned bunches of
>> these patients to see what their reaction to the letter had been, and to
>> ascertain whether it had achieved its intended purpose, I discovered that
>> patients were fairly uniformly *disregarding* the letters.  Most never
>> even returned my calls.  Those who did seemed completely unconcerned and
>> none even asked me what the findings we were pursuing were!  They simply
>> did not care to know—they were feeling well, and they were not receptive to
>> any potentially worrying information.  Far from being frightened by the
>> letters, they were not even concerned when the letter was followed up by
>> some doctor (me) phoning them *repeatedly*, leaving multiple voicemails
>> and messages with their family members at home and co-workers at their
>> places of employment.  It was clear that these patients could not care less
>> about our findings, our letter, or whatever it was I may have had to say to
>> them on the phone.  In short, we encountered a large group of patients who
>> were *so unconcerned* and *unfrightened* about their test results that
>> nothing we tried could frighten or concern them!
>>
>>
>>
>> This situation was essentially 180 degrees diametrically the opposite of
>> what we had expected—which was that patients would be highly invested in
>> the results of their studies, that they would be anxious to learn what
>> their imaging showed, and would be pressing their physicians for answers.
>> We expected the phones to be ringing constantly once the first batch of
>> letters went out.  What we found instead was that, at least for the
>> population seeking their medical care in the E.D., with a few notable
>> exceptions, our patients were pretty much un-engaged with their own care
>> beyond the acute episode of care.
>>
>>
>>
>> We have been struggling with this patient engagement issue and are now
>> working toward developing more effective ways to augment our program and
>> try to reach these patients.  But I would suggest, based on our experience,
>> that merely sending patients the results of their lab tests by mail is
>> simply NOT going to be adequate across the board.  Some patients are
>> turning out to be very hard to reach.
>>
>>
>>
>> All the best,
>>
>>
>>
>> <image002.png>
>>
>> Michael A. Bruno, M.D., F.A.C.R.
>> Professor of Radiology & Medicine
>> Director of Quality Services & Patient Safety
>> The Milton S. Hershey Medical Center
>> Penn State College of Medicine
>> 500 University Drive, Mail Code H-066
>> Hershey, PA  17033
>>
>> Phone: (717) 531-8703
>> Fax:      (717) 531-5596
>>
>> e-mail: mbruno at hmc.psu.edu
>>
>>
>>
>>
>>
>> <image003.png>
>>
>> *****E-Mail Confidentiality Notice*****
>> This message (including any attachments) contains information intended
>> for a specific individual(s) and purpose that may be privileged,
>> confidential or otherwise protected from disclosure pursuant to applicable
>> law.  Any inappropriate use, distribution or copying of the message is
>> strictly prohibited and may subject you to criminal or civil penalty.  If
>> you have received this transmission in error, please reply to the sender
>> indicating this error and delete the transmission from your system
>> immediately.
>>
>>
>>
>>
>>
>> *From:* Timothy Stevenson [mailto:Timothy.Stevenson at SSWAHS.NSW.GOV.AU
>> <Timothy.Stevenson at SSWAHS.NSW.GOV.AU>]
>> *Sent:* Monday, March 09, 2015 4:50 PM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] FW: [IMPROVEDX] Positive tests
>>
>>
>>
>> It is interesting, and yet a little disconcerting, to see the variation
>> in perception as to how important and/or necessary it is to provide the
>> patient with results from tests ordered that are “good news”. From the
>> patient’s perspective, “no news” does not necessarily mean “good news”.
>> Rather, it means “What did the tests show?” anxiety. Remember that the
>> patient came to see you because “something was wrong”. The fact that the
>> test comes back with a “There is nothing wrong” result does not answer the
>> question the patient originally came with. As a Quality Assurance officer I
>> regularly talk to patients who either have not heard the results of any
>> tests they were sent for, have not had the results of the tests clearly
>> explained to them or have been told “the tests show nothing is wrong”.
>> Their original question of “what is wrong with me” or “what is causing me
>> to feel like this” remains unanswered.
>>
>> Perhaps we need to go back to the original discussion with the patient
>> where *informed consent* was obtained to undertake/ refer for the test.
>> Receiving the results with an explanation as to what they show or don’t
>> show must be a part of the overall process. I would disagree that simply
>> sending the results to the patient in the mails is adequate. I have been
>> handed copies of my blood test results with “These show everything is
>> alright”, only to see **hi** and **lo** next to some results. If the LAB
>> flags these areas, then these results are “not okay”.
>>
>> I appreciate that explaining all results will put extra strain on the
>> already busy medical practitioners, but perhaps testing will become more
>> targeted.
>>
>>
>>
>> Tim
>>
>> *Timothy Stevenson*
>>
>> Quality & Safety Manager | *SWSLHD Community Health*
>>
>> Executive Unit, 1 Bolger Street, Campbelltown, NSW 2560
>> Tel (02) 4621 8767 | Fax (02) 4621 8775 | Mob 0455 075 055 |
>> timothy.stevenson at sswahs.nsw.gov.au
>> http://www.swslhd.nsw.gov.au/CommunityHealth/
>>
>>
>> <image001.jpg>
>>
>>
>>
>> *From:* Maureen Cahill [mailto:MCahill at NCSBN.ORG <MCahill at NCSBN.ORG>]
>> *Sent:* Tuesday, 10 March 2015 6:48 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Positive tests
>>
>>
>>
>> Would it be possible to negotiate with a practice’s  laboratory provider
>> that at a minimum all results are mailed and then abnormal results could
>> have an additional faster track notification?
>>
>> Maureen
>>
>>
>>
>> Maureen Cahill [Associate] 312.525.3646 (D) mcahill at ncsbn.org
>>
>> National Council of State Boards of Nursing (NCSBN) 111 E. Wacker Drive,
>> Ste 2900, Chicago, IL 60601-4277 312.279.1032 (F) www.ncsbn.org
>>
>> Our Mission – NCSBN, Leading in nursing regulation
>>
>>
>>
>> *From:* Avrum H. Golub, M.D., J.D. [mailto:avrum_h_golub_md_jd at ME.COM
>> <avrum_h_golub_md_jd at ME.COM>]
>> *Sent:* Monday, March 9, 2015 11:14 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* Re: [IMPROVEDX] Positive tests
>>
>>
>>
>> Lest we forget, patients are people and physicians may be patients.
>>
>>
>>
>> Please consider the “Golden Rule” and good manners.
>>
>>
>>
>> And, of course, the reassurance to a patient that we can convey.
>>
>>
>>
>> If not the physician, perhaps the ministering angel of the bedside
>> (nurse) or another physician extender who has empathy and compassion.
>>
>>
>>
>> Some of the incomprehensible telephone reports (or not report) that I, as
>> a patient, have received from physicians’ staffs are rude and anxiety
>> provoking, at least.
>>
>>
>>
>> I am a Pathologist.
>>
>> Avrum H. Golub, M.D., J.D.
>>
>>  On Mar 8, 2015, at 8:10 PM, Pauker, Stephen <
>> SPauker at TUFTSMEDICALCENTER.ORG> wrote:
>>
>>
>>
>> In my experience and writings , negative or normal test results can be
>> quite important in making a diagnosis, so not communicating them to the
>> patient can be withholding key information. All results positive or
>> negative should be communicated. Further withholding them can sometimes
>> lead to repeating the test
>>
>> Steve
>>
>>
>>
>> Sent with Good (www.good.com)
>>
>>
>> -----Original Message-----
>> *From: *Robert Bell [rmsbell at ESEDONA.NET]
>> *Sent: *Sunday, March 08, 2015 01:33 PM Eastern Standard Time
>> *To: *IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject: *[IMPROVEDX] Positive tests
>>
>> Many doctor's offices only call or mention to patients positive test
>> results that have been undertaken (particularly lab tests). Is that a good
>> thing and does it in any way impact diagnosis?
>>
>> Also, what are the effects of the new electronic portals on diagnosis. It
>> is a big change in medicine.
>>
>> Rob Bell
>>
>> Sent from my iPad
>>
>>
>>
>> http://LIST.IMPROVEDIAGNOSIS.ORG/ <http://list.improvediagnosis.org/>
>> (with your password)
>>
>>
>> Moderator: David Meyers, Board Member, Society to Improve Diagnosis in
>> Medicine
>>
>> To unsubscribe from the IMPROVEDX list, click the following link:<br>
>> <a href="
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1"
>> target="_blank">
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> </a>
>> </p>
>>
>> The information in this e-mail is intended only for the person to whom it
>> is addressed. If you believe this e-mail was sent to you in error and the
>> e-mail contains patient information, please contact the Tufts Medical
>> Center HIPAA Hotline at (617) 636-4422. If the e-mail was sent to you in
>> error but does not contain patient information, please contact the sender
>> and properly dispose of the e-mail.
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>>
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>
>>
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>> The information contained in this e-mail and any accompanying documents
>> is intended for the sole use of the recipient to whom it is addressed, and
>> may contain information that is privileged, confidential, and prohibited
>> from disclosure under applicable law. If you are not the intended
>> recipient, or authorized to receive this on behalf of the recipient, you
>> are hereby notified that any review, use, disclosure, copying, or
>> distribution is prohibited. If you are not the intended recipient(s),
>> please contact the sender by e-mail and destroy all copies of the original
>> message. The integrity and security of this message cannot be guaranteed on
>> the Internet. Thank you.
>>
>>
>> _____________________________________________________________________
>> This email has been scanned for the Sydney & South Western Sydney Local
>> Health Districts by the MessageLabs Email Security System.
>> Sydney & South Western Sydney Local Health Districts regularly monitor
>> email and attachments to ensure compliance with the NSW Ministry of
>> Health's Electronic Messaging Policy.
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>> _____________________________________________________________________
>> This email has been scanned for the Sydney & South Western Sydney Local
>> Health Districts by the MessageLabs Email Security System.
>> Sydney & South Western Sydney Local Health Districts regularly monitor
>> email and attachments to ensure compliance with the NSW Ministry of
>> Health's Electronic Messaging Policy.
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>> This e-mail message (including any attachments) is for the sole use of
>> the intended recipient(s) and may contain confidential and privileged
>> information. If the reader of this message is not the intended
>> recipient, you are hereby notified that any dissemination, distribution
>> or copying of this message (including any attachments) is strictly
>> prohibited.
>>
>> If you have received this message in error, please contact
>> the sender by reply e-mail message and destroy all copies of the
>> original message (including attachments).
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>
>>
>> --
>>
>> Peggy Zuckerman
>> www.peggyRCC.com <http://www.peggyrcc.com/>
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>
>>
>> --
>>
>> Peggy Zuckerman
>> www.peggyRCC.com <http://www.peggyrcc.com/>
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>>  ------------------------------
>>
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>>
>>  or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>>
>> ------------------------------
>>
>> ------------------------------
>>
>> *This email, facsimile, or letter and any files or attachments
>> transmitted with it contains information that is confidential and
>> proprietary. This information is intended only for the use of the
>> individual(s) and entity(ies) to whom it is addressed. If you are the
>> intended recipient, further disclosures are prohibited without proper
>> authorization. If you are not the intended recipient, any disclosure,
>> copying, printing, or use of this information is strictly prohibited and
>> possibly a violation of federal or state law. If you have received this
>> information in error, please notify Baptist Health immediately at
>> 502-896-3020 <502-896-3020> or via email to the sender. *
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>
>
>
> --
> Peggy Zuckerman
> www.peggyRCC.com
>



-- 
Peggy Zuckerman
www.peggyRCC.com






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20150311/03ef6551/attachment.html> ATTACHMENT:
Name: Patient_Toolkit_v4A_CAN BE FILLED IN ON COMPUTER.pdf Type: application/pdf Size: 1493861 bytes Desc: not available URL: <../attachments/20150311/03ef6551/attachment.pdf>


More information about the Test mailing list