The Torkel Saga 2059: May 2016

20160513-F: Charter Information – Standards (From RENHEW)
20160513-F: Blog Keeping
Date Chartered – May 13, 2016-F (Actual as expected before deadline)
Means/Method – Blogger/Post (Gallery First Method)

20160513-F: Title
Dr David M Dobos, MD Kaiser Psychiatrist in Aliso Viejo, CA – Doctor On Call - Stats by TheDAG and Keith E Torkelson, MS

Test Subject - Dr. David M Dobos MD (Psychiatrist)
Photo – So far none online (unavailable)

Doctors On Call – Dobos (DOC01) & BSL (DOC02)
Development Stage - Beta Testing Around MSG’s Datic Division

Principle Author – TheDAG for MSG

Dobos' Introduction Link

http://the-torkel-saga-2059.blogspot.com/2016/06/keith-e-torkelson-ms-introduces-dr.html

Primary Assessments (MSG)
Doctors’ On Call Assessment Tools - Doctor Tech Assessments - Accountability and Transparency

20160528-TH: Executive Summary – Abstract
This study and report is about our real world experience with one of our, if not he best, psychiatrist – Dr. David M Dobos of SoCal Kaiser Permanente. Referencing Vitals online Rate Your Doctor Experience data: Three others rated Dr. Dobos services at a 3.5 out of 5 stars. Doctor Dobos was (Circa 2000) and is a practicing Kaiser psychiatrist. For this year (2016), the Centers for Medicare & Medicaid Services (CMS) awarded Kaiser 5 Stars with 5 being the best. Vitals stars are not the same as CMS Stars with the latter involving way more data points for its calculation. Using the Vitals method we scored our service experience with Dr. Dobos a 4.5 out of 5 stars. There is no evidence on-line as of May 26, 2016 that Dr. Dobos has reported on any of his successes for self-performance (cure rates, savings with medications, hospitalization diversions, etc,). Some doctors are now reporting that depression is now more curable than ever. We use our Results Up Front Method (RUFM) in this report.

Applying Lessons Learned
We chose RUF because it is to be presented and a post in our Blog and not a refereed paper. For this study we created some assessment tools: Doctor On Call to further flesh out our service experience, an Addressing Transparency Tool, and two assessments to investigate Dr. Dobos in relationship to technology. Doctor Dobos outscores our current psychiatrist (BSL-Control) about all but one of the assessment tools. Our current psychiatrist (BSL) is a contractor about a program that CMS rates with only 3 stars. If we don’t get time to pursue this Doctor On Call endeavor we state that Dr. Dobos’ colleague Dr. David Royce Chandler was one of our worst psychiatrists. With the lessons learned here we hope to hire a superior psychiatrist to succeed our current one. We also hope to give any new psychiatrist a heads up as to our expectations. Key to our expectations is not to experiment on us. We are still deciding whether to publish the assessments (Betas) we wrote for this study.

Community Partners
20160515-SUN: Shared with AMIN-0011


	Method	Partner	Note
-
	Advocate for Peer Specialists in Behavioral Health	Californian Mark Leno (M_L)	Senate Bill 614
	Experimented & Experiments on Humans	Dr. Himasiri K. De Silva, MD (HKDS)	Unsuccessful biochemical lobotomies (Per APD, MD)
	Homeless Representative (OC - May 2016)	FV Tech Guy	Hope and Innovation
	Housing Specialist	Donald L Bren (DLB)	MHSA Funding
	Inappropriately Served & Over-served	Kelly Thomas (K_T)	Died Young while being served and protected
	Man of Peace Methodologies (Grace & Role Modeling)	Peter Brian Gabriel (PBG)	Promoted awareness of Stephen Bantu “Biko”

	Promising Practices Psychiatry	Clayton Chau, MD (C_C)	Consumer-survivor
	Technique of the Quarter	Antonio Egas Moniz (AEM)	Pre-Frontal Lobotomy
	Writer for “The Resistance”	Daryl Steinberg (D_S)	Mental Health Services Act
	HomeyGee’s	(EAK)	Promise for the future

20160515-SUN: Table – Maturing with our Community Partners (AMIN & Dobos, 2016)

Results Up Front Method (RUFM – Stars and VITALs - Combined Table)

-
Assessment	Dobos and Kaiser Legacy	BSL and GBDP Current
-
Obj – CMS Stars (Program)	5 (Out of 5 = Best)	3 (Out of 5 = Best)

Obj – Online Patient Ratings of Doctors	VITALS 3.5/5 (3 Responses)	VITALS Unavailable
MSG Subj – Using VITALS Model (20160507)	4.5/5 (1 Response)	4.0/5 (1 Response)

Obj – Doctor Self Report	0 - No Evidence Found	0 - No Evidence Found

Current Data as Of 20160507: Table (OBJ) – Results Up Front (RUF) – Featuring Objective Measurements – Comparing Dobos with an in scope control (BSL) - Both psychiatrists.

Table (OBJ) Legend

BSL = Ciphered
CMS = Centers for Medicare & Medicaid Services
GBDP = GB DEATH Program
MSG = Mentalation Solutions Group
Obj = Objective
RUF = Results Up Front
RUFM = Results Up Front Method
Subj = Subjective

Why We Cipher?
Our professor, Gary Michael Zager, for Introduction to Health & Human Services taught us ethical principals. One was called a Dual Relationship. Mr. Zager says (2012) not to destroy a therapeutic relationship if it exists or existed. We are seeing BSL right now and would like to avoid burning this bridge. Thus BSL and GBDP are ciphers for a person and a program.

An FYI: Acronym List - Centers for Medicare & Medicaid Services (About 1000 of them)

https://www.cms.gov/apps/acronyms/listall.asp?Letter=ALL

Features of a Superior Psychiatrist

Table (MDOC) Legend

% = One hundred percent is best
A&TPS = Accountability & Transparency Progress Score
ASSS = Appropriate Services Subjective Score
ATT = Addressing Transparency Tool
COTS = Commercial-of-the-shelf
S&DE = Strengths & Deficits Evaluation

TPS = Transparency Progress Score


AcroCode	Assessment	Dobos and Kaiser Legacy [% (Items)]	BSL and GBDP Current [% (Items)]

MDOCAT HWS	Doctor On Call Assessment Tool (Beta) – High Weight Screener	83 (12)	17 (12)
MDOCAT LW	Doctor On Call Assessment Tool (Beta) – Low Weight Fleshing	58 (13)	17 (15)

ATT	Addressing Transparency Tool Yields TPS	71 (11)	30 (10)
A&T Edmonton	Accountability and Transparency – COTS (The Edmonton) Yields A&TPS	68 (34)	40 (44)

S&DE	Strengths & Deficits Evaluation Yields ASSS	Strengths (#28) > Deficits (#4)	(*) Prediction Strengths = Deficits

Data Current as of 20160510-TU: RUFM – Table (MDOC) - Rating the Doctors On Call -Subjective from Lived and Real World Experience

ATT Control = Edmonton Commercial-off-the-shelf (COTS) Tool
[PDF] - Accountability and Transparency Board Self-Assessment - Charity Central
(4 pages – Tool itself “The Edmonton” & A&T-Edmonton)

http://www.charitycentral.ca/docs/selfdiag-ecl-en.pdf

As a self-assessment, these questions help clarify for you where your agency are going.
(*) - Held over for being out of scope at this time

IT Features for a Superior Psychiatrist

TCMS = Teckno Case Management Score (Yield)


AcroCode	Assessment	Dobos and Kaiser Legacy [% (Items)]	BSL and GBDP Current [% (Items)]

MDTAT-HWS	Doctor Teck Assessment Tool – High Weight Screener Yields TCMS-HW	83 (12)	10 (12)
MDTAT-LW	Doctor Teck Assistance Tool – Low Weight Yields TCMS-LW	31 (16)	32 (17)
	-

Data Current as of 20160510-TU: Table (TCMS) - RUFM – Rating the Doctor On Call’s Technological Prowess -Subjective from Lived Experience

Prosumer Rates Psychiatrist(s)

Table (TCMS) Legend


AcroCodes	Translation
-
MDTAT-HWS	Doctor Teckno Assessment Tool – High Weight Screener
MDTAT-LW	Doctor Teckno Assistance Tool – Low Weight

TCMS	Teckno Case Management Score (Yield)
TDCMA	Teckno Driven Case Management Assessment
TDCMA-P-HWS	TDCMA – Provider Version – High Weight Screener
TDCMA-P-LW	TDCMA – Provider Version – Low Weight

20160527-F: Table – Legend for Teckno Assessments

Statement of Intent (General for all MDOCAs)
20160602-TH: Statement of Intent
A major intent is for MSG to gain confidence about its’ External Quality Review (EQR) and sharing process. We try to share lived experience while applying MSG’s Harm Reduction Policy. We are shopping early for a new (superior) psychiatrist in order to prevent preventable losses (AKA an episode).

Predictions Using Stars - Performance Distribution

-Implied Perfection
A CMS Stars score of 5 implies perfection yet that is not the case. Scores are rounded. In the graph the area of green represents the program and staff keepers. The area in yellow represents the needs improvement - program and staff elements. The area in red implies elements that might best be replaced. As we look closer at the distribution it needs a bit of tweaking to better reflect reality. The point is: What is the true difference between a 5 Star (Kaiser) and a 3 Star (GBDP) program? How can one be used to help the other?

Gallery First (Then Embed)

"It's Only at the Turning Point

When You Find Out How to Fight"

Oly_091215_CTP_007

Consumer Paraprofessional Training Graduation 2009

Chau and Correa

A TorkMark Photo

Man of PEACE

Strengths and Deficits - Four by Four Method
Dobos Service Model (Circa 2000)
Search if you may - “doctor david dobos psychiatrist”

20160418: Strengths – A ListerLista

	-
Rank	Service and Supports Element	20160418
	-	Retro Circa 2000

01	We met our performance challenge together	YES
02	Superior medication management system	YES
03	Weekly medication adjustments PRN	YES
04	Medication Management Position (MMP) “Sometimes the patient knows how to manage their medication best” (Dobos)	YES

As of 20160418 - Table for Doctor Dobos’ Strengths (Of a SuperTotal = 18) – Scored by Client

20160418: Deficits – A ListerLista (MSG - ConMan)

	-
Rank	Shortfalls and Deficits	20160418
		Retro Circa 2000

01	Educated me about Clozapine	NO
02	Analyzed and determined root causes	NO
03	Felt secure that his office could manage all my behavioral health needs (keeping risk factors at bay)	NO
04	Reliability of relationship	NOT LONG TERM

As of 20160418 – Table for Doctor Dobos’ Deficits (SuperTotal = 4) – Scored by Client

Keith Torkelson An Evaluators Error Rate

Applying Course Work (Approximately 10%)

20160418-M: Strengths – ListerLista - More Strengths


Rank	Service and Supports Element	20160418
	-	Retro Circa 2000

05	Appropriate dress	YES

06	Authored letters when I requested	YES
	Bought into my goals	YES
	Few assumptions	YES
	Gentle and calming	YES
10	Grief work effective (Both my mom and dad died)	YES

11	“Seeking new clients” - Would I go back?	Probably Not
	Took the most thorough history of any of my psychiatrists (Handwritten – 40 minute intake)	YES
	Agreement on a working diagnosis	YES
14	Did my symptoms improve	YES