WBUR

Quality Of Care: Balance Of Knowledge, Communication

BOSTON — We’re hearing from a lot of different groups lately about what’s wrong with health care and how to fix it. But what do patients think? To find out, we asked Massachusetts residents who said they had a serious illness, medical condition, injury or disability requiring a lot of medical care, or spent at least one night in the hospital within the last year.

Our poll, Sick in Massachusetts, finds that 48 percent of those who responded said they are “very satisfied” with the quality of their health care.

Dr. Tara Lagu, researcher at Baystate Medical Center in Springfield and assistant professor at Tufts Medical School, joined Morning Edition Tuesday to talk about the how to measure the quality of health care — regardless of how it is paid for.

Tara Lagu: One of the ways quality has been measured, at least at the level of physicians and practices, is that we measure what doctors are doing. Are they meeting all the check boxes? And I think that we as physicians really are going to have to start to have a cultural shift as we realize that quality is about getting the boxes checked, but it’s also about connecting with the patient, communicating with the patient. And so, it’s not that surprising to me that you could identify a “high quality doctor” and then get there and find that they spend the entire visit staring at the computer typing furiously trying to make sure they get everything done in the ten minutes.

Deborah Becker: So what do you recommend that patients do in terms of trying to find this information about quality? And what are we doing to try to make sure that that information is as comprehensive as possible and does include this patient experience that you’re referring to when doctors are rated?

So in Massachusetts, we’re very lucky in that we have a regional, nonprofit collaboration between hospitals, physicians and insurers that presents both these checked boxes. Do doctors measure all the right things and give all the right drugs? We present those data on the Massachusetts Health Quality Partner website, but MHQP also presents data about patient experience.

One of the things that is done in the United Kingdom is that patients are actually able to go on to some of these websites and both write about their experience and read about the experience that other patients have had. And similar to a review of a hotel or a restaurant, you can actually read the reviews and say, ‘OK, is this a person that shares my values?’ And if they are, then if they like this doctor, it might be a doctor that I would choose.

If there are a bunch of online reviews of a doctor, I’m obviously going to trust my neighbor over that. I’d look for word of mouth and I presume a lot of other patients probably do the same thing. Where should they look for information about a doctor and what do you find to be most useful?

Word of mouth can still be one of best ways to find a doctor. If you really want to go with a scientific sample that gets the most patients and really you can be very sure of the results and you don’t have this issue of who’s writing in and who are these people. I think a patient experience survey in what’s presented on the MHQP website can be extremely useful. But if you’re somebody who has special needs or unique needs or really wants something very specific, something like online reviews can be helpful as well.

I think it’s tough when you’ve got the whole art, science question in medicine and rating quality when it seems to be a mixture of both, really.

And I think, overtime, websites will emerge actually that will be more like dating websites than anything else, where you type in your specific needs and at the end of the day you get out a match or a few matches that might be right for you. There will be a time when you can say, ‘OK, I need this insurance and this doctor and this kind of communication style,’ and you type that in and the website gives you the answer that you want. It’s not here yet, but I don’t think it’s too far away.

The Blue Cross Blue Shield of Massachusetts Foundation, the Harvard School of Public Health (HSPH) and WBUR worked in partnership to produce Sick in Massachusetts. The Foundation commissioned and funded the HSPH poll. An independent research firm, SSRS, conducted the telephone interviews and provided WBUR with the names of poll participants. WBUR met with the partners to review the poll questions and analyze the results. WBUR shared story scripts with Robert Blendon at HSPH for fact checking purposes. WBUR, using internal editing procedures, decided how to frame and expand on issues raised by the results.

Please follow our community rules when engaging in comment discussion on wbur.org.
  • http://pulse.yahoo.com/_MH7ATSNYASMCJO3MWNJ4C4T2KY Olivia

    I was in a AA meeting once and the speaker mentioned Dr Kishore, and the entire room erupted into laughter. I saw him back in the late 90s and he was a quack then. He was FAR from free. He had been fined years ago because when you sat in his waiting room (an hour was considered quick) he’d bill the insurance co’s for that time. Then once you saw him he’d tell you what a great guy he was for working with addicts. Ive been clean for over 10 years now and those professionals who really helped me were ones that didnt need to continiously pat themselves on the back. Addicts are a nightmare to work with, and I commend all those that put up with it all to help those in need. But theres no way you’re ever going to convince me Kishore was one of those people.
    This Fool Punyamurtula Kishore MD aka MAD DOG was never licensed by Mass. Dept of Public Health to practice Addiction Medicine. Punyamurtula Kishore MD aka MAD Dog Millionaire is a fraud ,
    The American College of Addiction Medicine and the National Library of Addiction has never existed except on paper. Punyamurtula Kishore has been indicted by 3 Grand Juries for Medical Insurance Fraud , bribery and giving out and receiving kickbacks. He was involved in Corruption when he was the Medical Director at the Massachusetts Dept. of Correction , Martha Eliot Health Ctr , Roxbury Comprehensive Health Ctr. and his possess Medical Practice , Preventive Medicine Associates.formerly Addiction Medicine Associates. He used two entities he created on paper that never existed called the National library of Addictions and the American College of Addiction Medicine to advocate his emergence in the field of addiction medicine. This unscrupulous MD used and exploited his patients and employees for financial wealth. The only thing that MAD DOG MILLIONAIRE aka Punyamurtula Kishore cared about

  • civilsocietyboston

    Civilsociety Boston                     

    OPEN LETTER TO THE GENERAL MANAGER WBUR: REGARDING: CYBERBULLYINGPaul LaCamera
    General Manager
    WBUR
    890 Commonwealth Avenue
    Boston MA 02215

    Reference: Cyber Bullying, Cyber Stalking, Cyber Hate Speech

    URL: http://www.wbur.org/2011/09/28

    URL: http://www.wbur.org/2011/09/27

    URL: http://www.wbur.org/2012/06/07

    URL: http://www.wbur.org/2012/06/12

    Dear Dr. LaCamera:

    Your organization is a champion of Anti Cyber bullying coverage. URL: http://www.wbur.org/2012/05/17

    Unfortunately your comment section in the URLs listed above
    is serving as a venue for Cyber Bullying, Cyber Stalking and Cyber Intimidation/Rant and Hate Speech targeting a Doctor.

    As you are aware this is a crime under 18 U.S.C. § 875(c) which criminalizes the making of threats via Internet.

    Your Community Rules also prohibit such conduct. URL: http://www.wbur.org/community/

    The Violations are numerous and have been reported previously.
    The individual/individuals keep posting.

    I seek your good offices to put an end to this either by removing and closing the Comments Section and or sending a legal notice to the Offender.

    A prompt response is needed to stop this harassment and intimidation. The individual is also posting these links to twitter accounts and pornography sites.

    Please take action.

    SincerelyCivil SocietyBoston6.21.12
    OPEN LETTER TO THE GENERAL MANAGER WBUR: REGARDING: CYBERBULLYINGPaul LaCamera
    General Manager
    WBUR
    890 Commonwealth Avenue
    Boston MA 02215

    Reference: Cyber Bullying, Cyber Stalking, Cyber Hate Speech

    URL: http://www.wbur.org/2011/09/28

    URL: http://www.wbur.org/2011/09/27

    URL: http://www.wbur.org/2012/06/07

    URL: http://www.wbur.org/2012/06/12

    Dear Dr. LaCamera:

    Your organization is a champion of Anti Cyber bullying coverage. URL: http://www.wbur.org/2012/05/17

    Unfortunately your comment section in the URLs listed above
    is serving as a venue for Cyber Bullying, Cyber Stalking and Cyber Intimidation/Rant and Hate Speech targeting a Doctor.

    As you are aware this is a crime under 18 U.S.C. § 875(c) which criminalizes the making of threats via Internet.

    Your Community Rules also prohibit such conduct. URL: http://www.wbur.org/community/

    The Violations are numerous and have been reported previously.
    The individual/individuals keep posting.

    I seek your good offices to put an end to this either by removing and closing the Comments Section and or sending a legal notice to the Offender.

    A prompt response is needed to stop this harassment and intimidation. The individual is also posting these links to twitter accounts and pornography sites.

    Please take action.

    SincerelyCivil SocietyBoston6.21.12

  • civilsocietyboston

    Civilsociety Boston                      OPEN LETTER TO THE GENERAL MANAGER WBUR: REGARDING: CYBERBULLYINGPaul LaCamera
    General Manager
    WBUR
    890 Commonwealth Avenue
    Boston MA 02215

    Reference: Cyber Bullying, Cyber Stalking, Cyber Hate Speech

    URL: http://www.wbur.org/2011/09/28

    URL: http://www.wbur.org/2011/09/27

    URL: http://www.wbur.org/2012/06/07

    URL: http://www.wbur.org/2012/06/12

    Dear Dr. LaCamera:

    Your organization is a champion of Anti Cyber bullying coverage. URL: http://www.wbur.org/2012/05/17

    Unfortunately your comment section in the URLs listed above
    is serving as a venue for Cyber Bullying, Cyber Stalking and Cyber Intimidation/Rant and Hate Speech targeting a Doctor.

    As you are aware this is a crime under 18 U.S.C. § 875(c) which criminalizes the making of threats via Internet.

    Your Community Rules also prohibit such conduct. URL: http://www.wbur.org/community/

    The Violations are numerous and have been reported previously.
    The individual/individuals keep posting.

    I seek your good offices to put an end to this either by removing and closing the Comments Section and or sending a legal notice to the Offender.

    A prompt response is needed to stop this harassment and intimidation. The individual is also posting these links to twitter accounts and pornography sites.

    Please take action.

    posting these links to twitter accounts and pornography sites.

    Please take action.

    SincerelyCivil SocietyBoston6.21.12

  • Civilsocietyboston

    STOPBULLYING.GOV

    Report Cyberbullying

    When cyberbullying happens, it is important to document and report the behavior so it can be addressed.
    Steps to Take ImmediatelyReport Cyberbullying to Online Service ProvidersReport Cyberbullying to Law EnforcementReport Cyberbullying to Schools
    Steps to Take Immediately
    Don’t respond to and don’t forward cyberbullying messages.Keep
    evidence of cyberbullying. Record the dates, times, and descriptions of
    instances when cyberbullying has occurred. Save and print screenshots,
    emails, and text messages. Use this evidence to report cyberbullying to
    web and cell phone service providers.Block the person who is cyberbullying.
    Back to top
    Report Cyberbullying to Online Service Providers
    Cyberbullying often violates the terms of service established by social media sites and internet service providers.
    Review their terms and conditions or rights and responsibilities sections. These describe content that is or is not appropriate.Visit social media safety centers to learn how to block users and change settings to control who can contact you.Report cyberbullying to the social media site so they can take action against users abusing the terms of service.  
    Back to top
    Report Cyberbullying to Law Enforcement
    When cyberbullying involves these activities it is considered a crime and should be reported to law enforcement:
    Threats of violenceChild pornography or sending sexually explicit messages or photosTaking a photo or video of someone in a place where he or she would expect privacyStalking and hate crimes
    Some states consider other forms of cyberbullying criminal. Consult your state’s laws and law enforcement for additional guidance.
    Back to top
    Report Cyberbullying to Schools
    Cyberbullying
    can create a disruptive environment at school and is often related to
    in-person bullying. The school can use the information to help inform
    prevention and response strategies.In many states, schools are required to address cyberbullying in their anti-bullying policy. Some state laws also cover off-campus behavior that creates a hostile school environment.

  • Anti Cyber Bullies

    Legislation geared at penalizing cyberbullying has been introduced in a number of U.S. states including New York, Missouri, Rhode Island and Maryland. At least seven states passed laws against digital harassment in 2007. Dardenne Prairie of Springfield, Missouri, passed a city ordinance making online harassment a misdemeanor. The city of St. Charles, Missouri has passed a similar ordinance. Missouri is among other states where lawmakers are pursuing state legislation, with a task forces expected to have “cyberbullying” laws drafted and implemented.[46] In June, 2008, Rep. Linda Sanchez (D-Calif.) and Rep. Kenny Hulshof (R-Mo.) proposed a federal law that would criminalize acts of cyberbullying.[47]
    Lawmakers are seeking to address cyberbullying with new legislation because there’s currently no specific law on the books that deals with it. A fairly new federal cyberstalking law might address such acts, according to Parry Aftab, but no one has been prosecuted under it yet. The proposed federal law would make it illegal to use electronic means to “coerce, intimidate, harass or cause other substantial emotional distress.”
    In August 2008, the California state legislature passed one of the first laws in the country to deal directly with cyberbullying. The legislation, Assembly Bill 86 2008, gives school administrators the authority to discipline students for bullying others offline or online.[48] This law took effect, January 1, 2009.[49]
    A recent ruling first seen in the UK determined that it is possible for an Internet Service Provider (ISP) to be liable for the content of sites which it hosts, setting a precedent that any ISP should treat a notice of complaint seriously and investigate it immediately.[50]
    18 U.S.C. § 875(c) criminalizes the making of threats via Internet.
    Harmful effects

    Research had demonstrated a number of serious consequences of cyberbullying victimization.[10][29][30][31] For example, victims have lower self-esteem, increased suicidal ideation, and a variety of emotional responses, retaliating, being scared, frustrated, angry, and depressed.[29]
    One of the most damaging effects is that a victim begins to avoid friends and activities, often the very intention of the cyber-bully.
    Cyberbullying campaigns are sometimes so damaging that victims have committed suicide. There are at least four examples in the United States where cyber-bullying has been linked to the suicide of a teenager.[29] The suicide of Megan Meier is a recent example that led to the conviction of the adult perpetrator of the attacks.
    Intimidation, emotional damage, suicide
    According to the Cyberbullying Research Center, “there have been several high‐profile cases involving teenagers taking their own lives in part because of being harassed and mistreated over the Internet, a phenomenon we have termed cyberbullicide – suicide indirectly or directly influenced by experiences with online aggression.”[51]
    The reluctance youth have in telling an authority figure about instances of cyberbullying has led to fatal outcomes. At least three children between the ages of 12 and 13 have committed suicide due to depression brought on by cyberbullying, according to reports by USA Today and the Baltimore Examiner. These would include the suicide of Ryan Halligan and the suicide of Megan Meier, the latter of which resulted in United States v. Lori Drew.
    Lost revenue, threatened earnings, defamation
    Studies are being conducted by large companies to gauge loss of revenue through malicious false postings. Cyberstalkers seek to damage their victim’s earnings, employment, reputation, or safety. A 2008 High Court ruling determined that, generally speaking, slander is when a defamatory statement has been made orally without justification. Libelous statements are those that are recorded with some degree of permanence. This would include statements made by email or on online bulletin boards.[52]
    Adults and the workplace

    Cyberbullying is not limited to personal attacks or children. Cyberharassment, referred to as cyberstalking when involving adults, takes place in the workplace or on company web sites, blogs or product reviews.
    A survey of 1,072 workers by the Dignity and Work Partnership found that one in five had been bullied at work by e-mail and research has revealed 1 in 10 UK employees believes cyberbullying is a problem in their workplace.[53]
    Cyberbullying can occur in product reviews along with other consumer-generated data are being more closely monitored and flagged for content that is deemed malicious and biased as these sites have become tools to cyberbully by way of malicious requests for deletion of articles, vandalism, abuse of administrative positions, and ganging up on products to post “false” reviews and vote products down.
    Cyberstalkers use posts, forums, journals and other online means to present a victim in a false and unflattering light. The question of liability for harassment and character assassination is particularly salient to legislative protection since the original authors of the offending material are, more often than not, not only anonymous, but untraceable. Nevertheless, abuse should be consistently brought to company staffers’ attention.
    Recognition of adult and workplace cyberbullying tactics
    Common tactics used by cyberstalkers is to vandalize a search engine or encyclopedia, to threaten a victim’s earnings, employment, reputation, or safety. Various companies provide cases of cyber-stalking (involving adults) follow the pattern of repeated actions against a target. While motives vary, whether romantic, a business conflict of interest, or personal dislike, the target is commonly someone whose life the stalker sees or senses elements lacking in his or her own life. Web-based products or services leveraged against cyberstalkers in the harassment or defamation of their victims.
    The source of the defamation seems to come from four types of online information purveyors: Weblogs, industry forums or boards, and commercial Web sites. Studies reveal that while some motives are personal dislike, there is often direct economic motivation by the cyberstalker, including conflict of interest, and investigations reveal the responsible party is an affiliate or supplier of a competitor, or the competitor itself.

  • INTERNET VIGILANCE

    General Information

    Bullies are notorious for tormenting their victims face to
    face – usually at school – on the playground or in the cafeteria. But in
    recent years the Internet has not only increased the ability to bully
    at school, but has brought the problem into our homes and elsewhere –
    actually just about anywhere – at any time.

    Cyber bullying is the repeated use of information technology,
    including e-mail, instant messaging, blogs, chat rooms, pagers, cell
    phones, and gaming systems, to deliberately harass, threaten or
    intimidate others. Unlike physical bullying, where the victim can walk
    away, technology now allows for continuous harassment, from any
    distance, in a variety of ways.

    While cyber bullying is often done by children who have
    increasing access to these technologies, it is by no means confined to
    children. The problem is compounded by the fact that bullies are often
    anonymous and never have to confront their victims. This makes it
    difficult to trace the source, and encourages bullies to behave more
    aggressively than a traditional “physical world” bully.

    The full scope of cyber bullying is difficult to measure.  However, according to a recent survey, 42% of children have been cyber bullied and 35% have been threatened online.
    Peer approval is very important to children. This means that cyber
    bullying can have a negative or even destructive emotional effect on
    victims, ranging from hurt feelings to intense anger. It can also result
    in significant depression and in the most severe cases has even
    resulted in suicide. Unfortunately, children rarely report occurrences
    to an adult.

    Cyber bullying is accomplished in many ways, including*:

    Flaming is a type of online fight.
    It is an act of sending or posting electronic messages that are
    deliberately hostile, insulting, mean, angry, vulgar or insulting, to
    one person or several, either privately or publicly to an online group. Denigration also known as “dissing,”
    occurs when a person sends or publishes cruel rumors, gossip or untrue
    statements about a person to intentionally damage the victim’s
    reputation or friendships.Bash boards are online bulletin boards where people post anything they choose. Generally, the postings are mean, hateful and malicious.Impersonation can be particularly
    harmful and occurs when someone pretends to be or poses as another
    person. This is usually accomplished by breaking into someone’s account,
    by stealing a password and perhaps changing it, or by maliciously using
    that information provided by a friend (one reason to never give a
    password to anyone but a trusted adult). Once the impersonator has
    access to the victim’s information, considerable damage can occur. By
    sending out emails supposedly from the victim or by posting material
    online, the victim’s reputation or friendships can be irreparably
    harmed.Outing occurs when someone sends
    or publishes confidential, private, or embarrassing information, online.
    Private email messages or images meant for private viewing, is then
    forwarded to others.Trickery is when a person
    purposely tricks another person into divulging secrets, private
    information or embarrassing information, and publishes that information
    online.Exclusion is an indirect method of online bullying, intentionally excluding someone from an online group or community.Harassment is when the electronic bully repeatedly sends insulting, hurtful, rude, insulting messages.Happy slapping is a relatively new
    type of bullying. This occurs when an unsuspecting victim is physically
    attacked, in person, as an accomplice films or take pictures of the
    incident. The image or video is then posted online or distributed
    electronically. Often the attackers will say it was only a prank or
    joke, hence the term “happy slapping”. Happy slapping is becoming more
    common, especially since many cell phones now include cameras.Text wars or attacks are when
    several people gang up on the victim, sending the target hundreds of
    emails or text messages. Besides the emotional toll it can take on the
    victim, the victims’ cell phone charges can be costly.Online polls ask readers to vote
    on specific questions, often very hurtful and demeaning, such as “Who is
    the ugliest person in 8th grade” or “Who do you love to hate?”Sending malicious code intentionally, to damage or harm the victim’s system or to spy on the victim.Images and videos are a rapidly
    growing concern. Due to the prevalence and accessibility of camera cell
    phones, photographs and videos of unsuspecting victims, taken in
    bathrooms, locker rooms or other compromising situations, are being
    distributed electronically. Some images are emailed to other people,
    while others are published on video sites such as YouTube.Griefing involves chronically
    causing grief to other members of an online community, or rather,
    intentionally disrupting the immersion of another player in their game
    play. http://www.microsoft.com/protect/family/activities/griefers.mspx

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