WGBH Radio; The Callie Crossley Show

I'm Calen Crossley and this is the Calla Crossley Show. The Tea Party movement has gained momentum as a political force by claiming the principles of the fight for freedom. Their original 18th century won as their own serving as a backlash to President Obama's agenda. They helped take Ted Kennedy's Senate seat away from the Democrats and nearly When President Obama's chief domestic initiative health care reform off the road. It's a party that's hard to get a grip on taking on both liberals and social conservatives who take a forensic look at the Tea Party pathology with the poor whose new book looks at how they're the latest movement to repackage the ideology of our founding fathers. But first we examine new initiatives afoot to get health care out of the Stone Age. When it comes to using technology and social media. Up next getting the word out from the spin doctors to real doctors. First the news. From NPR News in Washington I'm Lakshmi saying President Obama is holding

bilateral talks with the leaders of Israel and the Palestinian Authority on the eve of the first direct Israeli-Palestinian meeting in about two years. All parties in Washington are strongly denouncing Hamas's deadly attack on four Israeli settlers in the West Bank yesterday. President Obama warned Islamist militants which try to sabotage the talks there are going to be extremists and rejectionists who rather than seeking peace are going to be seeking destruction alongside President Obama today Prime Minister Benjamin Netanyahu welcomed the U.S. has public support. Well thank you Mr. President for expressing what I think is the sentiment of the decent people everywhere in the face of this. Savagery and brutality. Palestinian Authority leader Mahmoud Abbas whose Fatah party runs the West Bank also strongly denounced the attack by Hamas which runs Gaza. Abbas is due to meet with Mr. Obama later today. Dutch officials have freed two men who had been

taken into custody Monday because of suspicious travel patterns. NPR's Carrie Johnson reports on an end to the international incident. Authorities in the Netherlands detained the man Monday after they arrived in Amsterdam on a United Airlines flight. They arouse law enforcement suspicion in the US because they had changed their travel arrangements and one of them had taped together in his luggage watches cellphones in a Pepto Bismo bottle. FBI agents panned out to learn more about the backgrounds of the men who are of Yemeni descent but they concluded the man had no ties to terrorism. The two didn't even know each other authorities say and they hadn't been on any terror watch lists. U.S. law enforcement sources say the episode resulted from a series of odd coincidences and neither man will be charged with any wrongdoing. Carrie Johnson NPR News Washington. Authorities say at least 14 people have been killed in a series of suicide bombings in the eastern Pakistani city of Lahore today. Dozens of others have been

wounded. Hurricane Earl now a Category 3 storm is still making its way toward the eastern U.S.. The National Hurricane Center says it's been nearly 20 years since such a large storm targeted the entire eastern seaboard. NPR's Kathy Lohr reports some in North Carolina are evacuating a hurricane warning is now in effect for parts of North Carolina and northeast toward the Virginia border. A mandatory evacuation is in effect on Coke Island and visitors on Hatteras Island in North Carolina's Outer Banks are being told to leave. Officials fear high waves could wash out the main highway. Forecasters are warning residents all along the East Coast to be prepared to evacuate. Kathy Lohr NPR News. Amid renewed hopes about the economy Dow's going up 230 points at last check at ten thousand two hundred forty five. This is NPR. The number of planned layoffs at big firms fell 17 percent in August the lowest level in a decade. The consulting firm Challenger Gray and Christmas says

businesses cut more than 34000 jobs last month down from 41000 in July. But as Daniel Carson tells us some Analysts caution the drop doesn't mean the labor market is turning around. The bigger picture shows an even more dramatic turnaround in the first six months of this year businesses shed almost 300000 jobs compared to nearly 900000 lost in the first half of last year. The problem says John writing chief economist at already economics is that big businesses are sitting on a nearly 2 trillion dollar pile of cash and doing nothing. We're not seeing the hiring we would normally see so things aren't getting worse in terms of layoffs. But they're not getting that much better in terms of when the government comes out with its employment report on Friday. Writing predicts the private sector added around 25000 jobs last month a tenth of what he says is needed to start pushing the unemployment needle down. For NPR News I'm Daniel Carson manufacturing companies are still leading the economic recovery the Institute for Supply Management with which surveys about

350 companies announced today that its manufacturing index rose to fifty six point three in August a reading above 50 indicates growth higher demand for capital equipment and supplies as well as rising exports have helped drive expansion for more than a year now but a measure on new orders dropped to its lowest level in over a year suggesting that the manufacturing sector will slow in the coming months. I'm Lakshmi saying NPR News in Washington. Support for NPR comes from IBM working to help midsize businesses become the engines of a Smarter Planet. Learn more at IBM dot com slash engines. Good afternoon I'm Kalee Crossley and this is the Calla Crossley Show technology and social media are pretty much fully integrated in our everyday lives. But once fear where it's slow to catch on is health care. Joining me today to talk through how social media could change our

quality of care are Dr. Ronald Dixon an internist at Mass General Hospital where he also serves as a director of the virtual practice project. And Dr. Tara lagu a physician researcher in the center for quality care research at Baystate Medical Center. She's also an assistant professor at Tufts University School of Medicine. Welcome to you both. Thanks for having cue. Now before we dive in listeners we want to hear from you. Would you like to see social media such as text messaging and video conferencing become a part of your care. How do you see the traditional practice of medicine getting in the way of your care. We're at 8 7 7 3 0 1 89 70. That's 8 7 7 3 0 1 89 70. So Dr. Dixon I want to start with you because yours is the virtual practice project and you did a paper which the title says it all in hand saying primary care through online communication which means that if you communicate with your doctors nurses health care professionals online techs

whatever video you're going to be in better health. That's correct. I mean the premise is that using the same technologies that we use every day in our daily lives to communicate with friends family members colleagues. Could enhance the way that your relationship develops with your caregivers whether it's your primary care doctor or nurse even a specialist. So why are we depending on visits as the sole way to deliver health care when visits are sporadic. There is the opportunity for continuous health care delivery and monitoring through the use of online media and technology that's readily available. Now before I go to Doctor look one of the things that you have examined are just whether or not the way medicine is practiced traditionally is something that doctors are reluctant to let go of. And you found absolutely one of the one of the studies that we did was

look at video conferencing as compared to face to face visits. And we did a large randomized trial looking at this with my colleague James stall with one hundred patient one hundred eighty patients go through the trial. And what was interesting was we found no significant difference in the diagnosis evaluation or management that a physician found with either modality so if they saw the patient face to face or the videoconferencing modality they came to the same diagnostic decisions. So we're not just talking about communication I'd like to make that clear communication has value. But what health care is about is making decisions. We need to diagnose evaluate and manage our patients for their problems. And we believe that online media can really aid in that process. Dr. lagu now to you. You study doctors with blogs so that's kind of a little bit opposite of what Dr. Dixon has found he's he's dealing with maybe some of the physicians little bit more

reluctant to go that way. And you were looking at some doctors who maintain blogs and were out there using social media. And what did you find. Well you know we did the blog study in 2005 so it was right when blogs were starting to come out. And at the time I think there was a lot of naivete on the part of doctors about the fact that the Internet is a public place. And so when we did that project we actually found that there were doctors who were writing information about patients they were you could identify some of the doctors based on details they gave in the blogs. I think a good outcome of that study was that since that time a lot of doctors who write blogs have really changed the way they approach writing blogs and there's been a real change in the community in terms of online presence. I think physicians have in the last few years become more aware of the fact that the Internet is a public place. And more recently we studied this idea that patients can also

go online and write about their experience with their doctors. And that's the project and more recently on physician writing websites. And I think that what's become clear through the course of these two studies is that both physicians and patients are slow to adopt the Internet as a method for communicating with each other and for providing feedback about health care but that it has a lot of potential both for physicians and patients to improve the quality of care. That doctor Tara lagu She's a physician researcher in the center for quality care research at Baystate Medical Center. She's also an assistant professor at Tufts University School of Medicine. I'm also joined by Dr. Ronald Dixon an internist at Mass General Hospital where he also serves as the director of the virtual practice project. Now Dr. lagu before I go back to Dr. Dixon let me just offer this statistic which I find interesting 61 percent of Americans go online according to a study by the Pew Internet and American Life Project but only one in 10 of

them according to another poll actually e-mail their doctors. So what's going on there. I think that patients may be a little bit hesitant to use the Internet both to review their doctors and you know Dr. Dixon can talk more about this but also perhaps to e-mail their doctors. I think that physicians and patients also feel that the relationship is a little bit sacred and so perhaps patients are. Hesitant to initiate both online contact via e-mail and also to write reviews about doctors. I think that this is why we as physicians should perhaps take the lead on encouraging our patients to both go online and read and write reviews about doctors and about hospitals and also perhaps you know Dr. Dixon can provide us with more information about how we can do this so that it maintains confidentiality in privacy. But to also you know what their doctors and connect through other ways via the Internet. I think that maybe there is has it is because patients do

feel like physicians should set the tone and should provide feedback about how to approach the relationship. And so I think it's maybe our responsibility to take steps to do that. Dr. Dixon I do want you to weigh in on that. Let me just give a shout out to my dentist who set up an e-mail function. Dr. Robert Zilog I'm talking about you and he's very in touch with all of his patients. And that was his initiative so following what Dr. has said. I mean I was like wow I'm online all the time but it never occurred to me that I could have an exchange with him. It's absolutely possible and in fact where we are at Mass General at my practice and our patients email us regularly and it's a regular part of my job to review e-mails that I receive from patients and to respond to them. And we have a trio system in place that allows our medical assistants and nurses to help with the process flows involved in managing that information. The comedy is that most of that work happens on our own time and you have to be very

careful especially with the state of primary care. These days it's a job that most medical students are avoiding because of the pressures involved in being on a treadmill seeing patients and not really feeling that doctors have the time to connect with patients as they used to because of those pressures. You have insurance companies that ask you to fill a lot of paperwork you have results of follow up and referrals to manage adding e-mail. Whether it's secure this has to be secured just to get to a doctor whose point has to be secure. Adding e-mail communication takes time and we can't. And anything on to the time pressures of modern day physicians especially primary care physicians. So without a reimbursement model that makes sense and currently there is no model that makes sense. You cannot ask physicians to accept. Sort of modes of communication and validation and management because then it just amounts to them doing more work but not generating anything to keep their practices

afloat. So listeners let me let me highlight what Dr. Dixon has just said and that is if you come into his office he can get reimbursed for that. But if he has to email you in a way that's more efficient for you and you have more contact with him then he has less of an opportunity to be paid for that work so he's essentially doing work in off time really that's that you're just not getting paid and then to add to that we know in Massachusetts if you don't know there is a shortage of primary care physicians and since they are the entry point into everything else in the health care system it's it's really a critical kind of situation. Now there is some reimbursement by some insurers but I understand it's not nearly what it would be if it was an office visit. I must add there is some promise on that front so there are some insurers that are actually paying for even zits. And there are some reimbursement models that are different than the current model which is fee for service where you get paid for when you see the patient there. There are some models coming down

the pike that would allow you to get paid for the management of the patient in addition to when you see the patient face to face and that would encourage physicians to embrace and adopt these types of technologies I'm talking about. And what about liability you both touched on it a little bit. But you know as Dr. lagu said back to you in just a second. You know when the doctors first did the blogs they're probably they were putting on some putting some information there that maybe should have been there. So do patients have that fear are doctors more fearful that somehow if I'm in a constant e-mail connection with my patient I missed something they sent me a tweet I don't get it now I'm liable is that something that's putting it right so I think we have to be careful about them in which the communication is delivered. I think it has to be secure and it has to be documented. Currently there is no platform that allows for such a mechanism and that needs to be developed right now in my practice we have a gateway that patients use to excess of physicians. Therefore all of the documentation is automated and we get a record of when a patient sends

a message. I certainly wouldn't want tweets going out into the ether and me not receiving them and then being liable so that is a certain definite concern. Well let's just talk about Dr. Dixon what kind of conditions really adapt themselves best to this kind of online. At this point. At this point I would say most primary care conditions that we treat that are chronic things like hypertension management diabetes management depression management all in themselves very well to a mixture of in-person visits and memory never saying that we should replace in-person visits with online technologies. We still need to see physicians but a lot of the time we want some continuity in the management of those conditions and by using these online technologies whether it's messaging through a portal whether it's video conferencing whether it's a telephone and just having a phone call we can augment the continuity of care for these conditions and allow us to perhaps

adjust medications monitor symptoms a lot more accurately than we do on a sporadic basis. Dr. Lugo when you were reviewing the medical websites where where patients are or are consumers are taking themselves and reviewing doctors experience. Are you finding that that is about what the patients with the chronic conditions are checking and more. So what we did was we looked at websites physician rating websites they're called which are sites where patients can go online and write reviews about doctors it's like Trip Advisor but for your doctor as opposed to actually providing feedback directly to your doctor you're putting a review out there that not just your doctor can see but also other patients can see. And I think in contrast to what Dr. Dixon does I do more of a big picture how to how can the Internet improve quality of care and improve interactions between patients and their doctors in a more global way.

So what we were seeing wasn't so much feedback about conditions and it's interesting because doctors I think really respond and get very afraid when they think about patients going online writing reviews talking about them and talking about their experience with their doctor. I think a lot of doctors initially were very scared by that. And so our study was really intended to figure out when patients go online and write reviews about doctors what are they saying. And is it good or bad. And is it really as dangerous as doctors perceive it's going to be. And what we found was that in fact it has more specs of its more like Facebook its more social networking in many ways than it is providing criticism to doctors patients talk about their experience they talk about the parking they talk about the receptionist they talk about the nurses. Most didn't talk about technical issues like disease management they didn't talk about the quality of the diagnosis. They really talked about the entire experience. And I think our project was a lesson for doctors that we

can become a little more customer service oriented sometimes because I think we get trained to think about just our interaction and not about the entire patient's experience. And Doctor Who with the office visits becoming. Little bit more rushed in these days of shorter times because of reimbursement. I mean the entire patient experience is often not something that physicians may even be aware of. I think it's just such a hard situation particularly for primary care doctors. I don't know how MOST DO IT managing these incredibly busy schedules and trying to maintain a practice and and manage a practice. It's really challenging. And so I can see how it could be really scary to think that on top of trying to meet all the quality indicators and get your diabetics managed appropriately and make all your follow up appointments and not miss a thing it can be very frustrating to think that then your patients leave your office go online and complain about the magazines in the

waiting room. I can understand that that would be a little bit scary to think about. On the other hand. We're really seeing this as a possibility for improving quality of care in a way that wouldn't stretch doctors time. I mean these are things that a lot of times can be improved without costing the doctors more phone calls more e-mails and may bring patients back. And that's really a win win for the doctors and the patients. All right. We're talking about health care and how the doctor patient relationship could improve through the use of social media. My guests are Dr. Tara lagu who's with the Bay State Medical Center and Tufts University School of Medicine and Dr. Ronald Dixon. He's an internist at Mass General Hospital and the head of the virtual practice project. Listeners let us know how your current experience in the healthcare system could benefit from integrating social media. Or do you like doing business the old fashion way in the doctor's office. We're at 8 7 7 3 0 1 8 9 7 8. That's 8 7 7 3 0 1 89 70. We'll be back after this break stay with

us. With the. With the. With the. Support for WGBH comes from you. And from Ace ticket. With tickets to sports concerts and theatre events nationwide. Ace ticket can help you find tickets to Red Sox Patriots Celtics and Bruins games and many other venues. 1 800 my seats or ticket dot com. And from the Franklin Jay and Stephanie M. Marriott Memorial Fund. Established to support public radio and public television programs devoted to music. Learn more at WGBH dot org slash planned giving. To everyone who made a contribution during the WGBH tend of the fiscal year community campaign.

THANK YOU THANK YOU THANK YOU THANK YOU THANK YOU. Your gift is going straight toward supporting the programs that you depend on. If you didn't have a chance to get involved you can always start your membership online or WGBH dot org. I'm crazy. On the next FRESH AIR. OUR COUNTRY MUSIC WE continues with interviews from our archive featuring Willie Nelson who brought his guitar and perform some of his best known songs. And the late Well ingenues join us razoo. Crazy for soul food. The fourth WGBH with a $90 contribution right now might be nine point seventy six. Thanks. What it takes to catch David sit there like a listers Hanover theatre on

September 30. Details online at WGBH dot org slash box office. Good afternoon I'm Cally Crossley and this is the Kelly Crossley Show we're talking about integrating social media into the health care system. My guests are Dr. Ronald Dixon an internist at Mass General Hospital where he also serves as the director of the virtual practice project and Dr. Tara lagu a physician researcher in the center for quality care research at Baystate Medical Center. She's also an assistant professor at Tufts University School of Medicine. Listeners we want to hear from you to the doctors out there. Would you like to see medicine go in this direction or do you fear you might be on call 24/7 with online access. We're 8 7 7 3 0 1 89 70. That's 8 7 7 3 0 1 89 70 and we have a call. Dr. Melissa Go ahead please. Hi Kelly Yes. I've I've never made a phone call to a radio show before so this is the first I'm a little bit

nervous. I'll go right ahead we're friendly here. I haven't. Hard to bite anybody else's head off. I'm a chiropractor. I have 20 years of experience and as I was telling your screener my dearest hope is that I will be able to finish out my professional career without venturing further into technology than I already have. 8 it's an intrusion into my life and it is a tremendous imposition. I don't want to have to put my patient notes online I don't want to have really any experience where where things that are written in print can be misconstrued I'd like to have the face to face hands on type of experience both with my patients as well as with other referring positions so that we can coordinate care. I find that it might be a small town approach but overall it's. A much more holistic approach to wellness and to go into business as well.

All right I'm going to let Dr. Ronald Dixon see if you can convince you otherwise go ahead Dr. Dixon. So the first point I'd like to make it certainly would never want to replace the relationships that we have with either our patients who are colleagues with online media and technologies. Secondly although it is it is wonderful if you can have all of your interactions in person the way that primary care is going and most of how there is going is that we have decreased access to services and what we think that online technologies provide is a way to improve access allowing physicians to see the patients that most need to be seen while the patients have the opportunity to have their interactions with physicians and nurses in environments that are familiar to them whether it's their home or their office using technologies that are available to them. Alright next caller Rachel go ahead from still go ahead. Oh OK I think because you touched on what I was going to say. My daughter has a chronic medical

condition excuse me and I'm so she says a lot of specialists because of that. And one of the specialists you have e-mailed as part of his caring for patients. I just want to say how much easier it makes my life. You know if I have a quick question I just read them an e-mail and I know you know usually by the end of the day I'll have an answer because the questions that really isn't worthy. So I know if I could just. It makes things better at least on the patient's side. All right well I know that Dr. Dixon very happy to hear that you know it's interesting tell you things that are status are difficult to change and unfortunately a lot of the opposition you see these things come from the physician community more out of concern that the change is going to be unmanageable and that is going to create this onslaught of more work and a decrease in the personal satisfaction personal relationships that they have with patients and and physicians and

evidence suggests that that's not the case. So you're right. And one more call. Miriam Go ahead please from Arlington. Yes. Good to hear you Kelly. Thank you. Wonderful show. First of all I think my major point is that many of us have access to the technology. We've got our laptops. We've got our PCs. We are wired and many many people do not. And I see the shift. To these online services as perhaps this advantage NG people who do not have access easy access to technology. I also want to say that I that I taught writing for many many years. Fiction poetry whatever was given the opportunity to teach online courses and felt that it wasn't for me. I needed to see my students faces. Overall I certainly wasn't examining the way a doctor would.

I needed to be with them. I needed to hear the tone of their voice. Of course I saw them longer than 15 minutes. So I would like to see a mixture by the again I have these great concerns they get about more class division in this country and we see so much of it. Thank you that's a very good point. Dr. lagu you want to weigh in on that I'll ask Dr. Dixon as well. I think that I don't know. Yes thank you very much Maria. Thank you I think it's a really great point actually and I think even the issue of access for low income or for other socio economically disadvantaged people is extremely important. But I also think that there's a huge swath of our population which is the elderly which may have financial opportunity to use these resources but just can't because they don't have the experience or are not comfortable I was vacationing this last week and I was staying at the home of my retired friends and she said to me Oh I read your paper and then I immediately tried to go online and

figure out how to write about my doctor and I couldn't figure it out. And I said I understand that and I think that's a real concern if we make everything about online access then we definitely miss out on a portion of the population that may be among the most vulnerable. I don't think either of us who are on today are advocating that I think we're just saying let's be more patient centered and offer patients the opportunity to receive services or to communicate in ways that they're most comfortable. And so I think if she's not comfortable teaching an online class or my patient isn't comfortable emailing me or my elderly friends can't write reviews of their doctors online that's totally acceptable I think we just need to open our minds to the possibilities. All right Dr. Dixon I'm going to ask you to weigh in on that but before you do I just want to refer to the study that was conducted by a Dr. Michael Crowe Shaddy of Johns Hopkins Children's Center. He surveyed two hundred twenty nine parents 75 percent said they were regular e-mail users.

Ninety percent of those patients indicated they were open to using e-mail to communicate with their child's doctor. Although African-American respondents and those making $30000 or less were much less likely to agree. Now I know you've said you don't think there's going to be a division with this but is there is that should be a concern for people. You know it absolutely should and we certainly don't want to limit access in our ready access storage environment. The last thing you want to do is say well we're not going to really attempt to make any changes because we might exclude a certain part of the population. The system has already proven itself not to be most efficient. So we do need to innovate with regard to the issues that the caller raised and with what Dr. Goosen number one is that I'm talking about all sorts of devices mobile phones have sprung up as. Their use has increased the most in the lowest socioeconomic sectors of our country.

And I believe that mobile phones can provide excellent access to all sorts of modes of health care I have a colleague and a friend who is developing a business around. Text messaging young urban women about their HPV vaccine appointments to get them back for their second vaccine. Is it working is it. And is it appears to be working well. So we're using available technology that is exists that the urban environment is welcoming and it can augment the kind of care that we're delivering. And secondly with regard to the elderly. The elderly that the person is 60 years old now was 55 five years ago so anybody 55 now their likelihood of using the web using social media is going to be quite a bit higher than somebody who's 60 now so what you were going to see technology creep into the so into the older population.

Not not because it's more elderly friendly it's simply because older people are just getting more comfortable with technology so there's no need for us to say well let's wait until the people who are 25 or 65. We need to develop these things now. One one last thing from the study that I did. We looked at all the patients in our patient population so there was patients who are 80 whose video conferencing technology people who are 25 and across the board people were happy and excited to use the technology and what was interesting is that they found using technology easier than making an appointment with the office. And we should note that the fastest growing group on Facebook is over 50. All right Bruce from Marblehead Please go ahead. Hey tally great show as always I can I would count on you. Thank you. Oh I will have my. I'm elderly on

71 don't have a computer don't want one don't like technology. Filip an invasion of privacy. On the other hand I do feel that one should never generalize about any age group. You want to use technology fine but I'd like to the comment by one of their previous callers a teacher I was at two in the dear dead past beyond recall. You need space you need to read in Russian you need to feel the warm hand or the cold hand you to be hearing a real time voice. I'm reminded of some things if advertising on NPR now and says you can talk to a real human being 24/7. My other comment is that if we're really going to count and look at comments like Well I didn't like the magazines in the office or you know the doctor doesn't wear nice to his or the carpeting is ugly. All of them may be true but that's absolutely trivial and I

would shoot myself before I'd ever write a thing like that OK I'm going to let let the doctor respond because he does want to come off as a meanie I don't think he is. I think the best response to this case is a story and I completely grew the car again reiterate there was no intent to replace the relationship the people have with their physicians. That's a sacrosanct safe relationship where having face time is important. Touch is important. Touch is important for many physical ailments. I'm saying that we augmented that relationship through the use of these technologies in the story that I have as I had a patient who was diagnosed with lung cancer and we actually make the diagnosis from afar because I saw him before I left for a conference and deliver the news unfortunately over the phone. And after four months was a very aggressive lung cancer he ended up bedridden and basically getting palliative treatment. And he was a teacher like the prior caller but he was not technological

phobic. He was 65 at the time. And he had a lot of difficulty getting out of bed and he had quite a bit of pain from his cancer spread to his bones and he had problems with his role secretions which is common and what he actually suggested that we do with Skype and this was his suggestion and this is again this is a lot of patient centric stuff that we're talking about here. I know people who don't know what Skype is you can see the person on the screen Absolutely. So I could see him lying in his bed and we would basically go over his medication we'd have a visit which is what I still do that was some of my patients ask about his symptoms review his medications review if he'd had any studies in the interim because sometimes he would go in for studies and then we'd make decisions about how we can better manage his pain how we could better mention secretions. And we had six of those visits and the last was that he had before he died

was one of those Skype visit. So I again if you were to ask the patient how our relationship went he would certainly not say that it was harmed by this technology I would believe he he would feel that it really served his care at the end of life very effectively. Finally Dr. lagu and Dr. Dixon the American Recovery and Reinvestment Act of 2009 says we have to have secure patient physician messages so that we can get into this electronic records. So whether or not people have feelings about this kind of access or the way they communicate with doctors we're moving forward right Dr. logo this is going to happen. This is happening. Absolutely and I think this is sort of the future of online communication between physicians and patients which is that most likely the payment model is going to change and so as we transition away from fee for service it will actually

be more cost effective for doctors to implement a lot of these services because it won't cost them time it won't cost them a visit time. It will save them and help them take care of their patients and keep their patients out of the hospital. And so I think there's a really interesting future here where you know Dr. Dixon has a video conference with his patient at the end of the conference there is a series of questions that asked the patient if they were satisfied with the interaction. And both of our visions are sort of realized. All right Dr. Dixon It's happening. I agree it is happening. All right well you've seen the future and it is now as they say. We've been talking about bringing the health care system into the 21st century by way of social media. I've been speaking with Dr. Ronald Dixon an internist at Mass General Hospital where he also serves as the director of the virtual practice project. And Dr. Tara lagu a physician researcher in the center for quality care research at Baystate Medical Center. She's also an assistant professor at Tufts

University School of Medicine. Thank you both for joining me. Thank you very much. Up next putting the Tea Party in the context of American history with writer and history professor Jill Lepore. Stay with us. Support for WGBH comes from you. And from Ace ticket. With tickets to sports concerts and theatre events nationwide. Ace ticket can help you find tickets to Red Sox Patriots Celtics and Bruins games and many other venues. 1 800 my seats or Ace ticket dot com and from Skinner auctioneers and appraisers of antiques and fine art. You might consider auction when downsizing a home or selling a collection 60 auctions annually 20 collecting categories Boston in Marlborough online at Skinner Inc dot com and from the growing number of WGBH sustainers who manage their

contributions to public radio with the help of monthly installments and automatic renewals. Learn more about sustaining membership at WGBH dot org. This is eighty nine point seven WGBH Boston NPR station for trusted voices and local conversation with the takeaway. The Diane Rehm Show and the Emily Rooney show explore new voices with us all day long here on the new eighty nine point seven. WGBH. As a public radio listener you're probably familiar with this voice with its writer David Sedaris and he's coming to town laugh out loud radio with the contribution of ninety dollars and eighty nine point seven banks with a ticket to see his latest collection at the Hanover theatre on September 30th.

Just visit the box office run barefoot. Maybe better for their bodies than running shoes in the world on the radio. The afternoon I'm callin Crossley and this is the Kelly Crossley Show. That's the song. Rise up by Jeremy Cooper. The song was used to raise money for last week's Restoring Honor rally where multiple thousands gathered on the National Mall. Glenn Beck and Sarah Palin were at the helm of what looked and sounded like a 21st century tea party of sorts. Today we're taking a forensic look at the Tea Party pathology with my guest Jill Lapore. She's a professor of history at Harvard and a staff writer at The New Yorker and her new book is The Whites of Their Eyes the Tea Party's Revolution and the battle over

American history. Philip Hoare welcome. Thank you. So I got to get your take first of all about restoring honor rally What did you think. Well I. I didn't think too much attention to it. I knew a lot of people were quite dismayed about the political symbolism involved and claims made on either side about whether that was intentional or whether that was a kind of desecration I think the rhetoric as you know has been very heated especially this hot hot summer. Yes. Well you know the thing that's very interesting about your book is that you spent a quite a bit of time going to attend rallies like this here in Boston and really asking people you know why and why they were making that particular connection that they did to the Founding Fathers which is the point of your book that the Tea Party in its reincarnation at this moment really feels a connection to the founding fathers. Yeah and I think that's very genuine and for many people in the Tea Party quite a passionate piece of what draws them into the movement. The symbolism and actually even

in some literal sense the costuming I mean. That's what if I teach courses on the American Revolution at Harvard I've taught that course for a long time I used to teach at Boston University I taught a course on the revolution there and it's always some areas to go through the streets of Boston on a field trip with students and see the re-enactors and you know the people in the trolley tours and there's just a lot of revolutionary kitsch all over our city. You know you can't walk downtown without bumping into someone in a tri corner hat. So it was all over the last couple of years to see people coming out in those costumes to argue against the economic policies of the Obama administration. But in some ways it seemed to be a similar gesture actually I think that a lot of what brings people into the Tea Party is some of the same kind of in a stall for a simpler version of American history that draws people into heritage tourism. You know the kind of old style tours of Monticello or Mount Vernon or John Adams House and the dressing up in that play acting is a is a big part of I think in some ways the fun of the movement.

I have to say that I was in a cab this morning and I looked over and on the screen is a picture of a guy in a three cornered him wearing the appropriate revolutionary costume I guess symbolizing Boston I don't know I just thought wow that's really interesting because I'm going to talk to Joel or. Here's something that you wrote in your book that I thought was very interesting. This book also makes an argument about the American political tradition you're right nothing trumps the revolution from the start the tea party's chief political asset was its name the echo of the revolution conferred upon a scattered diffuse and confused movement a degree of legitimacy and the appearance almost of coherence. Aside from the name and the costume the Tea Party offered an analogy rejecting the bailout bailout is like dumping the tea. Health care reform is like the Tea Act. Our struggle is like theirs. So here we are and people are very serious about the work that they're doing now as members of the Tea Party however coherent It may or may not be having it. The basis of their ideology in the words of the

founding fathers. What do you say as an historian who you've studied this you've written this. And is there a connection that we're not thinking. Well it's. They are very serious about it I think it's important not to you know diminish that or to question the earnestness for most of the people in the movement I think for some of the leaders and everyone else I think is quite cynical. But I think for people on the ground who are out there you know talking to people hanging out in bars talking to people who are members of the Boston Tea Party I think they found this very inspiring and obviously you know one of the points of my book is that this has been the case throughout American history from you know just years after the revolution ended there were bitter partisan hill battles over who was properly carrying forth the mantle of the revolution you know was it the Jeffersonian or was it the Federalist had the Federalist betrayed the revolution in the Jeffersonian or carrying it on. Then the Whigs and the Democrats waged the same fight the Confederacy and the union battle over who inherited the revolution civil rights workers in Southern segregationists had the same battle. You know Martin Luther King wrote in his letter from a Birmingham jail that the Boston Tea Party was the first active

nonviolent protest in American history. And in order to align civil rights with the revolution its political goals to do this and it's that isn't mean it's disingenuous it's part of our political tradition. It's not actually historical analysis and that is what I think as a historian as a scholar of American history someone who teaches it. That's the piece of it that's disquieting right to to do that is to make a political argument out to make a historical one. And in fact one of the things that's interesting about the Tea Party I think is that a lot of it is the extremes of the Tea Party there's a great undermining of. Academic study of history as itself a left wing conspiracy as though we have lost our proper connection to the Founding Fathers because leftwing radicals have taken over the academy and they are teaching socialist version of American history or something. So which actually has the effect of If you're making a political argument but attempting to suggest that it's a historical one and then you've discredited actual historians there's no one left to refute your political argument.

So one of the points of writing the book is to say I actually know what you've made as a political argument it's not a historical argument. In fact it's quite at variance with what historians know about the past and more particularly about variance with how historians think about the past. What does this mean. I mean you've made the point that this is cyclical in a way that it comes up every now and then somebody claims some connection to the founding fathers whether real or imagined and then it comes up again a few years later. This one seems to take hold in a different kind of way. Maybe it's just because I'm living in the moment and of course you're the historian so you can tell me differently. But are we to take something more meaningful from this at this point. Well I think we could take something meaningful from from each iteration of it. I mean I don't know that it's that it's familiar that it may be cyclical it's an interim report. Then it's a long standing tradition doesn't mean it's not important. I mean I very much see your point there. The question is What are we to make of what this is and

is where is this going is sort of what everyone wants to know. And you know no one has an answer for that. I think that what to me as a historian what's interesting about this particular iteration of a kind of fascination with the revolution as a as a form of heritage is that although it's a political argument its modes are actually religious. To me looks like a religion more much more like a religious revival. Then in some ways been like an explicitly political move and that's when the shooting things about the Restoring Honor rally this past weekend as so much of it was in fact very explicitly religious revival. But the way the Tea Party people talk. Talk about the founding fathers and the founding documents is essentially evangelical. These we have for sake of the founding fathers and that is what is wrong with the American spirit and we must return. We must have a renewal we must have a rebirth in which we rededicate ourselves to the to the beliefs of these great forefathers and we must study their texts and Tea Party activists use kind of the bible study group as a model

for studying the Constitution say unbiblical X a Jesus that is not historical analysis and so on it to me that's the big gap. So these people think you know they have a lot of passion for history but what they have is it is a way of thinking about the past that is essentially religious. We're speaking with historian Jill Lapore. Her new book is The Whites of Their Eyes the Tea Party's Revolution and the battle over American history. She just made the point that there is religiosity as a part of this new Tea Party movement. And I want to give our listeners a chance to hear Glenn Beck who kicked off last weekend's Restoring Honor rally on the National Mall. Thank you Your imagination is happening. Something that is beyond man is happening already. They turn to God so there is your point. You know you know it's beyond man it's supernatural you know.

Beck is brings this point back AGAIN and AGAIN and AGAIN and AGAIN And AGAIN he talks about the founding fathers as having been divinely inspired which is something that comes from Warren Harding. He talks about the founding documents as he specifically say they need to be read like the Gospel they are Scripture they are American scripture and he doesn't mean that in the sort of secular sense of a civil religion in which we all kind of show what binds Americans together is our abiding faith in democracy that is a kind of religion. But it is secular for Barack in the way he talks about the founding fathers and their documents that their prophets their words or scripture and any attempt to and analyze them with the kind of academic skepticism is essentially heretical. And that's what's troubling about the extreme argument there but that there's no there's no room for debate anymore there's actually there's a position that amounts to. An unimpeachable belief. And to criticize that is somehow

to not care about the Constitution I think it's only there's only two possibilities. There he then on top of yeah you blaspheming the Constitution. You know actually the Constitution has been amended many times. I mean many people with Thurgood Marshall made that wonderful speech and its bicentennial about you know what he wanted was a living Constitution he didn't want us to just venerate the Constitution he didn't. And in fact you know Jefferson said people ought not to revere such documents with sanctimonious reverence. So if he makes it very hard to refute these arguments while taking them on their own terms. Well I thought was interesting also you made the point that John Adams said that it predicted that down the road that we're going to be what we've said here we founding fathers is going to be misused and abused. So he anticipated this happening. Oh yeah. These were some incredibly smart people and I'm one of the things they understood was the fundamental instability of a nation founded in revolution. I mean that's actually the magnificence of the United States that a country founded in violent revolution could be so stable that we have adopted a system of pluralist political

ruling and the party system you know for all its problems and probably impermanence is never has nevertheless brought us tremendous political stability. But the but the reason that is necessary to kind the balance of the revolutionary origins of the country as against its constitutional stability is this constant battle over what it meant and that's that battle is part of who we are and having it is I think it's important it's better than not having it. What do you have. Let's just say that today some of the organizers of the of today's Tea Party said you know what I'm going to read Jill's book I'm going to figure out what the real history it is what the real history of the Founding Fathers and then I'm going to re-adapt what I've been saying about our party in that context. Is that possible to do or we're just talking about there is they're too far gone that to separate now from the history they've left the history for the impression of the history if you will and gone off in a way that can't be brought back if in fact they were too grounded in the real history.

Yeah I do. You know I mean you know the real history is always also changing because people are always making new discoveries and new interpretations come along and that that is actually just how historical analysis and research works for some. Somehow this kind of conspiracy theory about that you know somehow this is this is wrong and that means history is lies to me. But that is the history is like science that when science doesn't stay stay in one position either ideas change and new findings come in which that's what makes them suspicious of his story and that's what makes people suspicious of historians that doesn't mean things didn't happen and they aren't real and we can't find them out and that's an important point I think that actually part of the space that opened up in the culture for people to be so critical of American history as it is taught in the schools was postmodernism frankly where you know it's like the new math people says there's a syllable could I mean I don't think there's anything you know you know how I think about the revolution and the founding of the United States that's in some sense wholly inconsistent with a more mainstream view of it I mean I think the revolution is very

exciting politically and thrilling I actually just think that the. History is an old idea that we would go back to that time is to me when I think about 773 you know these people say let's party like it's 1773 Let's go back to 70 and 73 I think OK in 1773 I would not have survived childhood if I had I would have died in childbirth if I had survived childhood not died in childbirth. I would have nevertheless been illiterate and I would have had many kinds of misery in my life which would have been one probably here in Boston say a pretty grueling poverty. So I'm not too keen on going back to that when I think about the 18th century I think about the daily life of ordinary people. And one of the great ironies of the populist so-called populist movement of the Tea Party is that these are ordinary people who actually are reviewing the elite Harvard educated scholars like John Adams of the day John Adams one you know. I'm not saying you are hearing John Adams I'm actually interested in ordinary people who in the kind of broad canvas of American history are who I think we most of

us probably do finally care most about and are really descended from. Well I can tell you I wouldn't be interested in going back either because I'd be a slave. I'm not really interested in that which brings me to this point. A lot of people have said that the basis for some of this anger in the Tea Party really is about you know President Barack Obama being in office as the first African-American president and then all of our issues about race coming front and center. You know they I take your point in your book you interviewed many people who are members of the Tea Party who said we're sick of that. Stop stop calling us racist that's not where we hear about we're angry about some other things. But yet as you detail the history connected to the time that they refer to so much was going on with regard to slavery and race it almost seems like a 17th century version of the 21st century if you will about our issues. So since I don't know this history I'm assuming the people that you were talking about they didn't they weren't aware of it. But do you subscribe to the theory that

President Barack Obama's election and the rest has really been a tip off for some of this anger. Well I think there's a lot of different things going on I mean to me the point I think is there almost. Well to me. Well was interesting about how the people I spoke to in the Tea Party and people I know watch on television whoever it was or where these people think about the revolution is that they think the 18th century was in fact a simpler time where there was no racial conflict and where we had these you know white founding fathers marching around in their tried clarinet. It wasn't a simpler time it was just as messy as our time. They weren't slaves I would say. We've been talking about the modern day Tea Party with Joe Lapore. She is the David Woods Kemper professor of American history at Harvard University and a staff writer at The New Yorker. Her latest book is The Whites of Their Eyes the Tea Party's Revolution and the battle over American history. Jill aport thank you so much for joining us. Thanks a lot. This is the Calla Crossley Show where production of WGBH radio bust and NPR station 4 news and culture.