Carly Smith

Thanks Linda! That finding was my favorite for two reasons: first, because it was just so neatly testable - I could look at the difference in forgetting between these two groups of people who I knew had and had not experienced institutional betrayal. The second reason it was my favorite is because it is so consistent with betrayal trauma theory, which states that mistreatment in the context of trusted or necessary relationships tends to be "forgotten" in some ways in order to preserve the relationship. If you are getting treatment at a hospital where you've had a bad experience and/or institutional betrayal but you still need to finish your treatment, it could be really hard to think about the bad experience (and have all the feelings that go with it) while still going to all your appointments and trying to believe in the treatment. Instead, we develop coping strategies that allow us to push those memories away when necessary. What's cool about this is they obviously are able to remember things well enough now that they can report it for the study, but there was at least a time where they had more trouble.

Hi Spam Girl, Lab note fixed to remove erroneous reference to mTurkers :) I also changed the part about the built in rating system. I hadn't realized that the ratings of requesters were an organic thing, you are taking a risk in agreeing to tasks that may be carelessly rejected and hurt your reputation. The worker forums are more important than I realized, given it's the only means to share information about requesters. I wasn't actually thinking of Master's when I thought of ratings for workers, more so of the criteria I had to select for who would be eligible for my HIT: how many HITS completed and % rejected work. Amazon prompted me to use Masters but since I couldn't find a firm definition of what that meant, I chose not to. Looks like that may have been a good choice. Thank you for your comment, I am really intrigued by MTurk and I hope to keep asking people there to participate in my studies!

Matching donation for donation up to 50% --- thank you anonymous science supporter! Your check will fund almost 400 participants!!

Hi Paloma, it's great that you're interested! I'm hoping this research will impact the way healthcare systems work by uncovering patterns in patients' experiences that point to systemic (but preventable!) issues. For example, in my other research on institutional betrayal, a pattern I see over and over is that students who have been sexually assaulted during college indicate that an institution (usually the college itself) created an environment where reporting sexual assault is difficult. This has led us to examine barriers to reporting on campus and helped us talk to the people who handle reports about how they might be more accessible. Similarly, in this project we will be asking people to describe negative or unexpected healthcare experiences (e.g., prescription errors, complications from surgery, miscommunications between providers, unanticipated bills) and whether a healthcare institution may have contributed to these types of experiences in the form of institutional betrayal. This might look like creating an environment where these negative experiences seemed more likely to occur, hard to address, or even facing negative repercussions for trying to voice concerns. I hope to both document institutional betrayal if it is occurring as well as measure the effects it has on peoples' health. If we are successful, we can help healthcare institutions be safer and more supportive, help doctors, nurses, and other professional understand their patients better, and even help patients make sense of their own experiences. It's a big goal but I'm positive we can do it!

Wooo! Dynamics lab!

Thanks Marty - it's awesome that you donated!

Awesome project, I am so excited for this work to continue!

Hi Dr. Carbonell, thank you so much for your support! I do have some longer term plans to study specific institutions; next year I go on my clinical internship at either a VA or a medical school, and I would love to follow some patients over the course of their treatment. As part of the current project, I will be collecting information about the type of institution my participants are describing, so I will at least be able to draw some general conclusions about institutional predictors of better or worse care. I also hope to eventually look at the experiences of physicians/other providers in these systems; I suspect that it can be quite harmful to try to work within a system that does not allow you to provide the type of healthcare you wish.

Thanks Kevin! This project is a new direction but it is exciting -- I really appreciate your support.

Thank you Mike! I'm harnessing all my stats and psychometrics know-how for this one.

Friday night announcements, from here on out!

Hi Oscar, that's an important distinction! I guess it depends on what deliberate means. In the case of betrayal, it can just as readily occur when an institution fails to take an action that would prevent poor care (e.g., not using software to catch prescription interactions) as when it takes an action that results in poor care (e.g., discouraging a patient from seeking a second opinion). The important thing to note is that the betrayal is not so much that an adverse medical event happened (mix ups, infections, painful procedures are normal healthcare risks). The institutional betrayal occurs when something about the institutional involvement made the experience more likely to occur or creates a hostile environment afterwards (e.g., by denying a patient's experience, covering up mistakes, making it difficult for a patient to continue care). Institutions are not often setting out to betray their members, it tends to occur as a by-product of some other interest - maintaining a reputation, seeking to minimize legal liability, keeping costs down, etc. These are all deliberate decisions, perhaps undertaken without the full realization of their true cost. That's what I am hoping to find out with my project!