A Robot To Deliver Bad News? What a Really, Really Bad Idea
As Telemedicine grows, hospitals and health systems need to have plans in place
I had to do a double take when I read the headline: “Fremont family upset that Kaiser let ‘robot’ deliver bad news.” For a moment there, I thought it was a robot like the picture above…until I read the article:
It’s never easy to hear bad news about a family member in the hospital. For the family of Ernest Quintana, hearing it from a robot video device that rolled into his room made it worse.
“This was horrible for me and him,” Quintana’s granddaughter, Annalisia Wilharm, said in a Facebook post that included a picture of the machine, which features a live doctor on a video screen. Quintana, 79, died Tuesday, two days after the device delivered the news his lungs were failing.
The family and friends of the patient expressed outrage.
“This is not the way to show value and compassion to a patient. Shame on you Kasier,” wrote one family friend. The outrage is completely understandable.
Now, I am big proponent of telemedicine. I worked as an “e-Intensivist,” or remote Critical Care specialist, for over ten years. The technology is great, and it can bring experienced, board-certified Critical Care specialists — along with other medical specialists — to hospitals all across the country and the world. It can be a great boon to many hospitals and hospital systems.
A TeleDoctor is great for a consult in an ICU that does not have Critical Care specialists or for overnight coverage in a hospital that does not have physicians in house at that time. At the same time, we need to be very careful about when to use this technology.
Delivering bad news to a patient through a Telemedicine robot is a really, really bad idea. In some circumstances, nothing can replace the human touch. I know this from personal experience.
My wife and I lost our eldest daughter to cancer in 2009. It was devastating. As they were pouring dirt over my daughter’s pink casket, I lost it and broke down in tears. The words of those telling me to “be patient” did not help. You what did? My friend coming up behind me and holding my hand. I will never forget that gesture of friendship and love for the rest of my life.
Now, what if a patient comes in very critically ill overnight — where the doctors have all gone home — and all we have is a remote physician on a “robot”? What if the patient is not going to make it, and the family needs this news? There need to be contingency plans in place.
Is there a Hospital Medicine specialist involved in the case? Can she or he be the one to sit down and talk to the family? While admittedly a tough ask, could the Primary Care Physician or Specialist on call come in from home and talk to the family? What about a Hospital Chaplain, who is trained to comfort patients and families who are faced with terrible circumstances? Sometimes, there is nothing better than the human touch, where that person-to-person connection can be made; where we can look into the patient and family’s eyes, reach out and hold their hands.
Kaiser responded to this incident in a statement and acknowledged that the robot is not intended to replace personal, face-to-face interactions:
Michelle Gaskill-Hames, senior vice president and area manager for Kaiser Permanente Greater Southern Alameda County, said in a statement that “we offer our sincere condolences” and that “we take this very seriously and have reached out to the family to discuss their concerns.”
“This is a highly unusual circumstance,” Gaskill-Hames said. “We regret falling short in meeting the patient’s and family’s expectations in this situation and we will use this as an opportunity to review how to improve patient experience with tele-video capabilities.”
“This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology,” Gaskill-Hames said. “It does not, and did not, replace ongoing in-person evaluations and conversations with a patient and family members.”
This incident is a cautionary tale for all of us, as we look to adopt Telemedicine to deliver healthcare in more and more places across our country. There are just not enough doctors, nurse practitioners, and physician assistants to be in every hospital in every town at all times of the day and night.
That said, if we implement this amazing technology in the wrong way, it can backfire in a big way, as this case from Kaiser clearly demonstrates. Yes, technology has made great strides in Medicine and Healthcare, and it has helped advance our field in ways previously unimaginable. At the same time, there is nothing more powerful than personal care and compassion, and we should never, ever lose sight of that fact.
The opinions expressed in this post are my own and do not reflect those of my employer or the organizations with which I am affiliated.