By now, the story has been around the internet three times. When 78-year-old Ernest Quintana went to the Kaiser Permanente Medical Center in Fremont in the San Francisco Bay area with difficulty breathing, his family knew that at some point his chronic lung disease would claim him. But, on the night he arrived in the intensive care unit (March 3), they were hardly expecting what happened next:
Told that the doctor was to make rounds, his granddaughter Annalisia Wilharm, 33, settled herself to help her grandpa understand. Then a robotic cart rolled into the room, accompanied by a nurse:
Mr. Quintano, who needed help understanding the voice explaining that that further treatment would not help him, and that he was being offered palliative care, died March 5. According to Wilharm, the medical staff told her that the video link method is “policy” and “what we do now.” But Wilharm had taken cell phone video of the event, intending to show medical information to other family members.
The family, who thought that the robotic video cart was just “making a routine visit,” was outraged:
Daughter Catherine Quintana said: “If you’re coming to tell us normal news, that’s fine.
“But if you’re coming to tell us there’s no lung left and we want to put you on a morphine drip until you die, it should be done by a human being and not a machine.” “California hospital defends use of robot that told patient he was going to die” at Sky News
Some experts think that people just need time to get used to the new AI reality:
Dr. C. Michael Gibson, a Harvard Medical School professor of medicine, questioned whether a face-to-face convo is necessary in such instances. In a Twitter poll, over 4,300 replied, with 79% admitting they would “be upset” to receive a terminal diagnosis by telemedicine or robot…
But others had seemingly more understanding for the newfound practice. Dr. Zubin Damania, founder of a primary care clinic in Las Vegas, points out it’s likely less about the method of transmission and more about the content and delivery. “It’s really hard to give and receive bad news in person or telephonically,” he wrote on Twitter. Rini Raphael, “Doctors are using hospital “robots” to tell patients they’re dying, sparking an outcry” at Fast Company
Surely this situation is a classic in technology as it shouldn’t be. But some of the furor was driven by media coverage that conveyed the idea that the news was delivered by a robot: “Doctors are using hospital “robots” to tell patients they’re dying, sparking an outcry” (Fast Company), “California hospital defends use of robot that told patient he was going to die” (Sky News), and “Doctor delivers end-of-life news via ‘robot,’ leaving family frustrated” (USA Today). Hype doesn’t help us understand what went wrong or how to fix it.
There is a risk that debacles like this will harm the reputation of telemedicine. Telemedicine is, as a matter of fact, the only practical means for bringing medical specialists at urban university teaching hospitals into contact with patients living in remote areas. But in that setting, the telemedic is communicating with the patient alongside local health care personnel who know the patient and are in the room. The patient and/or family members are not staring alone at a screen.
I watched the video with interest because my own family has faced a loved one’s impending death twice in the last few years. The problem at Kaiser Permanente, in my view, is the technology, pure and simple. No two ways about it.
The doctor did not give wrong information or fail to offer help. But if he had been sitting there by the bed, patiently explaining, the family would likely have “got,” through multiple levels of cultural signals, what he was trying to say—even if he couldn’t come right out and say it.
Perhaps the doctor found it difficult to bear bad news. But at the bedside, he would be sitting with people who were uncomfortable hearing it too, which feels more like a community facing what must be faced. People need personal contact to move through phases of accepting bad news that can only be alleviated, not changed. The video link just did not feel like a normal interaction so the technology appears utterly unsuited to the purpose.
The response statement from Kaiser Permanente, acknowledging failure, recognizes the problem, but only in part: “Our health care staff receive extensive training in the use of telemedicine, but video technology is not used as a replacement for in-person evaluations and conversations with patients.” Don’t kid yourselves, Kaiser Permanente. The video link is not a “replacement” for anything. It doesn’t do the same things.
Only people who can be vulnerable themselves should give bad news.
We need to recapture the perspective of the great Canadian physician, Sir William Osler (1849–1919): Medicine is “to cure sometimes, to relieve often, and to comfort always.” Kaiser Permanente should underline that last point, going forward; it’ll come in handy.
See also:The $60 billion-dollar medical data market is coming under scrutiny For good reason. You don’t own the data they collect and you don’t know what they do with it.
AI dangers that are not just fake news