The patient, 78-year-old Ernest Quintana, was sitting in his hospital room when a “telepresence robot” — or a mobile robot with a video screen that live-streams a physician in another location — rolled in and informed him that there was nothing that could be done to treat him. Quintana, who had chronic obstructive pulmonary disease, was with his granddaughter and a nurse when he was told his options for managing pain at the end of his life. The granddaughter, shocked at this bombshell dropped from a disembodied robot, filmed part of the encounter, which subsequently went viral online. Mr Quintana died the following day.
The fact that a patient and their family member were delivered devastating news via a telepresence robot is a rightfully shocking episode that runs counter to much of what many of the prophets of the digital revolution in medicine have been preaching. It has confirmed the worst fears of many patients and doctors that technology might increase the distance between physicians and patients during their most vulnerable moments. As a cardiologist training in advanced heart failure who frequently has such conversations with patients — and knowing just how complex and emotionally fraught these moments can be — I am not surprised that the patient and his granddaughter reacted with horror.
Yet a knee-jerk reaction may distract us from looking at the big picture. Just like any medical technology, digital health can be an excellent tool for better, patient-centered care. But it also comes with risks that could erode the practice of medicine, especially for patients who might already have limited access to health care resources and physicians. However, we cannot allow digital health to take over, it remains one more tool in treating patients, not an endpoint.
The human factor cannot be denied. A cold unfeeling machine is not the same even though a human face is present. Even with a two way video feed certain emotions are not palpable.
A patient expects a human being with whom to interact, either good news or bad news. Technology, artificial intelligence will not replace 'presence'. Even virtual reality probably cannot replace the physical presence of a physician or nurse.
A patient expects a human being with whom to interact, either good news or bad news. Technology, artificial intelligence will not replace 'presence'. Even virtual reality probably cannot replace the physical presence of a physician or nurse.
Many in the public and the physician community are skeptical about whether the digital health revolution can bridge the gap between patients and doctors. While I consider myself one of the cautious optimists, the fact is that the way our current health system is designed — and, especially, how we pay for it — digital health innovations could very well stretch the widening gulf between patients and their doctors.
Given that our health system continues to reimburse based mostly on the volume of medical services delivered rather the quality of the care or the patients’ experience, technology will only be deployed so that health systems squeeze their physicians and nurses for every last dollar they can eke out of them. And if the doctor shortage in America’s rural areas continues, scenes such as the one in Mr Quintana’s room may be repeated in the lowest-income communities.
The reason I remain hopeful is actually because of another important side of Mr Quintana’s story. Earlier in the day, a female physician, who was described by the granddaughter as “very sweet,” visited the patient. The content of what this physician said was very similar to what the robo-doctor said, but there was an important difference. She held his hand, explaining the same grim news in a much more humane way.
A “robot” doctor told a patient he was dying. It might not be the last time. - Vox:
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