This is the future of care for many patients with limited access.
The rapid influx of advanced technology is changing the practice of medicine — at times for the better, but sometimes for the worse. Nowhere is this more apparent than a story where a physician told a fatally ill man in a Fremont, California, hospital that he was dying via video chat on a screen attached to a robot. The news should serve as a wake-up call to the medical establishment on the limits of technology.
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.
The promise of digital technology — when used appropriately — could in fact allow doctors to be more humane. Eric Topol, a cardiologist and author, argues this persuasively in a just-published book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. For example, doctors are forced to spend much of their time interacting with patients taking notes. But if advanced transcription services could transcribe and document complex discussions between patients and their caregivers, this could not only open up time for doctors to spend being present with their patients, it could give patients a literal voice in their own medical record. Artificial intelligence could and should successfully offload inane repetitive tasks from physicians and could provide them the time to look their patients in the eye, rather than eyeing the computer screen.
Telemedicine can also allow physicians to be in places that might be hard for them to reach physically, an advantage that can have profound benefits in areas where physicians are a scarce resource. The hospital in Fremont, for example, appeared to be using the robot to provide patients and the nurses access to an intensive care specialist during the evening — something that is not always possible in areas where such specialists might be few and far between.
But there is a time and place for the use of this kind of technology, and informing a patient he is dying is not a great time for telepresence. One of the worst feelings a patient or family can experience in the throes of critical illness is a sense of abandonment — and few things can transmit that feeling more than a poorly designed machine and protocol that provides the least amount of human connection possible. As this episode makes crystal clear, technology, if not thoughtfully designed or implemented, can have disastrous consequences.
Yet the fact remains that many patients may be seeing a lot more virtual doctors in the future. Telemedicine technology will continue to be used most frequently in areas that already have limited access to doctors, and these areas will likely have overlap with communities of limited resources.
This highlights a significant concern among physicians that digital technologies will increase the inequity in American health care. Technologies such as smart watches and other personal health tech is largely affordable by the most affluent of patients who can subsequently enjoy the benefits those technologies might provide. The same could be true of medical technology. In essence, if current trends hold, the rich only get richer.
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.
As we become increasingly inundated with innovation, digital technology has the potential to be a uniter of patients and doctors and not a divider. But technology is an instrument, and its success depends wholly on the human beings designing, deploying, and operating it.
Haider Warraich (@haiderwarraich) is a cardiologist at Duke University Medical Center and author of the forthcoming book, State of the Heart: Exploring the History, Science and Future of Cardiac Disease.
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Breaking News: A “robot” doctor told a patient he was dying. It might not be the last time. - News Paper
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