- Robots delivering bad news to a patient?
Is that really what happened?
Let's talk about it on this week's Wednesday Checkup.
(bouncy music)
Earlier this week you guys tagged me in a story on Twitter.
You sent it to my DM's, about a family that was complaining
about Kaiser Permanente Hospital in Freemont, California,
where their family member was given bad news
by what they perceive to be a robot.
I did these at the wrong time.
The story goes as follows,
and again this is not gonna be 100%
factually accurate because I didn't speak to the family.
I'm reading reports from various news agencies
and we know how those can be inaccurate at times.
Also Kaiser Permanente the hospital system itself
released a statement, but the report itself was limited
on information, and rightfully so,
because that patient privacy, HIPAA Law,
that we always talk about.
Basically what happened was there was a family
that went to the Kaiser Permanente Hospital
with one of their elderly family members
who was diagnoses with COPD.
It was very advanced COPD.
There've been many hospitalizations in the past.
The patient was brought to the Intensive Care Unit
where he was being cared for, seen by in-person doctors,
nurses, given an initial diagnosis.
At some point, most of the family left for the night
to get some rest, but one of the family members
ended up sticking around.
In the midst of this night, I don't know at what point
in the night this happened in, a robot, or machine,
however you wanna call it, that had a video connection
to a doctor sitting at the other end of wherever
this machine connects to, with a headset on,
was giving the results of the scan that came in.
This doctor came on saying that the scan results
did not look good, there was basically no lung tissue left,
that comfort care was likely to be the only option.
The family member was actually trying to translate
all these details to her grandfather
'cause he had trouble hearing.
It didn't look like the interaction was happening smoothly.
There was also a nurse in the room,
but I did not see the nurse having any kind of engagement
or interaction with the patient or the family
while the doctor was making the conversation
via the video conference.
So after this event happened, the rest of the family
rushed back at the request of the granddaughter,
they found out that based on this conversation,
their family member was dying and had only
hours or days left to live.
And they were very unhappy because the news
of this terminal illness, diagnosis.
and comfort care treatment plan, was given by a human,
but through a piece of technology
where it didn't feel human.
And I think that's a really important distinction
that we're gonna talk about throughout
the rest of this video.
The family went on to contact some media,
letting them know they were unhappy
with the treatment they received.
They didn't feel like it was compassionate care.
And media ran with this story, I mean,
talking about robots, healthcare, victim,
there was just like all the trending things that are needed
for a story to go viral were all there.
Then Kaiser Permanente, the hospital system,
put out a release saying they were unhappy
with the coverage that this was getting,
they couldn't give details out
because of health privacy for the patient.
Which is, at times, unfair to the hospital system
but also very important for the patient.
But what they did say was they were unhappy
that people were calling the machine a robot,
because it sounded like a robot like you are gonna die
came out and said something like that.
It wasn't that, it was a doctor on a screen
doing a video conference.
I wanna talk about the family's side of things,
of how they experienced it
as well as Kaiser Permanente's side 'cause I think
both parties are right to some extent.
But I'll tell you ideally how I'd like
for these situations to happen.
I'll start with Kaiser Permanente
because that's a simpler portion of the story.
I think they have a right to be upset,
'cause media often gets healthcare stories wrong.
They don't report accurately,
they like to have a sense of outrage
'cause it gets more clicks, views,
likes, tweets, all of that stuff.
So I can see why they're upset 'cause there was a lot
of misinformation shared.
Now, from the families side of things,
there are certain situations that require
a human touch in medicine, and life or death conversations
certainly falls into that subset.
If I'm gonna be giving life changing news,
I want that person sitting in front of me.
Now they can choose to not do that,
but ideally this is how you should handle
these moments as a physician.
This is the way we were trained to do it.
Because there are some subtleties that
a video conference or a telephone can't pick up.
You can't pick up if it's smelling in the room,
you can't pick up sight, sounds,
you can't pick up subtle gestures and facial expressions
or body movements that the patient's making.
It's a suboptimal approach that should be used
in extenuating circumstances.
And based on my limited knowledge of the situation,
I don't think this was an extenuating circumstance,
I also don't know how much the family knew beforehand.
Telemedicine is just not the way
we start a comfort care discussion.
And it may have been, you know, brought up in the past,
but it was clear in this video that the doctor
was instituting, or starting to institute comfort care,
asking the patient what they wanted
without the patient fully grasping the concept
and without the family members present.
To me, it even little sense why the teleconference machine
had to be there at night.
Could've the scan results waited til morning
when the doctor came in in person,
or when the family members were gonna be present?
If it couldn't wait, let's say, you know,
it was an emergency situation.
The labs were looking really bad,
the scan was looking really bad,
and an emergency situation happened.
A, the entire family should be contacted
because the change of status was about to happen.
B, the nurse should go in and discuss that
with either the family member or the patient or both
and tell them that because of the sudden change of status,
they're gonna get the video teleconference machine
to have this intimate discussion with the patient
that's not ideal, but because this happened late at night,
it's a rural center, they don't have a doctor,
this is the only way to make it happen.
I could understand that.
I could get behind why they need to make that happen.
But if that wasn't the condition,
if they were just relaying the results of the test,
and that's the way they chose to do it
without informing the family,
without having proper understanding of what comfort care is
or when to make the decision for comfort care.
That's not an ideal way to do it
and family members are right to get upset.
Now, that does not mean I'm saying the media is right,
because the media is wrong, they're overblowing the story,
they're saying a robot gave a terminal diagno.
That's not exactly what happened.
I'm also not saying that telemedicine is evil.
In fact, it's necessary.
But it needs to be used in very specific cases
and you need to understand what it lacks
and it lacks that ability to catch subtleties,
it cannot do a perfect physical exam,
it cannot grasp the emotion of a given moment
through a computer screen.
Until we understand that, until we perfect that,
we're gonna have cases like this come up every now and then
that we need to learn from as health professionals.
We need to see at times when we can use technology
to our advantage and when we cannot.
And I think this is a great time to broach the subject
of AI in medicine, because I feel like doctors
will never be replaced by AI.
Humans trust another human sitting in front of them,
even if they're less likely to be accurate than the machine,
we still want the human.
Because the human can understand our emotions.
And humans, we're imperfect creatures.
That's why medicine is as much art as it is a science,
because the art is understanding the human in front of you.
Understanding that they may have emotions
that's causing them to misunderstand the situation.
Having emotions that's gonna make them
incorrectly follow a treatment plan,
and only when you can grasp a person's emotions,
their state, their body language,
their capacity to reason and understand,
only then can you give a diagnosis, a treatment plan.
Will we have AI technology at some point reading scans,
or doing pathology?
Yeah it's possible.
But replacing doctors?
I don't think so.
This is a tricky conversation,
and I know people have their own thoughts on it,
so I encourage you to jump into my comments section
so we can continue that conversation.
You know, I stand with the Quintana family.
I think that humanity should be kept at all times
within medicine to get the best result possible
for the patient and the patients family.
I send my condolences to the Quintana family
and I wish you guys at home to stay happy and healthy.
Thanks for watching.
(upbeat electronic music)