[The negative reaction to a San Francisco hospital’s use of a telepresence robot to deliver sensitive medical news is receiving international coverage; this story from The New York Times recounts the situation and considers some of the ethical issues. Hopefully the case will prompt both users and designers of the technology to figure out ways to avoid situations like this. An important question we should consider is whether even a future technology that could perfectly transmit all, or at least all visual and aural, social cues would be acceptable. –Matthew]
[Image: A doctor on a video conference explained to Ernest Quintana that he did not have long to live. Mr. Quintana’s family members criticized the use of telemedicine in that circumstance. Credit: Annalisia Wilharm]
Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast
By Julia Jacobs
March 9, 2019
Catherine Quintana’s father had been in and out of a hospital for weeks, and the family understood that his time was running out.
Her 78-year-old father, Ernest Quintana, had lung disease and was struggling to breathe on his own. On March 3, he was admitted to a Kaiser Permanente hospital in Fremont, Calif., for the third time in 15 days, Ms. Quintana said. He had his wife of nearly six decades and other members of his family at his side.
While they awaited the results of a CT scan, Ms. Quintana, 54, and her mother decided they would quickly go home to shower. Ms. Quintana’s daughter Annalisia Wilharm stayed at his bedside.
Ms. Wilharm, 33, said a tall machine on wheels eventually rolled into the room. Attached was a screen streaming a live video of a doctor wearing a headset.
“I just figured it was routine,” Ms. Wilharm said on Saturday. “I didn’t think he’d get his death sentence here.”
The doctor on the screen said there was serious damage to Mr. Quintana’s lungs. “Unfortunately, there’s nothing we can treat very effectively,” he said, according to a video recording that Ms. Wilharm shot on her cellphone to later share details of the conversation with her family.
The doctor suggested giving Mr. Quintana morphine, although that could make breathing even more difficult. When the question of hospice care came up, the doctor shared a grim outlook: “I don’t know if he’s going to get home.”
Throughout the conversation, Mr. Quintana was having trouble hearing the doctor, Ms. Wilharm said. She said the machine was on the side of her father’s deaf ear, so she had to repeat the doctor’s news.
“I wanted to throw up. It felt like someone took the air out of me,” she said. “I said, ‘Do you want the morphine?’ He looked at me like, ‘What choice do I have?’”
When Ms. Quintana and her mother returned to the hospital, the family was furious that Mr. Quintana was told via video conference that he did not have long to live.
“It should have been a human,” said Ms. Quintana, his daughter. “It should’ve been a doctor who came up to his bedside.”
Mr. Quintana died on Tuesday, two days after the conversation with the doctor, she said.
Telemedicine is an increasingly popular tool in the health care industry. Experts said it was expanding access to care in rural areas while also allowing patients to communicate with specialists they would not ordinarily be able to reach.
But in situations like the one involving the Quintana family, in which doctors were communicating sensitive information about end-of-life treatment, health care providers may have to modify their approach in response to patients and their families, John Banja, a medical ethicist with Emory University in Atlanta, said on Saturday.
In those cases, Professor Banja said, telemedicine technology may not be sensitive enough to pick up nuanced social cues, like body language and tone of voice, in an emotionally charged moment.
In response to the Quintanas’ situation, Dr. Barbara L. McAneny, president of the American Medical Association, said that delivering bad news electronically should be a doctor’s “last choice.”
“We should all remember the power of touch — simple human contact — can communicate caring better than words,” she said.
Michelle Gaskill-Hames, the senior vice president for Kaiser in southern Alameda County, said in a statement that the hospital’s doctors and nurses had been communicating regularly with Mr. Quintana and his family since he arrived at the hospital.
The video conference with the doctor that night was a follow-up to earlier in-person visits by other medical staff, Ms. Gaskill-Hames said, and his initial diagnosis was not communicated via video. It is unclear where the doctor on the video screen was physically located.
Telemedicine technology allows small hospitals to have critical care physicians available at all hours, Ms. Gaskill-Hames said, adding that a nurse or another doctor was always in the room at Kaiser to explain the purpose of the technology to a patient.
“We don’t support or encourage the use of technology to replace the personal interactions between our patients and their care teams,” she said. The doctor in the video was not identified, and Catherine Quintana said she had not seen him before.
The American Medical Association’s ethical code for telemedicine raises possible ethical issues apart from a loss of intimacy in a patient-doctor relationship, such as data security.
Although it may sound futuristic, telemedicine is not a new practice in health care, said Dr. Shivan Mehta, a physician and associate chief innovation officer at Penn Medicine in Philadelphia. Telemedicine can be as simple as a doctor communicating with a patient over the phone, he said.
Some patients embrace telemedicine because they want their test results quickly, whether it is by phone or video chat. Others want a face-to-face conversation.
“We can’t have a one-size-fits-all mentality for it,” he said. “We have to cater to what our patients are hoping for.”
Ms. Wilharm said she was not opposed to doctors using telemedicine to communicate with their patients. But for people who are terminally ill, like her grandfather was, Ms. Wilharm said the technology did not feel appropriate.
“I just don’t think that critically ill patients should see a screen,” she said. “It should be a human being with compassion.”