When Bedside Manner is Conveyed Through a Screen

If medicine is also an art and not just a science—as physicians who argue that each patient requires a different approach assert—then it’s hard to understand the rationale that led a California hospital to deliver end-of-life treatment plans via telemedicine “robots.”¹

As several national news outlets reported when a video of the episode went viral, a Kaiser Permanente hospital in Fremont, CA, gave grim diagnostic results to 78-year-old Ernest Quintana and his granddaughter Annalisia Wilharm through a “telepresence robot,” which in this encounter involved a mobile robot with a video screen that live-streamed a physician in another location, Vox reported. Wilharm was tasked with making sure her hearing-impaired grandfather understood what the remote doctor was saying, as the hospital had not taken steps to ensure the news was given when Quintana’s wife and other family were present.

The initial diagnosis was given to Quintana in person by a staff physician, who Wilharm described as very “sweet” and said held her grandfather’s hand during the encounter. But the message that only morphine could be provided for comfort care—and that it carried the risk of depressed breathing—was delivered by a doctor on a screen placed alongside a nurse. According to CNN, the hospital uses the telemedicine robot for rounds only in the evening. Quintana passed away the next day due to complications from chronic obstructive pulmonary disease.

While many medical professionals consulted through the press admit this was the wrong application of telemedicine, some health technologists predict that this could become the norm due to a mounting doctor shortage crisis in rural healthcare.

“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,” cardiologist Haider Warraich, MD, wrote in Vox. “…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.”

Note

1. Warraich, Haider. “A ‘robot’ doctor told a patient he was dying. It might not be the last time.” Vox. March 13, 2019. www.vox.com/first-person/2019/3/13/18262481/robot-doctor-remote-telepresence-care-terminal-patient.