
Doctor tells patient he doesn't have long to live through video screen - turtlegrids
http://www.ktvu.com/news/doctor-tells-patient-he-doesn-t-have-long-to-live-through-hospital-robot-s-video-screen
======
nkoren
For anybody who is confused about why this is an issue:

There's a right way and a wrong way to talk to someone about their death. The
right way involves making eye contact, making sure that they can hear you, and
if they are comfortable with it, holding their hand.

The wrong way involves doing none of those things, because you are talking to
them via a shitty Skype connection on wheels.

Technology has a huge role to play in healthcare. It's invaluable in diagnosis
and treatment. In the long run it'll probably put a lot of people who do those
kind of things out of work. But it should _not_ be used to replace the
empathic, emotional aspects of healthcare. If anything, the labour
efficiencies generated by technology ought to _increase_ the resources put
into empathy -- not be used to eliminate it.

~~~
chr1
Why is eye contact and holding hand the right way? For instance I would prefer
an email.

Honesty is better than empathy as a job.

~~~
SketchySeaBeast
Ah, the classic "why is this email a meeting"?

Subject: You're dying. Message: 2-3 weeks. Cancer. Please see attached
invoice.

~~~
pvaldes
Literature is more complex than that supposedly comic sketch. People is
expressing all kind of really complex feelings since a lot of time with
written language so that wouldn't need to be a problem. Is not a fair
comparison.

Some people would prefer a theater of acting sad, holding your hand and
pretending to be an old friend in a strange environment, other would prefer to
receive the hit at their home and cry in private. Each people is different.

~~~
SketchySeaBeast
As the physician doesn't get to know the ins and outs (emotionally, not
physically) of a person, they have to adopt the approach that they hope helps
the most people.

~~~
ergothus
There is great irony in your comment, given the topic. You are literally
advocating for an approach based on not actually knowing the patient and going
off of generalities. You aren't wrong, but it is...weird.

~~~
SketchySeaBeast
I think it's realistic - the physician doesn't know you as a person. They care
about you as another human being but not on a personal level, and don't have
the time or the emotional energy to get to know you. Really, I'm just
advocating for a return to the conventional approach which the article is
saying they should have followed. I'd say the "wheel a box into a room to tell
people that someone is dead" approach is a bad one.

~~~
ergothus
I get it - but I still believe that mimicry of concern is less desirable than
actually HAVING concern. I'd much rather get bad news from someone remote that
has concern than from someone in-person that doesn't. And I certainly wouldn't
want to have to wait for an in-person meeting with a diagnosis hanging over my
head if I can find out sooner.

------
wlesieutre
If you have 40 minutes, 99% Invisible did an episode last year on some of the
history of how doctors deliver news like this.

[https://99percentinvisible.org/episode/breaking-bad-
news/](https://99percentinvisible.org/episode/breaking-bad-news/)

 _> That’s why many medical schools now offer training for students on how to
break bad news, bringing in actors to help them learn how to navigate this
critically important and very high-stakes moment. And that’s not the only
connection between acting and this particular facet of medicine._

 _> It turns out that one of the first doctors to recognize the challenges of
this particular kind of doctor-patient communication wasn’t just a physician —
he was also a comedian. And he drew on that experience to transform the way
that doctors break bad news._

 _> His name was Dr. Rob Buckman, and his very unusual life experiences
prepared him to tackle what might be the hardest part of a very hard job.
Radio reporter and part-time medical school videographer John Fecile went back
to trace the strange journey of this comedic doctor, and discovered unexpected
connections along the way._

I don't think "through a video screen with poor audio quality" came up, but
I'm guessing Buckman wouldn't have recommended it.

~~~
2sk21
This podcast is a treasure!

------
miesman
I was training as a paramedic in a hospital. A doctor needed to give this kind
of news to a family. He took me aside and told me to come in the room 3
minutes after he went in and say that he was needed elsewhere. Apparently this
was used quite often and the staff there called it a "save". Dealing with this
sort of thing day after day the staff becomes numb to a lot of things.

Later in the week I was with someone who knew she was gonna die soon. I was
talking to her and was trying to be with her. It was very difficult and I
could feel part of myself slipping elsewhere. I was messed up the rest of the
day. My preceptor had come into the room and left quickly, he didn't want to
go there.

Anyway it does go both ways. Hospital staff need to do things to protect
themselves so they can keep functioning. Ideally someone needs to be
empathetic but they are also human. I don't feel delivering this sort of news
via a video screen is appropriate though.

~~~
PhasmaFelis
Every now and then there's a scandal where doctors are caught saying mean shit
about a patient, behind closed doors or during surgery. (As if surgical
awareness wasn't horrible enough.) There's always a lot of talk about whether
such heartless people can be trusted to do their best and not cut corners.

Something I heard years ago, and have never heard mentioned since, is that
doctors are _trained_ to do that, to talk shit about their patients in
private, to give them emotional distance. If they let themselves care deeply
about every suffering, dying person, they'd crack under the stress.

------
dougmwne
I think this article deserves visibility on HN because it's such a vivid
example of technology without ethics. The technology is incredible. It can
reduce costs and improve access to specialists. These tools should be a part
of our medical system.

But this man and his family are flesh and blood people. And the doctor too.
They have feelings. They have mental health and spiritual health needs. In the
rush to deploy the technology, the human dimension was ignored.

So this might have been just another fleck of clickbait if it weren't for the
fact that it's another example of a deep problem we technologists have. When
we create the tool, we are also responsible for its ethical use and the
impact, positive or negative, it has on the world. Don't dissociate from the
impact of your work. Own it.

------
Nomentatus
Maybe it's just me, but I'd vastly prefer to be alone, in privacy when I get
the news, thanks so much. Text, mail, even a skybanner pulled by a small plane
would suit me more than someone seeming to stare me down while telling me I'm
dead.

Not to mention that I have no wish to put another human being through the
tough experience of breaking the news. Why would I want to cause them
distress? It's gonna be a bad enough day as it is.

It might be a favor to both doctors and patients to have patients register
their preferences in this event in advance; as we register our preferences re
organ donation in many jurisdictions; or perhaps better allow people to
register a preference.

~~~
kaybe
Mhm, here, when you take part in an experiment than involves an MRI
(especially of the head), there is a checkbox on the form that asks whether
you want to informed about any funny things in the images at all just in case.

~~~
Nomentatus
Interesting, but then the question remains, just how you want that message
delivered.

------
AnIdiotOnTheNet
As it is a Doctor's time is scarce, which is why systems like this exist in
the first place I imagine. One wonders if expecting them to be comforting when
delivering bad news, or taking the time to explain things properly to a
patient, is realistic. After all, even though this is one of the most
important events in the patient's life, to the doctor it's tuesday.

I sometimes wonder if the patient demand for "bedside manner" has led to
having doctors with less actual medical skill. I mean, I wouldn't choose my
mechanic based on how comforting they could be. I wouldn't even choose my
veterinarian on that criteria. One could argue that doctors are all roughly
equal in diagnosis and prescription I suppose, making bedside manner the only
real differentiation, but my personal experience is that that isn't true.

Maybe a different person should be handling the role of interacting with the
patient in these ways, Someone who can take the time to do it properly? I
don't know. I just think it is worth reconsidering how this works in today's
world.

~~~
zentiggr
I'd say a mechanic's manner is almost off topic... anything mechanical ranks
far far below life and death notifications. But I do get why you included them
in the comparison.

I would want my vet (and so far HAVE had my vets) be even more compassionate
than my own doctor. I know enough to talk at least basic jargon with my PCP
and specialists as needed.

None of my animals has been able to communicate about their trouble, and have
relied on that extra bit of comfort and care when they are terminal, or even
just very ill.

Again, personal preference.

------
otras
I’m reminded of the NYT piece _How to Tell a Mother Her Child Is Dead_ by
Naomi Rosenberg, an ER doctor in Philadelphia. Highly recommend reading it for
insight into the relationship between doctors, death, and patients.

[https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-
tel...](https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-
mother-her-child-is-dead.html)

~~~
zeveb
That is, indeed, a beautiful piece of writing, but this bit here got me to
thinking:

> You are here for her. She is his mother.

Does it really make sense that the person whose job is operating on physical
trauma victims is _also_ the person who deals with emotional trauma victims?
Seems to me that those are two entirely different skill sets, and even
mindsets.

On a human level, yes I'd want to hear the news from the surgeon who operated
on my loved one. But on a practical level, I think I'd rather my loved one be
operated on by the surgical equivalent of House than by someone less talented
at surgery but with a greater capacity for empathy.

------
droithomme
For some of these tele-specialists their main specialty is that they live in
another country and are willing to work for a small fraction of what an on
site doctor charges.

For some time, many xrays have had their initial reading done by a radiologist
overseas. Tele-doctors bedside via a robot screen is just a continuation of
this.

It's a pity the journalist didn't follow up by asking Kaiser where the
specialist was physically located.

~~~
danso
The article includes the full statement from KP's PR department. No where do
they try to claim that the specialist's physical location, or other logistical
consideration, was the reason for the use of telemedicine.

Furthermore, the family themselves said they didn't realize what was going on
until afterwards. Which strongly suggests the doctor, for whatever reason,
decided at no point to tell them, "I'm a specialist at Kaiser's radiological
department in Boston...", if that were actually the case.

------
elpakal
I worked at Kaiser IT, and there are definitely some well intentioned IT folk
there trying to make revolutionary changes to healthcare. However, the
company's internal infrastructure (inventory, expenses etc) is a giant cluster
running on deprecated versions of XYZ. At one point we heard the metric that
almost half of the inventory they have in hospitals was just lost in the
system so they have no idea where it could be. Gets off the truck, scanned in,
the inventory system craps out and it's lost forever. I don't know if that was
accurate or just the remarks of a crusty manager, but I left after a short
time because they definitely made me believe it.

~~~
potta_coffee
Most hospitals are running on woefully outdated and/or inadequate technology.
I've had a few different friends in healthcare IT and every story has been a
nightmare. I'm not sure why it's this way.

~~~
nradov
In hospitals, most back end IT improvements don't directly drive revenue or
care quality. So funding tends to be diverted to other things like new surgery
centers, higher resolution MRI machines, nicer patient rooms, free care for
the indigent, etc.

~~~
elpakal
This. Backend IT was most definitely a cost center and even more so one that
was very poorly run and incentivized to not change. They have a pension
program there and there are soo many people who made it and are pensioned that
the only incentive they have is to ensure things do not change.

------
danso
I had thought maybe this was needed because of the patient being treated
remotely, but the article says it was at the ICU and the family was told "the
doctor was going to make rounds". Was this particular doctor actually at the
facility?He didn't look he was dressed to work at the ICU that day.

~~~
stevenwoo
I haven't had a chance to talk to him about this, but an acquaintance of mine
is an ER doctor for Kaiser and he showed me training material for this system
at home last year he was required to learn, he groaned when he talked about.
Not sure if he could use it from home. Possibly Kaiser is trying to cover more
hospitals with less doctors.

~~~
ken
Kaiser bought my healthcare co-op a couple years ago. They promised that
prices wouldn't increase, and that they could provide better service for
everyone under a unified system. Each year since then, my personal premiums
(on the cheapest plan they offer) have gone up by 20%, with no improvement in
service, and with no cheaper options added.

I don't know how low-income people are supposed to be able to afford this.
I've never even used my plan, except for flu shots and dental checkups, but
I'm involved in dangerous work and play so I can't exactly cancel.

I assume Kaiser today is just a generic big company run by bean-counters. This
doesn't surprise me in the least.

------
sodosopa
It didn’t matter who gave them the news, that’s a helluva impact. A doctor
could be in the room and give the same message in a cold manner as many do
each day and the family would have felt the same. The blame on reading the
screen is more technophobic and sensationalized.

~~~
plants
Is "technophobic" really a bad word now? If so, I'm an outright technophobe.
If you're going to break hard news to anyone (whether it be a breakup, telling
someone their loved one has died, or telling someone they are dying) you might
as well give them the benefit of being there in person. You can hug a person,
you can't hug a screen.

~~~
pas
People are in general have a very bad handle on fundamental parts of life,
like death. (And personal finances, metacognition and so on.) And sure,
doctors can play the emergency psychologist while delivering the news, but
people don't just go to the hospital and get a random death sentence. They
knew there was a very significant chance that the news will be bad. Yes, when
the uncertainty evaporates together with the favorable outcome, that's fucking
harsh, and there's a process for dealing with that (the good old Kübler-Ross
stages come to mind). People should be better prepared for these
eventualities. (And I'm not saying it's easy, and people must be perfect
stoics, but these theatrics we assign to conveying a few bits of information
coupled with the human touch is just a psychology theater.)

~~~
ripsawridge
"these theatrics we assign to conveying a few bits of information..."

Really? You really are of the opinion that news about death is just "a few
bits of information?" And you are capable of describing the ways humans
attempt to be empathic with each other as "these theatrics?"

I'm not sure I want to live in this world. :(

~~~
pas
Yes. You already have an expected lifespan. Getting sick, makes you reevaluate
that, and getting a concrete diagnosis with an expert opinion should not be a
big change.

Of course, we can do the be positive, be optimistic, you can fight it, you can
do it mantra, and then watch as their heart breaks when they get the
diagnosis. Empathy shouldn't mean helping people to delay facing the hard
problems and truths.

This is the same world that largely considers suicide a crime, and denies a
dignified and conscious end of life to a lot of suffering people. I watched as
a family member went through the stages of physiological and mental decline,
dementia, muscle atrophy, and eventually even breathing was a full time job,
and it became too much. And it was a relatively painless end. (And there were
others with different, faster ends. Recently one with cancer.) And taking it
for what it is seemed the healthier mindset and approach.

Accepting the inevitable led to those last days and months better spent. And
preparing for it is just as important.

We already drag doctors into enough futile quarrels of our own. At least
that's my opinion.

~~~
ripsawridge
Sorry for the long delay, I just saw your reply. I agree with you more than I
disagree. That is -- facing truths is important. Suicide should not be a
crime. A dignified death is often about knowing when to go, and that choice is
the final sentence of the long book that is a life.

I don't want to drag doctors into "futile quarrels." I just think that the
occasion of death is special, and deserves to be communicated face to face,
not with robots (oh sorry, with iRobots).

------
uberman
I'm not sure what definition of appropriate Kaiser is using when they describe
it as being appropriate to tell a 79 year old that he is dying via a robot

~~~
tantalor
Assuming no other doctors were available (hence the robot) the alternative
would be to not the patient. Which is worse?

~~~
neom
If it was me: The doctors tells _literally_ ANY OTHER human there first, and
THAT human tells me. Robodoc can be in the room, I don't care, but robodoc
does not tell me I am about to die, I would be livid.

~~~
reidjs
I wouldnt really mind either way. Why do you need the doctor to be there? How
would that change anything? You’re still going to die, why waste the doctors
time by forcing them to drive over and deliver the news personally?

~~~
nkrisc
Maybe you haven't been in a position where you're days away from death, but
most people would probably want to have that devastating news delivered to
them by a real person who is present with them.

It's not a rational thing. Of course it changes nothing, apart from the fact
they might feel better having the doctor there instead of receiving it through
a crappy matte screen with tinny speakers. If you still can't understand that,
perhaps you can't empathize with most people.

------
ryanmarsh
I remember the day the doctors told us my daughter wasn't going to live. My
wife didn't even want to be in the room, she knew what was coming. It was
something we were prepared for so frankly it doesn't matter if it would have
come through a video conference. So long as the doctors are respectful I'm not
sure what someone expects. Death is coming. It's horrible news. We talk about
so much through glass these days anyway I feel like this won't be a concern
for long. Death is coming. There's no good way to spin this or make it go
away. Just, prepare.

------
ldargin
I would prefer this over getting the news even a day later.

------
onetimemanytime
>> _" Devastated. I was going to lose my grandfather. We knew that this was
coming and that he was very sick. But I don't think somebody should get the
news delivered that way. It should have been a human being come in," Wilharm
said._

Well, when you are ready to clock out at a certain age, people should
celebrate the life you lived and make peace with the fact that this is part of
life. Now a 15 year old boy /girl is very different for obvious reasons.

If his life was measured in minutes ("might not make it home") maybe they had
no other choice by Skype? Maybe another doctor at the hospital but he isn't
his doctor

------
kbos87
I have a relative who recently passed away after a short battle with cancer.
In the weeks and months following her surprising diagnosis, she didn’t want to
know the details of her prognosis, which I’ve come to respect and understand.
While her physicians also understood and respected that, during an emergency
room visit due to her cancer, she was quite coldly and clinically told what
her prognosis was. I’ve come to recognize how important proper communication -
communication that respects the parties most deeply affected - really is.

------
pkaye
I've and some family members have been going to that particular hospital.
Generally had good experience especially if getting admitted. Most of the
nurses are so compassionate. However its been getting more and more busy.
These days their entire parking lot is filled during daytime. I sometimes have
to drive around for 10-15 minutes to find a spot. Its quite the change from
even 2 years ago.

------
yellowapple
> "We offer our sincere condolences," said Kaiser Permanente Senior Vice-
> President Michelle Gaskill-Hames in a written statement, "We use video
> technology as an appropriate enhancement to the care team, and a way to
> bring additional consultative expertise to the bedside."

You keep using that word, "appropriate". I do not think it means what you
think it means.

------
jordache
there are plenty of terrible doctor's out there... Why should we expect
doctor's to be any better than the avg population? Same goes for other jobs
that we put on a pedestal, like police etc..

should a personality qualifier be required for certain jobs?

~~~
dpark
Lots of jobs have personality qualifiers. If you work in a service industry,
in a position that involves customer/client interaction, you're going to need
some reasonable amount of social skills. The more esteemed your position is,
the more your social skill level will matter.

~~~
AnIdiotOnTheNet
Sure, but I guess the question is, is that a doctor's value? Being good at
interacting with people? Is that really the primary thing we want from them?

~~~
ripsawridge
What, is healing pure mechanics now? Like, the doctor is a programmer in a
room far away and that's a good doctor?

------
writepub
@turtlegrids - genuinely curious about the secret behind multiple submissions
from a new account making it to the top 60, and racking up ~500 karma points
in 10 days.

------
_aleph2c_
Like this:
[https://www.youtube.com/watch?v=b9PyR71Aefk](https://www.youtube.com/watch?v=b9PyR71Aefk)

------
mcguire
Was the doctor local? If he was an outside consultant, specialized in the
disease, he may have been the most appropriate to break the news.

Really poor idea, though.

------
spease
I worked for a few years at a company whose exclusive product line was office-
oriented telepresence robots, so I probably have a different perspective than
most people here. The model in the article is from a company that was medical-
oriented. Sort of a competitor to us, but they got the robot certified as a
medical device and sold it at a medical-grade price point whereas we did not
go for certification and sold it at an enterprise price point to more office-
oriented customers.

We had a store in downtown Palo Alto that was a novelty for people visiting. A
lot of people were weirded out by the robots at first. Usually they understood
a lot better once they drove one around and could understand what they "saw".

Most of our customers were regular remote workers and they loved them because
they felt like people respected them more than just being a disembodied voice
on a speakerphone. Interactions were much more natural and you could use body
language to a certain extent. We had several remote workers ourselves and I
felt like I could communicate almost as well as if they were there, and found
myself giving the robots 'personal space' like I would a person.

So I personally wouldn't be offended as long as I felt like the doctor was
doing everything they could. In fact I'd much rather deal directly with the
doctor so I could pick up on if they had misunderstood something about the
case history, rather than to play a game of telephone with a human proxy
instead and potentially be left wondering what exactly the doctor had said.

So I don't know why the doctor wasn't there that day, but I do understand that
he has his own life and other patients to get to. If he's sick, or his kids
were sick, or something else came up, I understand that just because he's a
doctor who makes life or death decisions doesn't free him from the
responsibility of the rest of his life. He may be dealing with a dozen other
delicate cases that can't easily be handed off, and it just so happens that
mine is the one he can't solve. Pulling another doctor in means that doctor is
interrupting that other doctor. He does the triage and sends the nurse in with
the robot instead.

I suspect Kaiser will revise their policy based on the publicity this has
gotten. But while it might show more _empathy_ to have someone else deliver
the news in-person, I'm not convinced that it will overall result in better
patient _outcomes_.

(I'm also assuming that since it was Fremont, CA, it's not like the robot was
the only way to have a relevant specialist there. If it was a second- or
third-world country, by all means send in the robot with a pulmonary
oncologist to tell me there's no hope rather than having a GP try to make the
call).

------
naicuoctavian
1st world problem

I used to live in Romania where hospitals are full of deadly bacteria, doctors
are corrupt, nurses are corrupt. There's a shortage of equipment, vaccines,
cancer treatment, important medicine, you name it. There is no place in the
country to treat a seriously burned man, they all die. Obviously, lifespan
here is shorter than in the US by about 4-5 years.

~~~
minipci1321
> 1st world problem

I suspect it isn't.

You didn't tell us how human are all those corrupt nurses and doctors? Maybe
they offer first-rate compassion and spiritual support, once they pocketed
their bribe?

People die everywhere, and even in poor countries people not always die
because of shortages of equipment and treatments... hope in Romania terminal
patients are accompanied to death with all due compassion -- this has no
material costs that only 1st world can afford.

------
neom
The ridiculousness of the society we are building is moving from sad joke to
an utter tragedy.

~~~
dang
Maybe so, but can you please not post unsubstantive comments here? It just
makes this place a bit worse each time.

~~~
neom
Noted. Sorry Dang.

------
kiba
The headline confused me. I thought it was a doctor telling his patients that
he's dying?

~~~
waterside81
Yeah it is ambiguous. As Vince McMahon would say "Pronouns, pal"

