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Doctor tells patient he doesn't have long to live through video screen (ktvu.com)
115 points by turtlegrids on Mar 8, 2019 | hide | past | web | favorite | 144 comments

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.

I’m curious - What would it look like if you were accustomed to remote communication with your doctor(s) and handled most follow ups that way and then suddenly your doctor says, “You should come chat in person” if you know you have some results pending that could lead to a serious diagnosis? My first thought would be that it’s terrible news, and if that were the case I’d rather rip the band-aid off and just hear it via Skype instead of waiting a week to see the doctor in person. Maybe it’s less personal, but for me it would be less anxiety-inducing and give me a chance to start processing immediately.

That being said - I agree that the empathetic and emotional aspects are lost when communicating remotely. Heck, I already feel that even in a work setting. It’s hard to imagine what it would be like when handling a crisis.

That already happens. My mom had cancer a few years back, and it is immediately obvious after a follow-up test whether something is serious or not based purely on how quickly you hear about it. Doctor calls the same day, then something is bad. Takes a few days to get back to you with results, then there's nothing to worry about.

I think if it were the case that you and the doctor were already apart -- e.g. you were at home -- then you would be fine with a remote discussion because you implicitly know that the doctor is not actually in your home.

The OP article describes a situation where the patient is waiting in the intensive care unit.

Respectfully disagree. "You might not make it home", he said.

If my time on this earth is now measured in hours or days instead of years, every minute is precious. I don't want to wait for the doctor to drive in to the hospital. And I don't want to hear from a stand-in doctor who isn't familiar with my case. I have questions, and I need to compress both 1) acclimating to this new reality and 2) enjoying what remains of my life into a painfully short period.

Email is insufficiently interactive, but Skype is fine. I have family for emotional support, let me spend as much time as possible with them instead of waiting for test results.

If the questions and discussion you have are hampered by what the parent commenter (and family in the article) describes as a shitty Skype connection, that may more than make up for the time purportedly saved by doing the talk remotely.

It's possible/likely that better technology will make this kind of remote interaction much more palatable and useful. But it's obvious that that better technology is not quite here, and yet the hospital seems to have OKed it, as if they were doing internal beta testing an experimental feature.

I went through this recently with a family member, there were robots allowing specialists to review chart. There is always a hospitalist (doctor) on staff. The most appropriate way for the hospital to approach this topic is for the robot to consult with the hospitalist outside the room, and then have the hospitalist with end of care professionals have that discussion.

Very well put. As technology replaces more of the medicinal busywork and ostensibly even diagnosis, more emphasis should be placed on the doctor being the human element. In the end, that's what humans are good at. While I'm sure it was well intentioned, this technology tries to replace the one thing that machines cannot (yet, maybe ever?) provide: authentic human interaction and empathy.

I find it comical actually, in a grotesque way. It's a situation I would expect in the Simpsons: family huddled around a very ill relative, when the door opens and a tragic robot vaguely reminiscent of a Dyson vacuum cleaner rolls in and announces that the patient is going to die in short order.

The entire scene could be more bizarre only if upon this announcement, a small tray popped open with a tranquilizer pill that expedites the demise of the suffering person and prints a receipt for the "care" rendered.

The scene from Elysium really did this well... having him attempt to sign a receipt for the five days of terminal care painkillers. Very evocative.

I liked the part in Elysium where they had a magical science machine on another planet that they could use to heal anything, but they only used it for rich white people because they're evil.

I also liked that the machine must have run on sunshine and gumdrops and cost $0 to use because of course that is how health care works, we definitely have the means to heal every person on the planet, the only thing preventing us from doing so is evil white people.

A major purpose of science fiction is to examine the present through the exaggerated lens of a possible future. Can you really think of no present-day examples of high-capital-expense, low-marginal-cost, highly-effective medical care being priced away from a large chunk of the population?

If you can't, I'll do you one better - worldwide, infant diarrhoea is the second leading cause of death in children under five years old. It can be treated with pennies worth of clean water, sugar, and salt. It can be prevented just by providing access to clean water. We absolutely have the resources to heal every child on the planet of this disease, if we cared.

Note that rich white people witholding medical care =/= white people. It is a huge distinction, and seemingly refers to how more and more treatments and cures are being priced to extract the most money possible, heavily restricting who has access.

Hepatitis C is curable, but it is purposefully priced out of reach for much of the affected population, hoping that the local government will pick up the tab. Epi Pens have skyrocketed in price over the past few years, and the manufacturer that makes them has claimed that there is a shortage of the generic version, while plentiful supplies of the on brand version.

This is Late Stage Capitalism.

Purposefully priced?

Gilead did pay $11 billion to acquire Pharmasset and at one point was facing a $2.5 billion patent infringement ruling (later overturned) for that same drug.

AbbVie’s a new entrant which can treat certain strains at at about a third the cost.

Damn that Late Stage Capitalism developing a miracle cure for Hep C which is painless and effective.

This is the same AbbVie who’s treatment costs $26,000 right? I think it’s fair to say that’s priced well out of reach for most people, whatever the cost relative to Gilead’s product, which the CEO apologized for. The same AbbVie that sued the NHS? https://outline.com/brsHyA Incidentally Gilead made $5.8 billion in a single quarter so I think we can safely assume they managed to defray the cost of acquiring Pharmasset, don’t you think?

Companies making tens of billions a year while poor people suffer and die does seem to be a fairly negative situation, however you care to label it.

I simply refuse to believe that treatments that cost the same as a brand new luxury car are down to labour + materials cost of some pills.

There are absurdly massive inefficiencies if as you say they aren't making profits.

Well said. This kind of tech seems fine for less severe diagnoses, and the time saved could be used to make human doctors more available for the severe cases. It's not even an argument about whether terminal diagnoses "deserve" a personal touch. Patients and their families may press the doctor about Hail Mary options -- having this argument over videoscreen-on-wheels might exacerbate the conditions in which the family/patient goes for the unreasonable option.

Tangentially, this is a sub plot of the movie 2009s 'Up in the Air' but with being laid off. Not the same as being told you are going to die, but in 2009 just as the recession was really hitting hard it's similar in many ways.

[1] https://www.imdb.com/title/tt1193138/

You’d think with all the money people pay that hospital they can afford the cost of the doctor walking over to the room...

It doesn't cost the hospital a nickel to have that doctor walk into the patients room. You will get a bill for that from the doctor's practice, not from the hospital.

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

What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

If it's over Skype or nothing. I choose Skype.

"But it should not be used to replace the empathic, emotional aspects of healthcare"

I've been to hospitals different parts of the world and this is pretty much the norm (low empathy). Most Doctors are very busy/overloaded with patients, they don't have any time to sugar-coat results or make you feel better.

This is one aspect of government-run healthcare that I'm not sure many people are willing to accept.

> What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

Well, that's not what's happened in this particular instance, nor will it be anywhere near the common case.

And if the doctor actually can't be there, then at least have the attending nurse break the news. As long as it's a warm body with good bedside manner.

We're big, squishy monkeys hardcoded to have contact with each other. We're particularly bad at making connections with people through a low-quality screen. It actually makes a difference when the person is there and present with you.

Why do we bother going all that way to go and see therapists in person when we could just send them a text message?

What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

Maybe he or she can, umm... send someone else?

Huh, that's funny. I legitimately would prefer the "wrong" way. Does that make me dysfunctional in some way?

Enough people on this thread disagree with you that I think it's safe to say that there is no "right" method, just one that most (but not all) prefer. What's wrong with actually giving people a choice?

"Would you like critical medical news delivered to you

[x] Through teleconference (faster) [ ] In-person (depends on doctor's availability)"

Is there? I think this is fine for me. In fact a email or sms or whatsapp message might be even better.

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.

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

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

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.

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.

You're on to something, but have it slightly backwards.

"First, do no harm."

Physicians, at least in Western medicine, are bound to the principle of non-maleficence. Their obligation is to take the approach (by action or inaction) that does the least harm to most people, NOT what helps the most people. This is an important, but subtle distinction.

This principle prevents, e.g. administration of a treatment that would cure 51 of 100 patients of a chronic but not debilitating condition while killing the other 49.

It's hard to imagine the quantifiable positive ill of telling someone something in person that they'd rather receive in email. But the underlying principle here is not in helping as many as possible but, overall, hurting as few.

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.

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.

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.

Yes, but sometimes things are more complex. I know physicians that were assaulted with a knife in their workplaces. A bagcase raised in the last second stopped the hit, aimed towards her heart. Some people could have solid reasons for acting like that.

I'm confused as to your argument. Are you saying that because someone was attacked that means they SHOULD be emailing this news? I'd bet that most people , being social animals, would rather be told in person, face to face. One outlier doesn't change standard operating procedure.

I am saying that the physician could have logical reasons also to act like that, and that we could be missing some context.

After begin attacked by an enraged patient (or their relatives) I can understand how the physician could develop a phobia to put him/herself in a similar situation again. Just being forced to return to the same workplace day after day can be emotionally draining and very difficult for the physician.

The biggest problem of using e-mail in this case is keeping the privacy of the patient.

You're building a narrative that doesn't exist in the article - there was no mention of a previous violent incident leading to this.

This was just them pulling a stupid, and the hospital apologizing for it.

Not only is email not able to be kept private, you also can't guarantee the patient is going to get it in any sort of timely manner, or in fact, at all. It's also ensuring that no follow up questions can be asked in a timely manner.

Imagine if this got snagged into the Spam folder.

It'd be prime material for a Tom Lehrer song involving lawyers, malpractice law, ISPs, IT professionals, email protocols, and similar related ilk. Just this simple "proposal" is blowing my mind.

I know ads are already kind of doing this, but I look forward to google definitively knowing you have chlamydia before you do, or the first "Experiencing Heart Failure? This stay at home mom beat it in these 3 simple steps" banner ads.

When my friends parents had to get the unfortunate news that their sons body was found, the police drove to their home to give them the bad news in person.

The news was going to hurt one way or another, but they appreciated that other humans empathized with their situation, taking a completely less efficient means of giving them the information directly.

Granted, it's different than hearing you have a terminal disease, but both are jaw-dropping, numbing realizations few people could be mentally prepared for, especially with the swelling of emotions.

Perhaps there is no 'right' way, but IMO there is a humane way.

Honesty doesn't seem to be at issue here. Empathy definitely is. And while I take your point that you'd prefer an email, and I guess a degree of privacy with your own emotions on the topic, I can imagine that many people feel otherwise. I think I find myself in their camp, not yours.

@polly "bad news by email?" "hell no" "just post it on twitter"

As someone who made the professional healthcare to tech career crossover, I feel exactly the same way. Email me.

The world has changed. People are tried and sent to prison over video chat, surgeons remotely control surgery.

Telemedicine improves the quality of life for millions of people, allowing them access that they wouldn't have had in the past. It provides decreased morbidity and mortality as a whole.

Quick reminder: everyone is dying. everyone.

Email is wrong because the culture has decided it so, and doctors are judged based on how they exist within the culture.

As are we all.

It may not be the right way. We use it because some people need to hear it from a human. Given it's a fairly difficult thing to elect the method, we seem to have defaulted to humans being the best tool for telling other humans they are going to die.

Is this a joke? It's terrible.

This is not a joke at all, and was not an attempt to offend people's feelings, though it appears i did.

I truly do not understand why people want doctors to be required to hold hands and make eye contact, when telling there's no cure. I'd prefer doctors to be chosen based on their ability to cure illness, instead of the ability to demonstrate empathy to thousands of patients that will die during their career.

And i wonder how many of the people who are outraged by lack of the empathy from a doctor, also think that extending human lifespan to several centuries is a bad thing

Dear [TEMPLATE_NAME], We're sorry to inform you that you have advanced stage cancer and will die in the next [TEMPLATE_TIME_RANGE]. Good news however. We have partnered with FinalResting! Be sure to click on the following link to save up to 25% off your funeral services.

Yes that works

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


> 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.

This podcast is a treasure!

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.

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.

It's definitely something you should be trained for.

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.

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.

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.

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

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.

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.

>I mean, I wouldn't choose my mechanic based on how comforting they could be.

I grew up in an auto-shop in the SF Bay, my family still owns one of them. You may not choose a mechanic based on their empathy, but the large majority (~90%) of people do. Trust is a thing that is hard to establish, but incredibly easy to break. One bad part, one snippy phone call, will totally ruin the relationship that you've built up over decades with a customer and their family. They'll never walk in the door again.

We've experimented with all forms of customer communication. From texts, to online booking, to Groupon and Yelp. Nothing works anywhere near as good as an inperson chat. When you've got to deliver the message that their car needs a $3k new transmission, despite the family road-trip in a week's time, it's best to do it face to face. Most of the time, that's not realistic, so a phone call is the next best thing. When the estimate is high like that, then it usually takes over 10 minutes per call. There's a lot of yelling and crying, usually.

People get very attached to their cars. Hell, they'll abandon their house and home before they abandon their cars[0]. When you do extensive surgery on the car they drove their new wife home in, that they drove their first-born in, that they cried in when their Mom died, that they spilled innumerable sodas in, well, you can understand why they throw money into the repairs even when it makes no sense.

Providing that 'deft hand', those years of knowledge and experience, has helped the business not just survive the Dot-Com and Housing crashes, but has let us thrive despite those economic catastrophes. Knowing how to tell someone that the car is no longer worth the repair does take some experience and care. Customers have come to trust us in helping them make decisions they have a hard time with. The majority of what trust is made of, what it can be partitioned out into, is empathy.

[0] one reason I'm not bullish on self driving car services that are all rentals and leases.

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.


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.

Now that's a beautiful piece of writing on a terribly tragic subject.

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.

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.

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.

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.


You CANNOT have bugs in your ventilators, pill dispensers, heart-rate monitors, etc. As such, they are typically only certified on some old version of Windows. As such, they can't be updated, or they have to re-cert that new version of windows. By certification, it goes anywhere from the bugs in the compiler all the way to the EMI interference from a cell-phone that may interact and cause a fault. It can be very intense. Re-doing a cert is an incredible mess. So, they stay on the old version and that makes integrating with all the various versions of mainframes, windows, DOS, UNIX, etc. a total disaster of a task.

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.

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.

Kaiser could do so much with the data they have and could have. I wish they were more forward looking.


That EPIC lock-in, tho.....

Kaiser only started implementing Epic in 2005 and finished in 2010. So any lock in is squarely on their own shoulders.

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.

My best guess is that he was a specialist not currently available at that hospital, so they had him consulting via telepresence. It makes sense then that the news might come from him but it seems obvious that another physician from the hospital should have at least been present, if not read the results themselves with the specialist available by video for questions.

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.

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.

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.

Or the doctor could be in the room and act like somewhat of a human being and break the difficult news in a professional and socially accepted way.

But that’s also a problem with a lot of physicians, from my experience they provide vague answers and hint around. For one of my recent family members, I pulled her social worker aside and said this is a binary yes or no, Should we call hospice? And even then after much handwringing, the physician blurted it out to my family member despite having health care PoA

In a perfect scenario as it is on television a scholarly physician sits on the bedside, pats the patient’s knee and looks them in the eye and says, “we’ve done all we could”.

I worked in health care for decades, while not in a care role, I went through and managed some of the training programs to improve bedside manner/customer service. I had to document each physician as they spoke with my family member. Because of two of the three experiences they were eager to turn over the bed instead of providing compassionate care

Do you think it would be possible to deliver the news well via robot? I don't believe so. The news could be delivered well or poorly in person, but it could only be delivered poorly via robot.

But it really doesn't matter what we think about the robot. It matters what that family thought, and they had a problem with it. To say it's okay is to ignore their voice, because in their specific case, they weren't okay with it. It seems cold and lacking in compassion to not allow even such a simple request for the sake of comfort for someone in such a difficult place.

I believe it could be delivered good or bad by both. It depends on so many factors.

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.

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.)

"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. :(

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.

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).

It's just an ad hominem attack. I don't agree with you, so you're a "phobe". Technology isn't really the issue here.

That telepresence robot looks ridiculous. I would absolutely not want to have a serious conversation through it.

Agreed - While I have HUGE sympathy for doctors that have to deliver this kind of news, I have numerous complaints about the care and attention I get from my doctors today when they AREN'T remote - I don't see remote as really being relevant here: Attitude and behavior count for a lot more.

> 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.

So you think we should systematically bring this poor experience to everyone via robots because some human doctors perform the same task poorly?

I think we should make it agnostic to where it doesn’t matter how the person gets the message. Couple either experience with support groups.

"Daughter Catherine Quintana says the family is also upset because her father had trouble hearing the doctor through the robot's speaker forcing Wilharm to relay the terrible news."

The blame is on the full device, not just the screen.

I don’t think so. While the results don’t change, a lot of human sociability is about doing the nothings in life. Like going through the motions of offering to pay yet knowing it’s the other person who’s going to pay (maybe they invited you, have more money, etc.,) still it’s consideted bad manners not to at least feign an offer.

Same here. The doctor and hospital should strive to be as human and empathetic as possible given the bad news. Adding an electronic intermediary created distance and adds coldness and the artifice of bureaucracy to the event.

Couple each experience with social workers, religious staff and the patient’s care team. While a physician isn’t physically in the room, a caring influence over the discussion could help despite being a cold doc or a cold robot.

It's true that it didn't matter who gave them the news, but a lot of what we call "communication" is non verbal, so I think the screen did not help. You can forgive someone for something if he's in front of you, i doubt you would forgive him the same way by SMS/Phone call.

The point of having a doctor in the room versus a video screen is that the presence of the human is generally less "cold". Besides the audio quality problems the family describes, the manner of delivery has connotations of mass-produced automated service, which also feels cold.

"We're sorry, you have termin -kshhhh- cer. Our models estimate you have -kshhhh- to live. Have a nice day!"

Mizza on Mar 8, 2019 [flagged]

> technophobic

Welcome to 2019, everybody!

Won't somebody _please_ think of the robots!

This is a weird comment. When people are claustrophobic the implication is not that we need to sympathize with closed-spaces. You're injecting a meaning that was almost surely unintended to make a shaky ironic point.

You're feeding a troll.

I'm not a troll, I'm seriously objecting to the idea that we should reject the concerns of a dying person as "technophobic", as if that's some kind of silver bullet in an argument in favor of technology. I've never heard anybody seriously say "technophobic" before and I found it rather shocking and naive.

Ah, I do apologize then. I misinterpreted your post.

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

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

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.

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?

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.

Because dying tends to be a process, certainly if I was about to drop dead I might not care, but generally I would want to know about any pain treatment, changes in my meds, explain the process of dying to me. I would want to hear it from a specialist.

Wait an hour til someone can deliver the news in person? This seems not that hard

A phone call would've been better.

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.

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

>>"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

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.

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.

> "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.

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?

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.

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?

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

It's part of their value, yes. We can expect a doctor to possess more than one skill.

baseline people skill is necessary. Or necessary training.

We shouldn't expect them to be better, but we live in authoritarian society.

The family's complaint isn't about the doctor's personality.

It is if the decision to use the robot in this circumstance was made by the doctor, rather than being standard Kaiser policy.

> Catherine Quintana said she and her mother asked hospital staff about how the robot was used. "It's policy, that's what we do now. That's what we were told," said Catherine Quintana.

Because of the 8~ years of extra training they have to go through?

@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.

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.

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).

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.

> 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.

Sure, thinks are worse in other places. That doesn't make this right or make it less newsworthy.

I think it's reasonable for people who aren't living in Romania to expect conditions that are different than Romania's.

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

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

Noted. Sorry Dang.


"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."


Kaiser is a non-profit in the same sense that the NFL is a non-profit. Funding for the "non-profit" is funneled to the for-profit wings. In Kaiser's case, the actual medical groups are for-profit.

Also, how desperate are you to drag politics into the discussion? For-profit groups are capable of making the same shitty decisions as non-profit groups.

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

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

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